Wavin' (red) flag

 

Lahore, Pakistan

I watched the Ted x Change talk sponsored by the Bill and Melinda Gates Foundation earlier today.  It was exciting to see a range of diverse leaders speak to a lot of the issues that we've been wrestling with in an academic context around sustainability, moving from strategy to delivery, and the trade-offs between speed and quality.

Hans Rosling, whose ability to create amazingly illustrative visuals, kicked off and shared trend data for the whole world to show how long change can take--part of what explains the differences in child mortality rates between countries like Sweden and Sierra Leone is when they began to address the issue and create supportive infrastructure, like universal primary education.  While showing decades of data, he simultaneously stressed that breaking the data into smaller increments was critical for measuring country progress and helping countries maintain momentum in tackling health challenges.  This makes a lot of sense to me; it's really the derivative and direction of change that we should be interested in optimizing; the long-term trends will take care of themselves.  His graphs also show that we've made incredible progress over the last century, which was energizing.  It's easy to get bogged down in the remaining challenges and forget what has been accomplished.

He also ended by saying that tackling health was imperative for addressing climate change, and that as child mortality was strongly linked to fertility rates, we had to start there, and similarly make investments in education for girls. 

I had never seen Melinda Gates speak before.  She shared a lot of personal anecdotes and stressed the successes she's seen worldwide.  She discussed how coke's strategies of penetrating even the most remote villages, via real-time data utilization, identification of local entrepreneurs, and locally-sensitized marketing, offered many important lessons for global health.  She described current monitoring and evaluation strategies in global health as "bowling in the dark.  you hear the pins fall, but you don't know how you did until the game is over and you turn on the lights." Very apt, and very terrifying.  Creating adequate infrastructure for data collection and analysis is a critical challenge for global health right now, and refining funding models to allow for the freedom to make mid-course corrections will be a necessary step to realize potential gains.  It would be fantastic to see Gates as a leader here and demonstrate to other donors the value of loosening the operational controls at the right leverage points.  [Also on a more comedic note, every time Melinda mentioned that coke had helped produce songs like "I'd like to teach the world to sing" and "wavin' flag" that had made it to the top of the POP charts, I went, "duh."  Maybe people from Minnesota will get that, at least]

Dr. Mechai Vidaraiya is an unsung hero, as far as I can tell.  He's clearly weathered the many political storms of Thailand's recent history, and he shared examples of how government-sponsored public health programs can be catchy, clever and quite effective.  He showed a picture of a monk blessing birth control pills so that women would be more inclined to take them, t-shirts with slogans like "condoms are weapons of mass destruction" and "in rubber we trust".  They seem a little cheesy, but one thing that I'm starting to believe is that public health largely fails to enter the mainstream consciousness and engages in a parallel dialog that is largely ignored.  Creating fanfare and messages that resonate with the average person is going to be key if one wants to change routine behaviors, such as sexual practices.  It'd be exciting to see examples of this for other health conditions--Proctor and Gamble's work in Ghana around handwashing is one example, but the same principles can and should be applied to obesity and other conditions with causes largely attributed to lifestyle.

Graca Machel, the graceful and eloquent liberation fighter from Mozambique who has been involved in child and education issues in Africa for over 25 years.  First, what are the implications of freedom fighters moving into the public sector?  South Africa and Rwanda both share this trait as well.  I think it's fascinating and would love to see research on how that shapes a governance strategy.  Machel emphasized the need to focus on women and children, and that our current time horizon of five years (at best) is totally insufficient.  We instead need to think also about where we'll be in 30 years.  This was the other side of the coin of Rosling's talk in many ways; act now, but make sure that your compass is firmly pointed in the right direction and you've got enough gas to get you all the way there.

I've heard the argument for the "girl effect" many times, that is, that investments in women and girls produce a greater "return on investment" than investments in men.  Women are more likely to direct the resources to the family's needs, and increased in educational attainment in women results in reduced fertility rates and many other positive health benefits.  Kristof also really raises this point in his blog and in his book.  But, I'm growing increasingly uncomfortable with the way that these findings are being construed and operationalized in global health.  I see two obvious implications of the findings--the first, invest more in women.  The second, figure out how to make investments in men go further.  As a field, we've latched onto the former and marginalized the potential of the latter.  As a field public health seems to regard male behavior as largely static (that's my gross generalization of the day), but it seems absurd to ignore the potential to ignore opportunities for behavior change in half the world's population, particularly when the result simultaneously points to that half's greater control of power and financial resources.  Just as coke can make a consumer equate a brown, fizzy beverage with happiness and community, and Captain Condom (a Harvard MBA no less) can convince Thai teenagers that a condom is "a girl's best friend", why can't similar strategies create the image of a "real man" investing in his family, prioritizing his daughter's education or health needs over tobacco/alcohol consumption?  These seem comparably achieveable to me, and it'd be great to see the field flex its creative muscles to break out of a tired paradigm of attempting change.

Finally, don't miss the tunes of Bajah + the Dry Eye Crew, who offer a welcome alternative to "Love the Way You Lie" (and Bono for that matter).  A group of musicians from Sierra Leone that's written some great pieces that focus on social issues and promote world peace and understanding.  Definitely inspired me to work harder all afternoon.

