About Me

My photo
Policy provokes me to think and write. I currently work in ivory towers inspiring people to engage in their world. I am a student of the human condition and my classroom is the world. I don't need credentials to have an opinion but I've got paper to prove I know a few things about public health, social welfare and economics. I'm coming out of the tower and taking the words to the people and hope you will send some words back at me.

Wednesday, October 31, 2012

Beyond MDGs 2015: The search for new objectives, new goals and new measures.



Recently on the Humanosphere blog there was a call for comment on a paper, titled ‘How can a post-2015 agreement drive real change’, written by Duncan Green, Stephen Hale and Matthew Lockwood of Oxfam. So I took up the challenge to read the paper and I am offering up this feedback.

Defining Poverty
First, its time to stop with the global strategies, initiatives, imperatives, goals, objectives etc. Poverty, though common across the goals in its experience of inadequate resources for daily living, is by its complexity and locale-specific nature, not amenable to ‘global targets’. Any global target means that variations across locales disappear and the outcomes seems somewhat meaningless. Furthermore, and most importantly, the people setting these targets are usually not the ones who have to meet them, nor are they the ones who will be among the counted when these targets get evaluated.

Authoring Poverty
Second, it would be beyond wonderful if more of these papers get written by people in countries where these targets will be implemented and by in-country people who will have to implement the programs through which these targets will be met. Included in these papers should be the voices of the poor people whose lives these policies are supposed to change.

Aid and the Environment
Third, there is a significant cost to the environment (the focus of MDG #7) created by the aid industry. As well-meaning, well-educated and sometimes well-prepared development workers, finance ministers, UN staff etc etc zip around the world, they consume millions of plastic bottles of water in places where plastic is not recycled and leave an ever-growing carbon footprint in their wake. Given the state of technology, there should be less need for travel of the rich and more space for the voices of the poor. Until this happens, the business of aid will be increasingly one of self-perpetuating indulgence and less about helping poor people.

Rich-Poor Country Relationships
As the authors note, there is little evidence of the kind of rich-poor country strategies like technology transfer, trade, finance etc that could really make an impact on global poverty. Instead, it is the gift of cash, stuff and people that poor countries get. Furthermore, the ‘customization’ of the MDGs by many of the countries reinforce the need for local governments to set their own goals and not follow some guideline set and monitored by people far away: the so-called 'international community'.

The Politics of Poverty
The politics of poverty and aid (the latter needs to be tossed into the garbage pile of post-colonial, neo-liberal, capitalist failures), and the geopolitics that influence the relationships between rich and poor countries are more significant than any aid strategy. The USAID is explicit that their aid strategy must be in sync with their security strategy. And their security strategy seems to include supporting leaders who rape and pillage the national treasuries of their countries – money that could build the kind of infrastructure that aid wont build but is so integral to the alleviation of poverty. Of course, once these criminals deposit such funds in their offshore accounts, aid fills the gap; and often by avoiding the government sector all together as ‘civil society’ is the Cinderella of the aid game.

The Business of Aid
The business of aid seems to be an end in itself: meetings, conferences, conventions, consultations, site visits, photo ops with donations, writing of papers, and on and on. It has also proved to be great fodder for bestsellers. In many countries aid is its own sub-economy: hotels, maids, drivers, consultants, and speakers at the endless meetings where the same people say the same things – driving the hospitality and service industries of many nations, with trends in where meetings get located based on making successful transitions within the aid space. (Scared of Lagos but longing for Addis).

Self-perpetuating Aid
The authors propose ‘the best way for the international community to encourage pro-poor change’. I would suggest that the time has come to leave people alone, except to help in case of emergency. And the goal should be to work oneself out of a job. Noone will deny the romantic ideas attached to going around the world ‘helping people’ that perhaps began in the adventures of the Scottish medical missionary Dr. David Livingstone ("Dr. Livingstone, I presume") and continue through the passionate followers of Dr. Paul Farmer and Partners in Health. But I am reminded of how the system of apartheid fell: People around the world in their own countries pushing long and hard for change in solidarity with efforts on the ground in-country led by local leaders. (Noone was flying into South Africa for AIDS meetings serviced by prostitutes, instead political activists were running out). Perhaps the aid industry could study the anti-apartheid movement as a model for how to stay home and effect change far away.

Poverty Assumptions
The assumption that poor people in foreign lands NEED our help is the assumption we must challenge as the international community (whoever that is) start thinking of new ‘targets’. Instead of giving poor people what our theoretical frameworks, randomized controlled studies, and consultation with Ivy-educated energetic young experts ( that tend to populate consultant firms) say they need, perhaps we could set up frameworks for them to tell us what they need from us (I'm thinking YouTube, Skype, Google). We may choose whether or not to give it to them, but at least they would have had their say.

The Study of Poverty
As for the authors' ‘we need  more research’ conclusions. I beg to differ.  The key being “the substantial investment of money and brainpower in both the MDGs and the global debate over what should replace them" (p.17). That they state the existing research has provided so few answers is a sign that perhaps more research is not what we need. Nor is the need to spend all this time, energy, money and carbon creating new agenda items to write about and discuss in far-flung meetings in fancy spaces for the next x numbers of years. Yes, some countries may find that their tourism infrastructure may suffer the lack of peripatetic aid professionals but I am sure they will find other economic engines to replace them.

