Five thoughts at the same time

Carl Hamilton in Studio 8/TV8 claimed this evening that I am too optimistic about world development. Well, his program showed how majority of Swedes think that the world is getting worse. In this context it is difficult to avoid the impression of optimism when conveying that family size and child mortality has decreased considerably in Bangladesh and elsewhere in Asia and the Arab world. (http://www.gapminder.org/ and click "Has the world become a better place?").

An evidence base world view requires five thoughts at the same time:
1. World is getting better and better,
2. but at the cost of climate change,
3. and billions still live miserable lives in poverty
4. and in the last decade life got worse for 100 of millions,
5. but as the world is stupidly managed, we have many opportunities to fix the world for the grandkids!

It is not optimistic to see that 350 billion USD in agricultural subsidies in the richest countries is stupid, that fighting wars for oil instead of investing in energy research is suboptimal, that improved governance can do a lot for progress in low income countries, and that if Senegal has less than 1% HIV and South Africa has 28% among adults it is in human reach to change sex behavior and stop the epidemic. It is just to realize that there are plenty of opportunities at hand to make the world continue to improve. Reaming poverty, climate change, and ethnic wars are major threats.

When to speak about sex!

On 23 Nov in Stockholm I spoke on the Global HIV epidemic to an audience dominated by young African professionals in Enterprise and Labor organizations. The host was Labour Market Dialogue http://www.lmd.se/ formed by Confederation of Enterprise and Trade Unions in Sweden and funded by Sida to run international development activities. My speech coincided with the release of AIDS epidemic update 2005. http://www.unaids.org/Epi2005/doc/report.html It indicates declining HIV rates in some hardly hit countries in Africa, but still increasing rates in South Africa.

When challenging the meeting with 28% infected adults in South Africa and less than 0,3% in Egypt (100 fold difference!) a good discussion emerged about the sexual pattern that drive the severe HIV epidemic in parts of Southern Africa. The HIV rates vary greatly in Africa, and so must the sexual patterns do! There are 20 fold higher HIV rate in Zambia compared to Senegal!
But the discussions in the cofee break were even better. Young professionals from Southern Africa stated ??The male culture in highly affected areas of Southern Africa is that of many small houses, i.e simultaneous sexual relations with several young women. Most men in my country used to have as many sex partners as their economy could allow. That must and will stop, because these people are now dying!?
Discussions on HIV in southern Africa should have short sessions and long coffee breaks! It remains too delicate to discuss the sexual patterns that are driving the epidemic in formel settings. That is to talk about what in academic jargon is ?inter-generational transactional sex? in stright language is rarely done in international meetings. But I was quite impressed by the insights and understanding expressed by the young African professionals in the break. They will find ways to stop this epidemic, although they still do not speak with laud voices.

Who wants to be rich and sick?

At a meeting on the future of WHO I met Philip Stevens that authored "The Real Determinants of Health". Philip think tanks at international policy network http://www.policynetwork.net/ that is described at http://www.sourcewatch.org/index.php?title=International_Policy_Network His booklet tells that economic growth is the main underlying determinant of health. I agree! But the cover photo, a Vietnamese woman on a bike, illustrates major side effects of growth that is not mentioned in the text. The photo shows:
1. She drives in flip-flop without helmet reflecting the extremely high rate of traffic accidents in Vietnam.
2. She transports live birds to market illustrating the challenge to prevent avian flue in a fast growing Asian poultry economy. Avian flue is mainly a threat to the economy in Asia.
3. The women look sad illustrating the female epidemic of depression and suicide in Vietnam and China in the midst of fast economic growth. Money does not buy gender equity.

The cover illustrate the side effects of economic growth that are not found in the text. Is it not in corporate interest with mutually reinforcing economic growth and improved health? Many government regulatrions that are needed both to attain optimal health and to secure continued growth are left out. The corporate view on health and growth is one sided, even if it argues well on some issues. One wonders if analysts in corprate tanks are ignorant or if they are forced to close an eye?

Media worse than WWF on dam reporting

Swedish radio news this morning said that World Wildlife Fund (WWF) in a report (no referance and report not found on web) tells about 400 dams under construction. The news was that WWF´s view is that, especially in East Asia, these dams destroys the environment. As usual the reporter did not ask critical questions about environmental impact of alternative sources of electricity (coal or nuclear) , nor did he tell listners that electricity promote child survival as shown by L. Wang L in Health Policy. 2003 Sep;65(3):277-99. His study on 60 poor countries conclude: "The analysis on mortality determination shows that at the national level access to electricity, incomes, vaccination in the first year of birth, and public health expenditure significantly reduce child mortality. The electricity effect is large and independent of the income effect."

I note with interest that WWF lately carefuly state that they are not against dams as such, but this moderation is jet to reach the Swedish Public Service Radio. One wonders what turns good reporters into unprofessional promotion as soon as they repore about environmental impacts of dams. I thought the dam "myth bubble" had burst already.

African farmers need inorganic fertilizers!

On 10 November the Swedish Agricultural University boldly hosted a seminar on Livelihoods, Food Security and HIV & Aids in Africa, with the participation of ambassadors from Southern and eastern Africa.
Magnus Jirström from Lund University gave a key presentation. With colleagues he had recently researched the straight forward question: ?If green revolution worked in Asia, why not in Africa.? The study design was pragmatic, but well thought through, using macro and micro level studies in both continents. In Africa 3000 farm households in 8 countries were interviewed.
Results were that global and national agricultural policies must promote higher productivity at farm level by adequate input of planting material and fertilizer and that farmers market access is key to poverty alleviation. I got convinced that this research is worth reading in detail. It is now available as a book that I have ordered:
The African Food Crisis: Lessons from the Asian Green Revolution. Edited by Göran Djurfeldt, Hans Holmen, Magnus Jirstrom and Rolf Larsson.
That inorganic fertilizers were superior to organic in African small scale farming is not surprising. In spite of widely held ideas in post-industrialized societies that African farmers can do without inorganic fertilizers I have never read convincing studies that supporte these ideas, and therefore regard them as a promonent global myth.

Do more than fundrising

UNICEF-Sweden did not comment, but the secretary general mailed me. She reviewed the ad before publishing and states:
"to me it was obvious that the ad was not about family size in Bangladesh, but about factors underlying trafficking of children. To me it was also obvious that we did not base the ad on statistics about the number of children per family in Bangladesh, but on a rather representative example (of trafficking).

Problem is that no one pay for a full page in Sweden?s main daily that says:

Progress in Bangladesh! Number of children per women has fallen from six to three in the last generation. But for good humanitarian reason Swedish public is remanded about remaining problems. The result is a wide spread perception that the world is not improving. Is it contra productive for fundraising to share good news from Bangladesh ?

http://www.unicef.org/bangladesh/ provides a free pdf-report of a good study of child mortality in Bangladesh. Due to fast reduction of deaths from infections and malnutrition the main cause of death in children above one year is now drowning, i.e. progress but remaining problems. Why not in a full page put a small textbox with facts and links so that the public in the post-industrialized countries learn about the progress in Bangladesh and large parts of Asia.