displacement and development test

International issues that have caught attention in the past 20-30 years

• The increase in political freedom (south africa and eastern europe) 

• Several widely reported famines (ethiopia and sudan) 

• Destructive civil wars (Rwanda and Bosnia)

• Natural disasters (asian tsunami and haitian earthquake)

global health

• The study of the health of populations in a global context

• Studies both diseases and their causes 

disciplines of global health

• tropical medicine, primary health care, epidemiology, economics, and more 

global health background + today

• Despite widespread improvements in health over the last few decades, malnutrition, poverty, and health inequities are still very prevalent around the world

• Global health and the developing aid industry have had a long journey, and it is important to recognize their successes and their errors in order to improve in the future 

• Global health today consists of an intricate mix of private, governmental, and international organizations, with the overall aim of improving the health of populations in developing countries   

• Global health uses "collaborative trans-national research and action: to focus on people 

• No initiative will be successful without being conscientious about the target population. Thus, it is important to include and listen to local people during the planning and implementation of initiatives 

• Initiatives can include economic interventions (economists, business specialists, agronomists, small scale bankers, etc), medical initiatives (doctors, nurses, pharmacists, nutritionists, etc)., and human rights initiatives (politicians, rights, activists, and constitutional lawyers)

• Global health strives for health equity and freedom for people

Amartya Sen

• An economist who has had a profound effect on global health and argued development as freedom, outlining five specific types of freedoms: political freedoms, economic facilities, social opportunities, transparency guarantees, and protective security 

• He argued that such freedoms should be both ends at the means of development  

millennium development goals

• MDGs were created following the millennium summit of the united nations in 2000, with the aim to guide global health development for the next 15 years 

• MDGs goals 

1. To eradicate extreme poverty and hunger 

2. To achieve universal primary education 

3. To promote gender equality 

4. To reduce child mortality 

5. To improve maternal health 

6. To combat HIV/AIDS, malaria, and other diseases 

7. To ensure environmental sustainability 

8. To develop a global partnership for development

critiques about mdgs

• Progress reaching goals has been uneven across countries 

• MDG statistics were often reported as averages based on multiple countries, thus improvements of one country overshadowed the lack of improvements of other countries 

• MDGs were prepared by only a few stakeholders without adequate involvement by developing countries and overlooked development objectives previously agreed upon and not appropriately adapted to national needs 

• Ex. china and india had substantial improvement compared to subsaharan africa 

• MDGs did not have adequate involvement of developing countries and were not adapted to national needs 

• MDGs left out issues such as disasters, conflict situations, non-communicable diseases, mental health disorders, large inequalities, and more

overall did msgs make a difference

• Yes, MDGs increased health and well-being of populations in many countries 

• MDGs increased access to safe drinking water, sanitation, and education

• Targets for tackling malaria and tuberculosis were met 

• Significant poverty reduction and a decline in extreme poverty 

• In 1990, nearly half the population in the developing world lived on less than $1.25 US a day; that proportion dropped to 14% in 2015 

• Substantial progress was made in reducing child undernutrition, child mortality, and maternal mortality

sdgs

• The transition from MDGs to SDGs was premised on building a sustainable world where environmental sustainability social inclusion, and economic development were equally valued

• SDGs included issues MDGs left out, such as disasters, conflict situations, mental health disorders, and large inequalities 

• SDGs included non-communicable diseases such as obesity, smoking-related illnesses, and substance use 

1. No poverty 

2. No hunger 

3. Good health/ ensure healthy lives and promote well-being at all ages

• By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births 

• By 2030, end preventable deaths of newborns and children under 5, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under 5 mortality to at least as low as 25 per 1000

4. Quality education 

5. Gender equality 

6. Clean water and sanitation 

7. Renewable energy 

8. Good jobs and economic growth 

9. Innovation and infrastructure 

10. Reduced inequalities 

11. Sustainable cities and communities 

12. Responsible consumption

13. Climate action 

14. Conserve and sustainably use the oceans, seas, and marine resources for sustainable development  

15. Protect, restore, and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss   

16. Peace and justice 

17. Partnerships for the goals  

sdgs and poverty

• The majority of people living in extreme poverty can be found in south asia and sub-saharan africa, accounting for approximately 80% of the extremely poor 

• Inequity and injustice often follow poverty 

• Some other topics to think about in relation to poverty and health include the cycle of poverty, health inequality vs. health inequality, marginalization, social hierarchy,  social position

