Monday, May 19, 2014

Week 11: My Thoughts on The World We Want

For week 11, we were asked to post our thoughts on one of two voicethread topics using the knowledge that we've gained on health and development throughout this semester.  This is my posting for the topic "The World We Want".

"One of the biggest things that I've taken away from this course is the importance of increasing human capacity, in other words developing individuals' abilities so that they can care for themselves and their families and contribute to society.  Ultimately, the goal is to get people and countries to be as self-sufficient as possible.  Thinking back to the lecture on leadership and Sen's views in particular on improving circumstances in Africa, it's clear to me that having developed simply throw money at the issue is not the solution.  I tend to agree a great deal more with the views of Dambisa Moyo who believes that change will have to happen from the ground up and that developing nations should be treated as responsible partners in their own development.  Continuously donating money can take away from the incentive to really make things better, especially if they've become reliant on that money.  Instead of continuously treating them like they are in need of handouts, which will likely perpetuate that mentality, wealthy countries should be interacting with them as equal partners on the world stage who have the potential move themselves forward with the right tools (i.e. information, proper governance, infrastructure and well-functioning education and health systems)."


Saturday, May 17, 2014

Week 10: Practical and Strategic Needs

Here are a few scenarios that were presented in class.  In each one, the individual has both strategic and practical needs to be addressed.  Our aim is to identify what they are.

Scenario 1:

"Tui completed two years of school, married at 15 with her first child soon after. She is a
rice farmer and typically gets up first light and when she has finished her housework she
goes with her husband and baby to the rice fields. In the evening she collects water from
the river, takes a bath in the river, collects firewood and cooks dinner (rice and a little
chilli sauce). Sometimes she walks the 5km to the market to sell some vegetables which
she grows on the bank of the river. She often feels tired. She had her first sexual
intercourse when she was 15 and soon after became pregnant and  got married. She
wasn’t sure if she wanted to have sex with her (now) husband but she was afraid she
would loose him. She had heard of condoms for preventing pregnancy from the local
health worker but she was too embarrassed to go and get some from the health worker
and she was not sure her partner would like them. She went to ANC a couple of times.
She wanted to go again as she had run out of the medication they gave her (not sure
what it was) but her husband was busy and could not take her. She gave birth at home.
She has not been to post natal care as she did not feel ill but her baby was vaccinated."

So what are Tui's practical needs?
  •  Tui could probably benefit from having access to a range of contraceptives other than condoms (seeing as she is uncomfortable asking her husband to wear one) such as intrauterine devices (IUDs), birth control pills, injectable birth control, diaphragm, etc, which may be more convenient and easier to negotiate but also so that she can have more control over her own fertility.
  • Because she only eats rice with chilli sauce and often feels tired, it's fairly evident that she needs more nutritious food including protein and vegetables and would likely benefit from vitamin supplements as well (iron, etc).
  • If accessing health services was difficult for her and that's why she gave birth at home, she may need better and easier transport to health services, more family support to help when her husband is busy and possibly a clinic with skilled health workers nearby.
  • Tui could certainly use a water pump in her village or near her house so that she doesn't have to go down to the river to get water and bathe, which could be dangerous if she cannot swim or the water is carrying pathogens (such as schistosomiasis, etc) that could make her ill.  Carrying water all that way could also be very labor intensive, especially if she's also carrying her child.
What are Tui's strategic needs?
  • Tui could benefit from some education (formal or informal) about nutritious food, family planning, contraceptives (the different kinds that are available and how to use them) and reproductive health (such as ideal spacing of pregnancies), particularly regarding the importance of having a skilled birth attendant and preferably going to the hospital to have a baby.
  • Tui needs more self-confidence and social and cultural empowerment so that she feels more comfortable voicing her wants and needs to other people and acting on them.  For example, she should be more at ease going to get contraceptives from the health worker and discussing it with her husband as well as other people in the community.  This may also help her to insist to her husband and family (his or hers) that she deliver in a clinic the next time she has a baby since she may have felt that she did not really have a say in the matter the first time.
  • Perhaps there needs to be more social acceptance of contraceptive use in the community, particularly for unmarried couples and women specifically so that they don't feel ashamed asking for condoms and birth control from health workers.
  • Tui may also need for her community to have more trust in health facilities and to change their views on giving birth at home in the traditional way to a preference for clinic deliveries.

Scenario 2:

"Lui is a rice farmer and she also grows some corn. The area where she lives is peri-
urban/rural and experiences some flooding during the  monsoon season, she did not go to
school and in her village there is access to secondary education opportunities and health
care. She considers herself ‘average’ socio-economic status for her village.  Mainly her family
eat rice with chilli sauce and maybe a little vegetable. The vegetables she eats are the ones
that are “easy to find at little to no cost. This is mainly morning glory, ivy gourd and ginger
leaf. In the wet season she raises fish in a small pond and eats the fish, fish are also fairly
cheap to buy. Sometimes she buys pork meat which is not too expensive but foods such as
pork intestine, beef, and  soybeans are too expensive. Other foods which she thinks are too
expensive are carrots and sweet potato. If she has a little money from selling vegetables she
likes to but some MSG and chilli. She gets her water from the river and is very careful to boil
it on her wood fire."  

