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/