Highly recommend you check out the event when you have an hour or so: http://www.gatesfoundation.org/tedxchange/Pages/default.aspx
Another (fairly positive) perspective on the event can be found here: http://humanosphere.kplu.org/2010/09/melinda-hans-mr-condom-and-graca-on-tedxchange/ 

Tough "love"

Rihanna and Eminem have produced a hit with "Love the Way You Lie."  It's catchy; you can hardly listen to the radio for an hour without hearing it.  And it's driving me crazy to not be able to avoid it.

I'm a little disturbed that America has consumed this song so willingly.  The video portrays a relationship that combines violence with passion, and interestingly, shows both the male and female partner hitting each other, with the female often initiating the violence.   Is this an accurate depiction?  Certainly in public service announcements, there's the implication that the male is the sole perpetrator of violence. But maybe this is not always the case.

What strikes me about the song is that in Eminem's lyrics, a few things ring very true with literature on relationship violence. 

1.  The emotions are intense; even though violence is involved, and likely fear, there may also be strong feelings of love, passion, and desire.  The violence is a piece of a larger, complex relationship.  For example, one verse goes:

Now I know we said things, did things that we didn't mean
And we fall back into the same patterns, same routine
But your temper's just as bad as mine is
You're the same as me
But when it comes to love you're just as blinded
Baby, please come back
It wasn't you, baby it was me
Maybe our relationship isn't as crazy as it seems
Maybe that's what happens when a tornado meets a volcano
All I know is I love you too much to walk away though
Come inside, pick up your bags off the sidewalk
Don't you hear sincerity in my voice when I talk
I told you this is my fault
Look me in the eyeball
Next time I'm pissed, I'll aim my fist at the drywall
Next time. There won't be no next time
I apologize even though I know its lies

2.  The violence isn't consistent.  It may ebb and flow; there may be periods of peace, or lulls between episodes.  BUT,

3.  As he so "eloquently" points out at the end of the song, often the violence escalates, and many perpetrators are blinded by their need to control their partner.
Lyrics (minus the f-word),
If she ever tries to leave me again/I'm going to tie her to the bed and set the house on fire.

Almost half of all murders of women in the U.S. are committed by intimate partners.  Isn't that incredible?  That the person that women should be most afraid of is the man that they are closest to?  And we're doing what to change this?

Why do we not find this song deeply disturbing, where's the moral outrage about these issues?  How can such violent sentiments be included in a top twenty song?  I'm a little disappointed in us for not listening a little more carefully.  Relationship violence remains an "invisible" problem; as in, one that no one wants to take on.  We think that there is a fine line being loving someone so much that you do crazy things to keep the relationship, but in actuality I think that love and violence are pretty different, and anyone who sees that line as blurry probably needs to back off and do some thinking.  Love cannot be about ownership and control; it should be about respect for another person's autonomy and trust.  I don't see how these could be confused.  Of course then I listen to Taylor Swift's "The way I love you" and think that the chorus, though much less graphic, communicates some of the same message that true love should hurt:
I miss screaming and fighting and kissing in the rain/3AM and I'm cursing your name/so in love that I acted insane/and that's the way I loved you.

I was listening to "Love the way you lie" earlier today thinking about Yeardley Love, the UVA lacrosse player who was brutally murdered by her drunk (ex?) boyfriend.  Did her friends see the danger signs?  Did Yeardley?  If so, was there a way that this could have been prevented? I had a good friend who was in a relationship that was emotionally abusive, and it was terrifying to watch how good her boyfriend was at manipulating her.  He managed to isolate her from so many of her good friends and make her dependent on him for just about everything.  When it finally ended, he couldn't handle it.  He started calling her repeatedly, at work when she would answer his cell, and just showing up at her apartment building.  It devastated her and I can still see how she's rebuilding back the confidence that he took away from her.

I've asked myself a lot if I should have done more.  I tried to point out the flaws in his logic, note that a lot of his behavior was included on any list of classic warning signs of relationship abuse, but I felt that I had to walk a fine line to avoid giving him more ammunition to use against me (he was clearly displeased that she remained friends with me).  She recently told me that she was surprised that I didn't say more--I'm not sure if that was a rebuke or just an observation.  But what I did do, and I think was the right strategy (though perhaps I wasn't proactive enough about it), was I tried to create space for her to decide to leave the relationship, and support her throughout the recovery from it, without judgment about her decisions.

Tomorrow I begin leading sexual violence risk reduction workshops for Harvard freshmen, and for the first time relationship violence will be one of the topics we cover.  I'm glad, as women 20-24 are in fact most likely to be victimized in a relationship.  But as to what advice to give these young women, I'm at a loss.  I think about the Rihanna/Eminem hit song, and I think about Yeardley Love, and I just cannot say honestly that I think that victims of relationship violence are supported.  In the absence of fundamental change in the gender dynamics of our society, which I think are needed, what I hope to communicate is that silence, in all cases, enables perpetrators to continue to own their victims, because victims know that others see the violence and don't intervene, thus creating the sense that they implicitly support it.  So any of us that consider ourselves anti-relationship violence should be speaking up whenever we see something that's inappropriate, particularly when it's a good friend who is the victim or the perpetrator (or both, in the case of a relationship that's violent both ways). 

Sorry for the rant--feels better to have it out there vs. inside.