Practical needs:
  • Lui does pretty well for herself but she could probably benefit from better access to healthier food items (i.e. the more expensive but more nutritious).
  • She could probably use a house that's a little further from the flood waters, or one that is on stilts so that her children aren't at risk of drowning and their belongings are not at risk of being damaged or lost.
  • She may also benefit from a water pump closer to her house so she has a close water supply nearby and doesn't have to carry water very far.
  • Hopefully she has an outdoor area to boil water and cook food so that she isn't inhaling a great deal of smoke which could affect her respiratory system.
Strategic needs:
  • Lui could probably use some more education (even if it is informal) about the nutritional content of different foods and the health benefits of paying a little extra to buy carrots or sweet potato at least every once in a while.
  • She may benefit from having a system in place to provide her with more knowledge about how to optimize and expand her crop and fish farm yields.
Overall, Lui does pretty well for herself and does her best to make practical decisions based on the knowledge and resources that she does have.

Scenario 3:

"Madeline moved from her village to the city. She works in a large factory making clothes. She
gets paid quite well as she makes boutique clothes and she is able to send some money home
to her family. She gets paid per piece so she works very hard to earn more money to send
home. In the factory they are not allowed to talk to the other girls and not allowed to go to the
toilet before mid-day. The supervisor comes round with water but she found after a while she
could not sleep and she started to loose weight, someone told her it is because there are
drugs in the water the supervisor brings round has drugs in it. Usually 10 people sleep in a row
in a small room at the factory where the scraps of material are stored. Sometimes people have
accidents, their hands get caught in machines of they fall asleep. The company will usually pay
for a doctor and medicines."

Practical needs:
  •  Madeline really needs a new job.  One where she has improved health and safety (no hands getting caught in the machines) and a better boss that allows her to go to the washroom when she needs to during the day, that doesn't drug their staff by putting amphetamines in the water, or refuse to let the workers talk a little bit throughout the day.
  • She also needs a better place to sleep where she can actually get some rest outside of the factory.
 Strategic needs:
  • Madeline needs empowerment and self-confidence to stand up to her boss and ask for better working conditions.
  • She would benefit from a government that is interested in establishing and enforcing policies to protect the rights of all workers.
  • She would also particularly benefit from having a union to speak on her behalf and fight to protect her rights.  Therefore she needs political and social systems to be put in place that will allow for the creation and functioning of labor unions.  In fact, she and some of the other female workers could start a union of their own if they felt confident enough to do so.

Scenario 4:

"Mary is 78. Her husband died several years ago and she lives alone in a small apartment.
Mostly she stays at home watching television. She is quite poor and worries about the rising
cost of living. She has ringing in her ears and cannot hear very well.  She also has high blood
pressure and type 2 diabetes has to take medication every. Mary has decided to save some
money she will try and reduce  by a small amount some of the amount of medication she takes.
She has not mentioned this to her doctor, to her doctor, nor has she mentioned the ringing in
her ears to her doctor."

Practical needs:
  • Mary needs to visit an audiologist, preferably one that will not cost her much or anything at all.
  • She may need a hearing aid to help with her hearing.
  • She needs access to less expensive medication, such as generic versions of the drugs she is on now.
Strategic needs:
  • Mary needs to feel like she can talk to her doctor or pharmacist about the ringing in her ears and not being able to afford medication so that she can receive proper treatment and so that her health and well-being can be taken care of.  Mary needs to feel confident and empowered to discuss her situation with them.
  • Mary would benefit from a government and society that are more concerned with looking after the elderly through social assistance programs so that she didn't have to worry about money all the time.
  • She might also do better if she knew about social groups and gatherings, especially for people around her age and the courage and willingness to go out and make new friends so that she doesn't feel so lonely.

One thing that we discussed in class, particularly in relation to Lui, was how resourceful people can be, even without a formal education.  It's important that individuals are treated like the capable people that they are when developing and implementing projects so that their skills are utilized and they don't feel put down.


Saturday, May 10, 2014

Week 9: Gender and Development

Why is the color pink associated with femininity and being a woman while blue is associated with masculinity?

Why have women historically been viewed as caregivers and nurturers while men are thought of as hunters and breadwinners?

What is the real difference between men and women?

The truth is that when considering issues like these, it is important to differentiate between GENDER and SEX.

Sex pertains to the biological characteristics of being a man or a woman.  It does not change from one society to another, it is universal.  While surgeries, medication and procedures can help to change the physical traits and appearances associated with being a man or a woman, there is nothing that can change the sex that is coded in our DNA.

Gender refers to the learned behaviors, roles and responsibilities ascribed to the concepts of femininity and masculinity by societies and cultures. It's an idea or belief about how men and women should act and/or be treated that can differ between communities and change over time.

Someone may identify with one gender over another irrespective of their sex.  For example, someone who was born as a biological male may identify more with the female gender and prefer to live life as a woman.  This is referred to as transgendered.