Sdgs and malnutrition

• Although global averages show a decline in malnutrition, there has been slow progress in reaching MDGs for malnutrition due to increased food prices and global recession, especially in parts of asia and africa 

• Large scale famines and death from starvation have predominately been replaced by chronic malnutrition 

• Malnutrition can refer to undernutrition or overconsumption

Sdgs and childhood illness

• The leading causes of death include preterm both complications (18%), pneumonia (15%), birth asphyxia and trauma (12%), and diarrhea (9%) 

• Child mortality rates have been reduced by half in many countries, but 6 million deaths still happen per year, and many of these deaths could have been treatable, preventable, and avoidable had they lived in developed countries 

• For example, roughly 100,000 children still die from measles every year, a disease for which there is a 99% effective vaccine costing roughly US $1 per child

sigs and pregnancy related deaths

• Developing regions account for 99% of all global maternal deaths, and sub-saharan africa accounts for two-thirds of that 99% 

• Majority of maternal deaths in developing countries can be avoidable with improved standards of care

• For example, approximately 25% of the total pregnancy related deaths were due to bleeding to death

• Effects of pregnancy can impact the rest of a woman’s life, as women can be left with disabling injuries, chronic infection, or permanent pain  

sigs and indigenous health

• Widely diverse → 370 million indigenous peoples around the world, forming at least 5 thousand separate groups expanding over 90 countries 

• Indigenous peoples often share a history of conquest and discrimination resulting in poor treatment and reduced access to health care 

• Commonly shared health problems include high rates of substance abuse, diabetes, family violence, suicide, and lower average life expectancy compared to the dominant population

• In 2007, the non-binding UN declaration on rights of indigenous peoples was signed, hoping to improve the visibility of indigenous minority groups

sdgs and war

• Internal wars have largely replaced external wars between countries, resulting in high levels of violence against civilian populations, progressive economic and social collapse, and displacement, and give rise to the term humanitarian disaster

• The cost and long-lasting impacts of war are incalculable on individuals, communities, and nations 

sdgs and natural disaster

• The two deadliest (the asian tsunami and the haitian earthquake) and the two most costly (hurricane katrina and kobe earthquake) disasters in history occurred during the last decade 

• As the global population increases, the movement of people towards living in vulnerable areas has attributed to the steady increase in death rates from disasters each decade

• Some other topics to think about in relation to natural diasters: 

• Climate change

• Mitigation efforts (preparedness and planning), and 

• Global migration (forced and unforced)  

sdgs and human rights abuses

• Just like many other global health issues (food insecurity, poverty, and indigenous health), abuses of basic human rights are not confined solely to the developing world 

• Issues include discrimination and oppression based on gender (e.g., female genital mutilation, and exclusion of girls from school), or violence against particular ethnic/religious/racial groups 

• Beneficial changes in the rights of individuals are a growing feature of large scale aid projects 

chapter 1 conclusion

• The MDGs have gone a long way toward:

• Changing the way we think and talk about the world 

• Shaping the international discourse and debate on development 

• Stimulating popular awareness of moral imperatives such as:

• Achieving gender equality 

•  Ending poverty and starvation 

• The new SDGs are bound to continually shape the foreign aid industry with more focus on metrics, impact, and equity

foreign aid intro

• Foreign aid is a multi-billion dollar industry with a complicated framework of agencies, organizations, and policies 

• Foreign aid has had its ups and downs, and it is important to understand how its history of a lack of central planning authority, experimentation, success, and failure has led to what it is today, and what it can be in the future 

• The framework of the industry has been fashioned by unavoidable external forces such as the cold war, the end of colonialism, the 1980s economic crisis, the HIV epidemic, and most recently by the millenium development goals, plus the moves toward improved funding and aid effectiveness stimulated by international agreement

developmental stages of foreign aid

• Public health initiatives can be found as early as during the reign of the roman empire, when the public had access to clean water, public baths, and toilets 

• The first recognizable aid project was conducted by the Spanish roughly 200 years ago, in response to smallpox in Spanish colonies 

• Charles IV sent Xavier de Balmis to spread the newly discovered vaccine to other colonies across the world 