Eliminating Poverty
The abject poverty targeted by the MDGs was created, and is maintained, by well-understood systems of power and wealth that reside in the countries that give aid. These are systems that few in the ‘international community’ are willing to change; including many in the aid business who would have no more travel to exotic locations for cool meetings with really interesting and smart people. (Have they heard of Skype?). Until they are ready to do that, they should leave the victims of their policies alone. I think they've done enough. Big goals for years ending in 0 or 5 may make us feel better before they even hit the ground, but that alone should make them suspect.

For an updated critique of the SDGs see 'The 169 Commandments', The Economist, March 28, 2015.

Saturday, October 27, 2012

Good intentions, exploitation and studying 'the poor'

I am an academic and thus I am required to do research and to write. As someone who studied sociology, social welfare, public health, international health, and economics I am plenty equipped to study poverty and the lives of poor people. And in my areas of study, these are the people of whom we ask questions, whether here or abroad.Were I to do a search of any library database using poverty as a keyword, I will get hundreds of hits for journal articles published in the past month alone. But I have decided that I will no longer study 'poverty' or 'the poor' because I find it exploitative in its convenience, somewhat useless in its findings and creates a conundrum in its recommendations: how to change poverty by changing the poor.

We study how the poor shop, what they eat, what they drink, how fat they are, how (un)educated they are, how much health care they (don't) get, how they parent, and how a wide range of social, political and economic factors interact to influence their patterns of behavior.

Given that the poor have been studied for more than a hundred years and are not responsible for their poverty, and that poverty is a result of social and economic policies and systems, the objective of studying the poor or poverty seems unproductive. For example, Charles Booth's study of the poor in East London in the late 19th Century has findings similar to recent studies of the poor of East London. Finding that poverty did not change should not be surprising if the system that creates vast swaths of poverty: capitalism and social/political neglect, have not changed. That we are fascinated by the increases in inequality after creating systems that create such inequality makes us seem out of touch with the 'real world' outside of the towers of ivory.

Through our 'engagement' with the poor and with poverty, academics have implicitly and explicitly made poverty, and especially the poor, the object of our inquiry and therefore the focus of our interventions. There is something inherently 'perverse' or 'interesting' or 'puzzling' about the behaviors of the poor that inspires intellectuals of all stripes to spend lots of time writing grants, seeking out 'controlled and randomized' samples (or more likely samples of convenience), and doing complicated qualitative and quantitative analyses using sophisticated software to find out wherein lies the problem of poverty and how we can change the behaviors of the poor to make them less poor or more 'functional' within their poverty.

 In the global arena, economists are leaving the theoretical equations of the classroom to test their ideas in the real world (see the books More Than Good Intentions, Poor Economics etc). Using localized research projects, these economists from Yale and The Poverty Action Lab at MIT seek to find 'the answers to poverty' by comparing how samples of poor people respond to different 'aid' scenarios. I will not deny the fascinating results of these studies, but the power dynamics of the 'lab rat' experiences that poor people must endure at our expense in the production of knowledge, leaves me queasy; despite all the very careful ethical standards that are in place.

Our extensive studies of the poor goes against the justice principle of the 1978 Belmont report that defined ethical standards for protection of 'subjects' in research. Academics put undue burden of research on the poor because the benefit to the poor is hard to justify the more we study them and the longer they remain 'poor' as mobility upwards slows down and the top 1% get increasingly wealthy. Perhaps we should study the rich in order to benefit the poor. We know a lot about the poor but it is hard to say how much 'new' information we gain about poverty/the poor with each new study, or how much poverty alleviation has happened as a result of the waves upon waves of various methodologies and strategies we have employed in the study of individuals who are poor.

The problem is not poor people. The problem is poverty. And there is no way to 'find answers to poverty' by studying poor people as they are not the creators of their demise. However, as people with power, we have chosen them as the 'object' of our research (though 'partners' is a more trendy notion - and lofty goal - I hesitate to tarnish the meaning of the word by using it in this context). We do this because it is challenging to find a sample of the top 1% to study in the same way that we study the bottom 1%. How fascinating it would be to find out about how the wealthy give to charity, pay their workers more, consume less, vote in a particular way, their savings patterns, their inheritance patterns, their parenting, consumption of pharmaceuticals and recreational drugs, their romantic relationships, their residential patterns etc. etc. However, the wealth and power of the rich insulates them from being subjected to the querying minds of academe. The Center for Wealth and Inequality at Columbia University was created several years ago in a groundbreaking move to study wealth and inequality and yet it still identifies poverty as the first item in its list of research interests.

Among my colleagues around the globe, I would be hard pressed to find anyone who finds new research on poverty groundbreaking in any way. This particular blog post was inspired by an online discussion on the Spirit of 1848 listserv of the American Public Health Association - a left wing community of public health professionals from around the world interested in the issues of inequality and its impact on health. Recently, the conversation was exploring the issues raised in an article titled, 'Low income linked to poorer health in both US and England, despite different health systems', which was published in the American Journal of Public Health in late September. An article that created a resounding 'duh!' online.

I think it is time to leave poor people alone; to use our power to protect them from our insatiable curiousity about their lives through actively fighting with them for social policies that raise their standard of living and education and gives them more access to resources and power. Replicability may be a founding principle of science but after a point we move to redundancy. If we still feel the need to ask questions of the poor, perhaps we can let them guide the way. This means we give up our 'intellectual superiority' and become servants to the poor, asking the questions to which they want answers. This may mean less articles for me to review for lofty (and not so lofty) journals but it may mean that more of what we write gets read by more people, and more of what we read educates us in a meaningful way that makes social change possible.

Picture from Grandmother's March 2012, sponsored by St Francis Health Services of Njeru, Uganda,