To be honest, I had never really thought about how gender and sex are different, but it definitely made sense to me the minute we started talking about it in class.

I have however, often pondered why men and women have been treated so differently throughout history and even now.  Despite all of the progress that has been made in the developing world towards equality (equal treatment in laws, policies and the access to resources and services) and equity (fair and just distribution of responsibilities and benefits between men and women), women still find themselves not quite on equal footing.  

Many wealthy countries still see a large pay gap between genders including Australia, which reported in November of 2013 that on average, men earned 17.1% more than women (Workplace Gender Equality Agency 2014).  This statistic from Australia actually shows an increase in the gap of approximately 1 percentage point over the course of 19 years, which is quite troubling when the goal is to reduce inequities (Workplace Gender Equality Agency 2014).  Some point to the fact that women leave the workforce, even if only for a short period, to have children and may miss out on experience that would lead to a raise and/or promotion during that time.  Others claim that it is due to the fact that women and men tend to prefer doing different jobs, for example, women are often under-represented in mining and construction, which may pay better wages than the professions that they do choose.  However, since a considerable proportion of the gap has no real explanation, it is almost certain that discrimination is a contributing factor (Workplace Gender Equality Agency 2014).

The circumstances regarding equality and equity are generally far worse in developing countries, most of which still operate under the guise of very traditional values regarding the roles of men and women.  For women in these settings, it's more than just a matter of equal pay or the right to vote and go to so school, it's about their right to simply live without being the subject of violence and having that right protected.  A report recently released by the Human Rights Commission of Pakistan (HRCP) in March of this year (2014), found that 869 women were killed for allegedly bringing shame onto their families in 2013.  These are typically referred to as "honor killings" and since the report was based solely on those cases found in newspaper articles, the belief is that the true number of women killed is higher.  Usually, the legal system does very little to hold the families accountable or punish them for the woman's murder because of the tradition of "karo-kari", a custom that allows family members to stone to death anyone suspected of adulterous behavior (HRCP 2014).  The Commission also found that 56 women had been killed for giving birth to daughters instead of sons (HRCP 2014).

The preference for sons is well-documented in several cultures and societies, daughters are often seen as a burden that families have to pay men a dowry to marry and take off their hands.  As much as developed societies may believe that they have moved beyond that to truly value girls as much as boys, there is evidence to the contrary. 

I have long-believed that couples with sons are more likely to stay together.  Looking at my own family, every couple that has only had girls (with the exception of distant relatives) has divorced, my parents included.  This amounts to 5 divorces for families with only daughters, compared to only 1 divorced couple with only sons and no divorced couples with both sons and daughters.  This trend does not change when I stretch the sample pool to include friends and acquaintances.  It would appear that this observation is not simply due to chance.  A research paper analyzing the census data for American families from 1960 to 2000 revealed some pretty shocking data indicating a general preference for boys (Dahl & Moretti 2004).  Families in which the firstborn child is a girl are 3.1% less likely to have the fathers living in the household.  Over 10 years, this translated to an estimated 50 000 families (Dahl & Moretti 2004).  Couples were less likely to get married before the birth of their first child if they knew ahead of time that they were having a girl (Dahl & Moretti 2004).  In fact, women whose eldest children were daughters were less likely to have ever been married (2.2%, which increased to 4.9% if first two children were girls and 4.7% if first three were girls compared to boys) (Dahl & Moretti 2004).  Finally, couples with only girls were also more likely to try having another child than those with boys (perhaps to try for that elusive male offspring).

This has significant implications for women and girls as single-mother households are more at risk of experiencing poverty than families with both parents or ones headed by single fathers (West Coast Poverty Center 2009).  Growing up in poverty without the emotional stability provided by a family that is intact could explain why there is evidence to argue that children with divorced parents are more likely to leave high school without graduating, become teenage parents and face unemployment (Dahl & Moretti 2004).  As a result, both the present and future health and productivity levels of these female individuals could be compromised, thereby impacting on the overall economic growth, development and well-being of entire communities.

The truth is that men and women are different in regards to their physicality as well as the way that they are viewed and treated in society.  It is important that these differences be acknowledged in development because it means that men and women have different practical and strategic needs that must be met in order to help improve their circumstances and ultimately increase equality.  We went through several examples during class but I wanted to look at another one that I thought of: the effects of menstruation on female education and future employment in developing countries. 

Young girls in developing countries often struggle to attend school while they are menstruating.  In fact, one study found that over 60% of primary schoolgirls questioned in Uganda missed at least some school every month because of their menstruation (Prestwich 2013).  Most women in developing countries do not have access to disposable sanitary pads and tampons, but rather have to use bulky reusable cloths or towels that must be washed.  They also often have to share latrines, which may not have doors, with male students (WaterAid 2014).  The topic of menstruation tends to be considered taboo and the actual process itself can carry with it social and cultural stigma (WaterAid 2014)s.  Some cultures believe that during menstruation, a woman is unclean and may pollute others around her and therefore should be shunned.  In other cases, young girls are simply teased by their peers for having their period, possibly in addition to experiencing painful cramps (WaterAid 2014).  Without access to the pain management, private toilet facilities and sanitation products that have helped make dealing with menstruation easier and more convenient in wealthy countries, many girls simply prefer to stay at home rather than try to cope with cloths at school and risk potential criticism and humiliation (WaterAid 2014).  Being absent from school due to menstruation impacts on education and future employment prospects as these girls are regularly missing out on learning opportunities that would help them to reach their full potential and put them on a more even playing ground with their male counterparts.