Francisco Xavier de balmis

• Born into a medical family, he first worked as military surgeon in Spain's north african colonies. He later worked in Mexico, as head of the Amor de Dios Hospital. He later worked in Mexico, as head of the Amor de Dios Hospital. He gained a reputation through his writing, particularly his translation of a french book on vaccination. When it was decided to spread the benefits of smallpox vaccination throughout the Spanish empire, he was chosen as head of the project. In the absence of refrigeration, the vaccine was kept alive by sequential inoculation of 20 orphans taken along for the trip. The expedition left Spain in 1803, sailing for Venezuela, Mexico, and Cuba. He then sailed on to China, the Philippines, and finally home after over three years of travelling. 

developmental stages of foreign aid: before wwII

• Colonial countries (such as britain and france) often viewed their colonies as a source of money and resources during the 19th century 

• The development of roads, railways, and ports was done in the colonies to benefit the colonial masters (very little importance was given to the local poor)

• Healthcare and local education for locals was usually provided either by missionaries or owners of large plots of land

• The development of large health agencies was stimulated by the spread of steam powered rail and sea transport during the 19th century 

• Increased quantity and speed of transportation increased the movement of humans and the spread of communicable diseases/epidemics 

• Large cities and major ports (especially in North America) were plagued with infectious diseases such as smallpox, bubonic plague, yellow fever, and cholera 

• Eventually, in 1902, the international Sanitary Bureau was established and included the United States and others from South America, which later grew into the Pan American Health Organization (PAHO)

• Other important organizations before WWII included: 

• The office international d’hygiene publique 

• The league of nations 

• The red cross 

•   Important changes in global health before WWII included international humanitarian aid for countries with famines (e.g., the Irish famine and the bihar famine), the abolition of slavery, and the establishment of tropical medicine schools in Liverpool in response to the need for well-trained doctors

developmental stages of foreign aid: 1940s and 1950s

• Wars had brought devastation to many countries but had also catalyzed social movements 

• A wave of nationalism swept the world from africa to asia

• For example, India became independent in 1947, Israel was created in 1948, and Mao came to power in China in 1949  

• Countries in western and eastern blocs grew apart due to different political ideologies, and would spend the next few decades fighting for political influence in newly independent states, using financial aid and military assistance

• President Truman’s “four point” speech in 1949 sparked the start of modern aid assistance and the “point four program” to give financial aid to countries in need 

• This was preceded by the lend lease program, which was created by the united states in 1941 to provide financial, food, and military assistance to war allies (Great Britain, Russia, and China) 

• Often, economic and health related projects of the 1940s and 1950s were based on the optimistic feeling that technology and money could be used to eradicate poverty and ill health: that money equaled growth

• Unfortunately, this was mostly not the case and missed the roots of the problem 

• The war left a poor agricultural industry, starvation, and malnutrition in several European countries, prompting the United States to create the marshall plan 

• Marshall plan (1947): a joint venture where money was given to European countries to help rebuild Europe. These countries formed the organization for European Economic Co-operation (OEEC) to run the project, which grew to become the organization for economic cooperation and development (OECD) in 1961 

• It is important to note that European countries were given control of how to use their financial aid, were offered low interest loans without conditionality clauses, and were allowed to maintain their own protective trade barriers, resulting in rapid rebuilding and economic growth 

• During this time, major international development agencies were established, such as the international monetary fund, world bank, and general agreement on tariffs and trade (which grew to become the world trade organization in 1994) 

• The united nations was established in 1945, replacing the league of nations and inheriting the international labor organization 

• Numerous health related UN bodies were also formed, including the food and agriculture organization (1945) and the world health organization (1948) 

• In the field of health, optimism boomed due to the quick fix discoveries of effective drugs and insecticides stimulated by the demands of war (such as penicillin, chloroquine, and DDT). However, modern drugs and insecticides are only one part of eradicating diseases 

• Effective disease control requires coordinated programs aimed at multiple levels of intervention. The disease reservoir must be identified and treated, transmission must be interrupted, and infectious contacts must be traced and treated

developmental stages of foreign aid: 1960s and 70s

• 1960s were declared the first decade of development by the united nations

• There was a continuing process of decolonization (seven newly independent African states were formed in 1960 alone) 

• These young countries needed help with their early economic and social development, so aid was naturally directed towards them 

• Many new, independent countries were not ready to align with big powers due to a history of colonialism, and they combined their voices to persuade the UN to call its first UN conference on trade and development (UNCTAD) in 1964 