So what are the needs of these young girls?  How can we help them miss less school so that they can learn more, gain more experience and be more productive?

First there are the practical needs.  These involve the short-term, tangible necessities that serve very specific purposes in accomplishing tasks on a daily basis (for example, a water pump).  In this case they include:
  • Improved access to private, clean latrines at school where girls can change their cloths without fear of embarrassment.
  • Access to sanitary napkins and hygiene products to make dealing with menstruation at school more convenient.
  • Water and soap so that girls can wash their hands after going to the latrine.
  • Access to pain management and knowledge about how to use it to help with cramps.
 Then, there are the strategic needs.  These are are more long-term, broad and systemic, they refer more to overall positions of disadvantage or socially held views and women may not even recognize them as an issue (for example, lack of confidence in women to pursue careers in politics).  The strategic needs for this particular issue include:
  • Removing the stigma and taboo of menstruation so that people are willing and able to discuss it without shame, criticism or embarrassment.
  • Increasing the self-confidence of girls so that they are more comfortable attending school during their period.
  • Encouraging acceptance and education regarding menstruation between women and girls and the society at large so that girls have the right information and myths are no longer perpetuated.
  • Political interest and willingness to at least begin discussing the issue.
In this case, a physiological process unique to one sex has resulted in differences in accessing resources that can help to raise the status of women in society.  Therefore, in order to improve equality in education, employment and health in the long run, these particular needs will have to be addressed for women, but obviously are not necessary for men.  Of course there are situations in which men are marginalized and of course development affects them in different ways that require attention as well.

Addressing issues like these in communities through projects and programs will require the following:

1.  Establishing the "What"
  • Forming an idea of what will be looked at, what are we concerned with?
  • What information will we need?
  • What are the entities that have a vested interest in this issue? (i.e. who are the stakeholders)
  • What are the local cultural customs, traditions, beliefs, attitudes and behaviors?
  • What is the local language?
  • What are the health issues of the community?
  • What are the socioeconomic and health profiles of the community? (i.e. how much money do people make on average?  what is the standard of living?)
2.  Figuring out "When"
  • When should data be collected?  At what point before, during and after implementation?
  • When will subjects be available to participate?
  • When will the costs of the running the project (i.e. performing data collection) be minimized to maximize funds?
3.  Sorting out the "Who"
  •  Who should participate in data collection?  (any language barriers that require a translator should be factored in)
  • Who will the data be collected from?  (i.e. the sample should be include a diverse population of subjects and be representative of the larger community, care should be taken to ensure that minorities are not left out).
Hopefully, one day I'll get to apply these steps in the development and implementation of a project on the ground myself.



Dahl GB & Moretti E 2004, The Demand for Sons: Evidence from Divorce, Fertility, and Shotgun Marriage. Working Paper 10281, National Bureau of Economic Research.  Available from: <>. [9 May 2014].

Human Rights Commission of Pakistan (HRCP) 2014, State of Human Rights in 2013.  Available from: <>. [9 May 2014].

Prestwich G (2013), An exploratory study into Menstrual Hygiene Management amongstrural, primary schoolgirls in Uganda: what implications does menstrual related absenteeism have for future interventions?.  Irise International.  Available from: <>. [9 May 2014].

WaterAid 2014, Time to talk periods: Coalition declares first-ever Menstruation Hygiene Day.  Available from: <>. [9 May 2014].

West Coast Poverty Center 2009, Poverty and the American Family.  Available from: <>. [9 May 2014].

Workplace Gender Equality Agency 2014, Gender pay gap statistics, Government of Australia.  Available from: <>. [9 May 2014].

Friday, May 2, 2014

Week 8: The Opportunity Costs of Paving Paradise

Week 8 began with one of my all-time favorite songs "Big Yellow Taxi".  It's a song that I grew up with and one that our very musical family sings at almost every family gathering when the guitars come out, so I know the lyrics very well.  The overall message that I always took away from it came from the line "you never know what you've got til it's gone".  In other words, as human beings, we often don't appreciate what we have or realize how much it's really worth to us until we have lost it.  When that loss is more or less permanent, we and the people who come after us are often left to ponder the consequences of our actions.  Were the right choices made?  Is the situation better now, or are things worse?

Because I'm very familiar with Joni Mitchell, the artist who wrote the song, I know that she meant it as a commentary on how we take our beautiful planet for granted in favor of urbanization, money-making opportunities and convenience.  After all, she has long been an environmental activist, participating in the Greenpeace movement even in its early stages.  

But, looking at the lyrics in class forced me to look at the issue from a different perspective.  Development has never occurred without urbanization (Bertinelli & Black 2004).  In fact, 80.2% of the total population in high income countries lives in urban areas compared to 28.2% in low income countries as of 2012 (The World Bank 2014).  As much as the hippie in me hates to admit it, parking lots do serve a purpose.  It's actually difficult to imagine a high-income society without any, even ones with well-functioning public transit systems.  The truth is that it is much easier for people to drive from point A to point B in their own cars.  It's more convenient, it saves time and can help people to be more productive since they can do what they need to do according to their own schedule.  In the end, it comes down to whether the trade is really worthwhile.  To figure that out, we need to know more about the opportunity costs and perform a cost benefit analysis.  

To start, what is an opportunity cost?  The definition according to Todaro and Smith 2009 is: 

"In production, the real value of resources used in the most desirable alternative-for example, the opportunity cost of producing an extra unit of a manufactured good is the output of, say, food that must be forgone as a result of transferring resources from agricultural to manufacturing activities.  In consumption, the amount of one commodity that must be forgone in order to consume more of another."(p.833)

In essence, a resource used in one capacity is a resource taken from elsewhere and opportunity cost is the sacrifice that is made in one area to accomplish something else .  When we make a decision to do one thing over another, for instance, go to university instead of work, the opportunity cost would be the earnings that we are missing out on during that time that we spend studying.

The opportunity costs of development in the song include:

  • Trading paradise for a parking lot, a hotel, a boutique and a "swingin' hot spot" (probably a nightclub or bar).
  • Giving up birds and bees to use pesticides like DDT so that we can have pristine-looking apples with no spots.
  • Taking down trees (probably for other purposes such as creating space for buildings or using the wood for products) and putting the ones that are left into a museum that we can charge people admission for (business opportunity).

Part of the challenge in performing a cost benefit analysis prior to making those decisions is highlighted in the song "you don't know what you've got til' it's gone".  In truth, it's difficult to predict exactly what the broader impact will be of choosing the parking lot over paradise and therefore to know which will be more beneficial.  That is why it's so hard to know where to draw the line when it comes to choosing urbanization over the environment.  We obviously have a responsibility to try to coexist with the other species and natural systems in our surroundings so that we do not completely destroy the processes that keep our planet liveable.  Once we alter the components of an ecosystem, for instance remove all of the trees and/or displace entire populations of animals (sunk cost), it's very difficult to reverse those changes and return everything to the way that it was if it turns out that the trade was not worthwhile.  But, we also want to thrive as a species and industrialization has allowed for unprecedented progress and development in human societies.   

Here's a review of some of the benefits of urbanization:
  • Development and all that goes along with it. 
  • Better access to healthcare and education services because of increased proximity.
  • Lower mortality and birth rates and increases in life expectancy.
  • Different job markets and more employment prospects.
  • Higher levels of female participation in the workforce outside of the home as a result of increases in job opportunities, which can help promote female independence and reduce gender inequality.
  • Shorter travel distances and therefore less time wasted in transit allowing for more time to be devoted to other things such as doing work, reading, recreational activities, etc.
  • All of these factors lead to higher levels of productivity, which increases income, spending, savings, investment and therefore economic growth in the country (after a temporary period of negative growth at the beginning of the demographic transition when life expectancy increases)
  • Increased income also means that people have more money to spend on keeping themselves and their families healthy (less of a burden on the healthcare system) so that they can continue to be productive.

 And the negative aspects of urbanization:
  • Reduced living space for plants and wildlife leading to a complete shift in the area's ecosystem.
  • Poor air quality and smog due to increased use of motor vehicles with combustion engines in a small, congested area and fewer trees to convert carbon dioxide to breathable oxygen.  This can lead to higher rates of breathing problems and lung conditions such as pneumonia, chronic obstructive pulmonary disease and asthma, thereby negatively affecting the health and wellness of those living in urban areas (Ramin 2009).
  • Urbanization leads to vast stretches of pavement that cover the soil and the uprooting of vegetation, both of which serve to absorb and retain water, thereby increasing the likelihood of flooding (Ramin 2009).
  • The high motor vehicle usage that goes along with urbanization increases the number of motor vehicle injuries and deaths, placing added pressure on healthcare systems and increasing the populations mortality and disability rates.
  • If large masses of people migrate into urban areas in a short period of time for work and a better life, a lack of sufficient proper housing can result in overcrowding and the spread of informal dwellings or "slums" (90% of which are in developing countries) (WHO 2014).  The World Health Organization estimates that close to a billion people reside in slums and that if current trends continue, that number will increase to 2 billion in 30 years time (Ramin 2009).