• However, UNCTAD had very little influence on international trade

• Following UNCTAD, the declaration of a new international economic order was created, which was accepted by the UN in 1974, to address issues such as increasing aid and trade liberalization, but still proceed little action 

• The international development association was established in 1960 from the world bank to coordinate interest free loans to poor countries 

• The development assistant committee was established in 1962 out of the OECD to give aid/donations 

• Individual countries started their own bilateral aid agencies around this time (USAID, Britain’s DFID, Europe’s ECHO, etc) 

• Organization of the petroleum exporting countries was established in 1960, consisting of oil-rich elites of the developing world 

• There were some major successes in health aid in the 1960s

• Through the smallpox eradication program by the WHO, announced eradication program by the WHO, announced in 1967, smallpox was eradicated by 1978 

• There also started to be more of an emphasis on addressing the health needs of the poor and recognizing that western style medical care (modern urban hospital, high-tech equipment) was no longer as useful as when it was first introduced 

• This culminated in the Alma Ata Summit in 1978, and the subsequent health for all strategy that emerged from it 

• The end of the 1970s saw health aid and economic aid moving in two directions 

• The health debate tried to base its programs on what was best for the poor very much a secondary issue, behind economic growth

developmental stages of foreign aid: 1980s and 90s

• The 1980s is referred to as the lost decade, due to negative effects of developing world debt, the structural adjustment policies (SAPs), the deepening crisis in sub-Saharan Africa, and the onset of the HIV/AIDS epidemic 

• The failure of Mexico to meet its debt repayments in 1982 heralded the start of the developing world debt crisis 

• The proposed solution for the debt crisis was the Washington consensus, which called for privatization of state industries, trade liberalization, and reduction in social spending on health, education, and food subsidies for the poor 

• These economic interventions in exchange for loans were collectively known as structural adjustment policies (SAPs)

• The effects of SAPs were extremely negative on the health of the poor. Despite 20 years of economic interventions, agreements, and binding resolutions, more countries than ever, especially many developing countries, were overwhelmed by debt 

• In response, the world bank and IMF created the highly indebted poor countries (HIPC) initiative in 1996, and a second try in 1999 (a more enhanced HIPC)

• During the 1980s and 1990s, health aid did fairly well, due to the implementation, and oral rehydration 

• But economic aid responded to the challenge of world recession by concentrating on economic growth incentives, even when some of those initiatives were harmful to the poor

developmental stages of foreign aid: the new millennium

• A growing emphasis on the poor 

• The increasing collaboration of economic aid and health projects with shared aims 

• Introduction of MDGs and SDGs to guide global development 

• Early eradication programs that were criticised for remnants of colonialism were replaced by large initiatives targeted at specific diseases 

• Foreign aid donations have almost doubled since the mid 1990s and major attempts are being made to harmonize the efforts of multiple agencies and improve the effectiveness of aid 

• The involvement of highly successful business leaders has brought new ideas for organization and fundraising from within the aid industry, while the growth of large non-DAC donors such as China, India, and Brazil now provides competition from without

Mdgs and foreign aid

• The launch of MDGs catalyzed major increase in development assistance 

• More aid has flowed into education and public health while also being directed toward poorer countries to supplement the increases in domestically sourced development finance 

• The development assistant committee provides a forum for (bilateral and multilateral) donors to come together for harmonizing their aid activities in order to decrease poverty and realize the millennium development goals 

• The DAC works on issues like aid effectiveness, collecting aid statistics, and the evaluation of the development process 

• DAC included donor countries like the US, Australia, the UK, Japan, and European countries 

• DAC donors’ net official development assistant consisted of net debt relief grants in donor refugee costs, humanitarian aid, multilateral ODA, and bilateral development projects/programs/ technical co-operation 

• There have been new emerging aid donors such as china, india, brazil, turkey, and south africa 

• In 2006, about 7-10 percent of total aid flows were provided by emerging donors, and in 2012 this had risen to 25 percent of the total official development assistance 

• In the 1990s, over 90 percent of development assistance came from the DAC countries, and developed countries dominated international development co-operation

conclusion chapter 2

• Foreign aid isn't a waste of time, but neither is it the savior of the poor. Its management framework and the philosophical and theoretical reasons behind current development initiatives have all significantly transformed over time 

• The final structure has been fashioned by experiences gained from the industry’s history, which has resulted in a complicated framework of different agencies and policies that have vacillated over the years