 The proliferation of slums brings with it an additional set of problems:
  • Living conditions in slums are very poor as there are generally no basic services such as regular waste removal, water and sewage systems (including drainage) or electricity (Ramin 2009).  The densely-populated environments combined with the reduced capacity for proper hygiene and sanitation, provide the perfect breeding ground for illness and the spread of communicable disease (Ramin 2009).  
    • Mosquito-borne illnesses such as malaria, yellow fever and dengue are an issue because stagnant water is conducive to mosquito breeding. 
    • Lack of access to clean water, hygiene and sanitation (including the proper containment and treatment of waste from pit latrines from drinking wells) can cause outbreaks of water-related diseases such as dysentery, typhoid, cholera, cryptosporidium and e.coli, especially during heavy rainfall and flooding (Kimani-Murage & Ngindu 2007; Ramin 2009).  A study involving urban slum-dwelling children in Kenya also reported an increased prevalence of soil-transmitted helminth infections, even with frequent deworming (Suchdev et al. 2014).  These diseases contribute to malnutrition and dehydration (Suchdev et al. 2014).
    • The close proximity due to overcrowding increases transmission of diseases that are spread by droplets that are sneezed, coughed or breathed into the air (i.e. tuberculosis, pertussis and influenza) (Ramin 2009; WHO 2014).
  • Populations living in slums are profoundly affected by extreme levels of poverty.  They often reside in households where the traditional family structure has dissolved (single-parent or no parent households, perhaps with several cousins, grandparents or family friends living there as well) (WHO 2014).  
  • Despite their proximity to city centers and the increased employment opportunities and services therein, these groups still experience high levels of unemployment and poor access to health services (possibly due to adverse economic circumstances and social barriers and prejudices promoting exclusion) (WHO 2014).
  • The rampant extreme poverty makes it very difficult for people living in slums to afford nutritious food and clean drinking water.  This situation is exacerbated when supplies are limited (as they often are in these settings), resulting in very high prices.  In fact, the cost of one liter of water in East Africa is 5-7 times what North Americans typically pay (Commission on Social Determinants of Health, cited in Ramin 2009).
  • A study performed in India showed that changes in behavior such as smoking and increased alcohol consumption, etc were associated with living in urban slum communities and increased the risk factors for non-communicable diseases in all age groups (Anand et al. 2007).
  • Personal safety and security are issues in urban slums as the housing is poorly constructed and subject to structural failure and therefore does not provide much protection from the elements or criminal behavior (WHO 2014).  
  • Slums tend to report higher rates of crime and many young people growing up in those conditions who have never seen the world outside of the slum see no other way than to participate in illegal activities (Fraser 2011; WHO 2014).
  • People residing in slum dwellings do not have secure, guaranteed occupancy or any real rights as tenants as they are technically living in those areas illegally (WHO 2014).  Therefore, they can easily be forced to vacate their homes without contest, notice or compensation.
  •  All of these factors (lack of access to healthcare and clean water, high transmission of illness, poor nutrition, etc) combine to have severe negative implications for the health of individuals living in slums, particularly children.  In fact, the rates of child mortality in Nairobi are 2.5 times higher among slum populations than elsewhere in the city (Commission on Social Determinants of Health, cited in Ramin 2009).  Ill health during childhood could impede proper growth, development and learning, which in turn will likely hinder adult health and output.  A study from Uganda published in 2012 reported that children attending school in slums were 1.7 times more likely to suffer from stunting than those in rural schools (Francis, Kirunda & Orach).  Ultimately, the detrimental effects of living in a slum almost certainly perpetuate the cycle of poor health, limited productivity and poverty.

Moving forward it will be increasingly important to decipher and balance how much urbanization is necessary to promote and sustain development and how many changes might have catastrophic environmental repercussions.  It will also be imperative to actively address the issue of rapid unregulated urbanization and limit its undesirable consequences.  Otherwise, the cost of urbanization may very well outweigh the benefits.



Anand K, Shah B, Yadav K, Singh R, Mathur P, Paul E & Kapoor SK 2007, 'Are the urban poor vulnerable to non-communicable diseases? A survey of risk factors for non-communicable diseases in urban slums of Faridabad', The National medical journal of India, vol. 20, no. 3, pp. 115-120.  Available from: <>. [2 May 2014].

Bertinelli L & Black D 2004, 'Urbanization and growth', Journal of Urban Economics, vol. 56, no. 1, pp. 80-96.  Available from: <>. [2 May 2014].

Francis L, Kirunda BE & Orach CG 2012, 'Intestinal Helminth Infections and Nutritional Status of Children Attending Primary Schools in Wakiso District,  Central Uganda', International Journal of Environmental Research and Public Health, vol. 9, no. 8, pp. 2910-2921.  Available from: <>. [2 May 2014].

Fraser B 2011, ‘Growing up in Rio’s favelas’, The Lancet, vol. 377, no. 9779, pp. 1735-1736.  Available from: <>. [15 May 2014].
Kimani-Murage EW & Ngindu AM 2007, 'Quality of Water the Slum Dwellers Use: The Case
of a Kenyan Slum', Journal of Urban Health, vol. 84, no. 6, pp. 829-838.  Available from: <>. [2 May 2014]. 

Ramin B 2009, 'Slums, climate change and human health in sub-Saharan Africa', Bulletin of the World Health Organization, vol. 87, no. 12, pp. 885-964.  Available from: <>. [2 May 2014].

Suchdev PS, Davis SM, Bartoces M, Ruth LJ, Worrell CM, Kanyi H, Odero K, Wiegand RE, Njenga SM, Montgomery JM & Fox LM 2014, 'Soil-Transmitted Helminth Infection and Nutritional Status Among Urban Slum Children in Kenya', The American Journal of Tropical Medicine and Hygiene, vol. 90, no. 2, pp. 299-305.  Available from: <>. [2 May 2014].

The World Bank 2014, Urban Population (% of total): Data: Graph: Low Income and High Income Countries.  Available from: <>. [2 May 2014].

The World Health Organization (WHO) 2014, Global Health Observatory: Slum residence.  Available from: <>. [2 May 2014].

Todaro MP & Smith SC 2009, Economic Development, 10th edn, Addison Wesley: Pearson Education Limited, Harlow.

Thursday, May 1, 2014

Week 7: Microfinance and the Links Between Health and Economics

Coming into this course, I was much more familiar with the field of microeconomics than that of macroeconomics.

Microeconomics is concerned with the economic activities and tendencies of individual entities driving markets such as individuals, families, businesses, organizations, groups and countries.  It looks at the smaller individual pieces of a much bigger puzzle, like me and my habits, which makes it a more relatable topic to me personally.

In Uganda I spoke with workers from a microfinancing sacco (a small savings and loan cooperative) and was introduced to the benefits of providing small loans with low interest to people in developing countries.  My education began with the basics:

  • Small loans are essential to help individuals and families set up small business enterprises like farms or shop stalls (so they can buy equipment and or stock, pay the initial rental fees, etc).
  • Small loans can also be used for education and the acquisition of skills or healthcare if illness has become a problem and is interfering with productivity.
  • Small loans help to establish independence and security by optimizing self-sustainability so that people can work to provide for themselves instead of relying on charitable donations.
  • Banks in developing countries do not typically provide small loans as it is usually not worth it for them.  In addition, banks generally require collateral to lend out money, which is something that poor people in developing countries rarely have.
  • In the absence of bank loans, many desperate people in developing countries have no choice but to turn to aggressive loan sharks who charge incredibly high interest rates and may threaten or even enact violence if payments are not made on time.  This can place these individuals and their families at great risk and dig them into an even deeper financial hole than where they started.
As I learned more, I came to know that microfinance was initially called microcredit and in 2006, the Grameen bank in Bangladesh won the Nobel Peace Prize for its groundbreaking work providing small loans to the poor (Karim 2011).  One of the primary reasons it has received so much praise is because of the opportunity it provides to women to become more financially independent in traditionally very patriarchal societies, thereby helping to elevate the status of women and improving equality.  I learned that the sacco in Uganda reported much higher recovery rates from women, that is to say that compared to their male counterparts, female clients are better at bringing in their payments in full and on time.  Upon further reading, I found that banks in Bangladesh including Grameen also reported remarkably high recovery rates (around 98%) from its female borrowers (Karim 2011). 

Of course, the push for widespread microfinancing in developing countries has received criticism, as with any development strategy.  The truth is that being a small business owner is difficult anywhere, in rich and poor countries alike.  Therefore, it is understandably difficult to see how helping people become small business owners will actually improve their circumstances and translate to increased development.  But, in the absence of sprawling department store conglomerates in low income nations, small businesses are the only ones providing goods and services to most communities (especially those that are smaller and more rural).   A fact that gives that much more gravity to the saying "small businesses are the backbone of an economy".

There have also been criticisms surrounding the real benefit for female borrowers for a couple of reasons.  First of all, some women are forced to surrender their loans to male family members in such male-dominated societies like those in Bangladesh (Karim 2011).    Associate professor of anthropology at the Univeristy of Oregan Dr Lamia Karim, was highly suspicious of the astonishingly high return rates reported by the Bangladeshi banks.  Upon further investigation Karim found that women were being publicly shamed if they defaulted on a payment, a practice she considered to be driven and encouraged by the NGOs helping to provide the loans (2011).  Due to the fact that women are valued for bringing honor to the family, Karim reports that applying this sort of societal pressure is extremely effective in getting people to not only make their loan payments on time, but to also manage their spending more carefully so that they can (2011).  In short, these are perfect examples of how cultural norms and corruption can sometimes nullify, significantly diminish or alter the effects of development efforts.

Unfortunately, no development strategy is perfect, but aid has not been very successful at improving circumstances in low income countries, particularly those in sub-Saharan Africa so we need to try something else.  Plans work best if they are multi-dimensional and address issues from a number of angles (for example from a cultural perspective).  Therefore, we should not completely discount microfinancing as a big part of the solution to extreme poverty in developing nations simply because there are some glitches with the programs rolled out in Bangladesh.  Strategies need to be reevaluated over time after being implemented and adjusted to properly fit communities.  It must also be acknowledged that economic progress in developing countries will take time and true long-term impacts and trends will take a while to become visible.

At least in the short-term, there is evidence that small loans in Bangladesh have a smaller than originally expected but still positive impact on: school enrollment for both boys and girls, labor supply (hours people can and want to work) and individual expenditure per capita (Chemin 2008), all of which are good for the economy.  We cannot forget that small credit loans are not only for businesses, they can also be used for furthering education, improving people's homes to make them more sound and other investments that can help make people safer, healthier and more productive.

Coming back around to the spending habits of individuals, one of our activities in class was to break down what we ourselves typically spend on food into product groups.  In other words, what proportion of the total money we spend on food at the grocery store is spent on: meat; dairy; fats; sugars; fruits and vegetables; and grains?

Initially, I estimated that our spending would be split in the following manner:
  • Meat and nut products - 40%
  • Dairy - 15%
  • Fruits and vegetables - 15%
  • Grain - 25%
  • Saturated fats and sugars - 5%
The majority of the students in our class admitted, just as I did, that meat would account for the biggest proportion of their overall spending.  I was curious about how accurate my estimation was so I took a look at a receipt from our big shopping trip on the weekend.  The actual breakdown was:
  • Meat and nut products - 52%
  • Dairy - 18%
  • Grains - 14%
  • Fruits and vegetables - 10%
  • Fats, sugars and oils - 7%
I was very surprised at how much we really spend on meat and nut products and a bit disappointed with how little we spend on fruits and vegetables.  Ultimately though, my initial estimate was not very far off and I was happy to see that I got the order of what we spend the most on to what we spend the least on correct. 

Next we were asked to put ourselves in a position where our finances were strained and to consider what kind of adjustments we would make to our spending on food.  Many, including myself, said that we would spend less on meat and sugars and more on grains.  Our reasoning was that grains are filling and less expensive, so we would buy more of them instead of meat which tends to be very expensive.  We also decided that if we were tightening our purse strings, luxuries like sweets should be cut down or eliminated all together.  I also opted for spending a bit more on fruits and vegetables because they are rich in vitamins and minerals and I would want to try and stay as healthy as possible.

I was shocked to learn that in actuality, the majority of people who find themselves in this situation struggle to cut relatively superfluous luxury items from their shopping list and instead cut from other areas.  Apparently it is more difficult for people to let go of the items that they really enjoy, so they are willing to sacrifice elsewhere to keep the things that make them happy, the things they have become accustomed to.  I was also surprised to find out that when the reverse happens, that is to say that people start making more money and have more to spend, they too struggle to adapt.  Even though they have are able to buy healthier, better quality foods, people who have recently come into more wealth will often go on eating the same cheaper foods for an extended period of time, even if they are unhealthy.

After thinking about it for a while, I understood why making these kinds of economic transitions might be challenging for some people, even if it is difficult for me to relate to.  I grew up in a one-parent household and what little money we had was spent on healthy food because my mom believed that it was worthwhile.  I adopted my mother's way of thinking very early on and it has stayed with me throughout my various financial circumstances.

I tried to look for research surrounding the claims that we heard in class to better understand the background and measures and came across an article relating to spending changes later in life.  In 2013, Aguiar and Hurst reported that in later years, spending on essentials such as food, transport and personal care decrease while spending on nonessentials like entertainment, charitable giving, utilities and domestic services remain the same.  This, despite the fact that these people are retired or heading into retirement and will have less income.  The authors postulated that these findings could be explained by a number of things including the fact that later in life people spend less money driving or taking transport every day to and from work, less money on work clothes, etc.  The authors also discuss time as a factor; older people typically work less or not at all and have more time for other enjoyable pass-times.  There's also the possibility that as they reach the end of their lives, they want to live life to the fullest and be happy.

The topic of how retirees spend their money is quite different from looking at the behaviors of people in financial transition for other reasons, but I believe there is a common underlying thread.  At the end of the day, people like spending the money that they have on things that make them feel good even if it is economically irrational.  For someone who has just lost a high paying job that might mean squeezing their finances elsewhere so that they can still have that steak dinner that they have come to enjoy on Saturday nights because it is worth it to them.  For someone who has just received a promotion maybe it's still eating that cheeseburger from the fast food shop on the corner twice a week because that is what they are used to, it is familiar, comforting and they like the taste.  Finally, for someone who is newly retired, maybe it's going to the museum to enjoy art or making a donation to a charity for sick children to feel like they are contributing to society.  Perhaps it also comes down to individuals having a hard time believing or accepting that their circumstances have changed, so they do things to convince themselves (or even the outside world) otherwise or to distract themselves.

Understanding illogical spending habits is still difficult for me at this stage, but I feel like I am getting better at it.


Aguiar M & Hurst E 2013, 'Deconstructing Life Cycle Expenditure',
 Journal of Political Economy, vol. 121, no. 3, pp. 437-492.  Available from: <>. [1 May 2014].

Chemin M 2008, 'The Benefits and Costs of Microfinance: Evidence from Bangladesh', The Journal of Development Studies, vol. 44, no. 4, pp. 463-484.  Available from: <>. [1 May 2014].

Karim L 2011, Microfinance and Its Discontents: Women in Debt in Bangladesh, University of Minnesota Press, Minneapolis.