Eric P. Green

Hiring: Part-Time Project Assistant

Eric P. Green — Fri, 09 Jul 2010 15:42:03 +0000

I am leading a project called Demographic Data for Development at the Population Council. My colleagues and I are working with partners in Ghana, Senegal, and Namibia on several initiatives designed to increase data access and use among journalists. We need someone with a lot of energy and ideas to join the NYC-based team.

You should consider applying if any or all of the following describe you:

(1) You are a journalist with experience writing about health and development issues.

(2) You are crazy about Open Data and have the World Bank data app installed on your iPhone (iPhone not required). A burning passion to win the Apps for Development contest would not hurt either.

(3) You spend your free time tinkering with open source projects.

(4) You are a master at curriculum development and are excited to help African journalists learn more about how to use development data in their reporting.

There are a few core project management tasks that will be required, but the position will be shaped to fit the successful candidate.

Please apply through the Council website.

On “Hatorade” And T-Shirts for the “People of Africa”

Eric P. Green — Tue, 04 May 2010 18:23:57 +0000

Cross-posted at Change.org’s Global Poverty blog:

Last week my Google Reader account was bombarded by posts about a guy named Jason, his idea to help the “people of Africa” with donated t-shirts and a steady stream of corresponding outrage from aid professionals and observers. Here is the go-to link for all things shirt-gate.

Here is my 140-character summary:

No shirts in Africa? Idea: Send 1M tees. Instant web of rejection. Anti-hatorade video reply posted. Roundtable convened. Rethink.

What did I learn from this back-and-forth? First, many Africans do already have shirts (thanks, blogosphere!). Second, in-kind donations of items like shirts and shoes from far away lands do not make for good humanitarian aid. We were reminded of this after the earthquake in Haiti.

A weekend re-branding suggests that the folks at 1millionshirts.org may have learned a few things as well. Most significantly, the site no longer refers to the “people of Africa.” The goal, however, is still 1 million shirts raised. Why 1 million shirts? Jason and colleagues admit that the answer is not clear yet, but commit to use T-shirts “as the vehicle to help sustainable efforts in specific areas that the charities we choose to work with are involved in.”

In their defense, you don’t have too many options after you pay $1.99 for the domain name 1millionshirts.org, right?

As we wait to see what will come out of this effort, are there any lessons that aid/development actors and watchers can take from shirt-gate? I think so. Here are a few suggestions:

In the world of web 2.0, “bad” aid ideas can come from anyone, not just aid professionals and donors.
Beware: their bad ideas don’t have to jump through as many hoops as our bad ideas.
When bad ideas are discovered, it helps to speak up. The crowd can make a difference.
In such cases, remember that most people will only come to the table with “good intentions.” Offer them a seat anyway.
All good snark has its limits.

There will be more 1millionshirts efforts — you can bet on it. USAID has. Here is a link to a contest to create a public service announcement to get out the message that cash is best when it comes to disaster relief. Upload your entry here.

Photo Credit: katieschenk

Children and the World Bank Agree: It’s Good to Share

Eric P. Green — Wed, 21 Apr 2010 18:13:39 +0000

Cross-posted at Change.org’s Global Poverty blog.

There is a big push these days to open up information. Open Government. Open Data. Open Access. Open Source. And now, open global health and development.

In January 2010, PLoS Medicine, a peer-reviewed open-access journal, published a commitment from eight major global health agencies to improve health data throughout its life cycle — from collection to access to use. Now, the World Bank is keeping its promise to improve access to data.

On Tuesday, the Bank launched www.data.worldbank.org, a new platform for sharing global health and development data. For the first time, data lovers worldwide have free access to a robust Data Catalog of more than 2,000 indicators from various sources. The interface is clean and easy to use. There is even an API (Application Programming Interface) for developers! This means that people will be able to extend this great service in ways the World Bank may not have envisioned.

That is the way to share.

Increasing access to raw data will change the way we learn about the world. But don’t take it from me. I did not invent the Internet. Tim Berners-Lee did. Go ahead and check out the clip below. Inspired? Good. Now here are a few key resources for global health and development data:

Data Management

1). DevInfo: Before you share data, you have to collect and store the information. After the Millennium Development Goals were launched in 2000, there was a recognition that the UN and its member states did not have this capacity. DevInfo was created to fill this gap. Anyone can download this free, customizable database system.

Data Sharing

2). World Bank Open Data Initiative Just what it sounds like.

3). MEASURE DHS: MEASURE has a number of online data tools and is preparing a nice revision to STATCompiler (to be released later this year). No API yet, but a great source of data.

4). WHO Resources: The World Health Organization has a few online data sharing tools, including WHOSIS, Global InfoBase and the Global Health Atlas. The latter tool has the most potential. Each, though, lacks an API and has an interface that is stuck in 1999.

5). DOLPHN: Short for Data Online for Population, Health and Nutrition, DOLPHN offers access to more than 70 key health indicators from various data sources. Hard-to-use design.

Data Visualization

6). Global Health Facts: This resource from the Kaiser Family Foundation enables users to download data and provides the ability to create basic tables and maps.

7). Girls Discovered: This site sets a new standard for web mapping of global health and development data. Data can be downloaded and maps can be exported to Google Earth.

8). Gapminder World: This tool is true to its tagline: “unveiling the beauty of statistics for a fact based world view.” Use Gapminder World to explore important trends in global health and development data. Google’s Public Data Explorer uses some of the same Trendalyzer technology.

9). AidData: This new site, which we blogged about here last month, was created to make development finance more transparent. The beta version released to the public in March has already seen a number of updates.

Evaluation Reports and Systematic Reviews

10). ALNAP Evaluative Reports Database: Reports about humanitarian action.

11). The Campbell Collaboration Library of Systematic Reviews

12). Eldis: Free access to evidence-based development literature.

13). The Cochrane Library: A resource for systematic reviews.

Add to the list in the comments!

Photo Credit: www.istockphoto.com

Presentation at AAG: Geographic Contexts of Global Health

Eric P. Green — Tue, 20 Apr 2010 12:46:06 +0000

AAG 2010: Geographic Context of Global Health (Green) from Eric Green on Vimeo.

Association of American Geographers, 2010 Annual Meeting

Interactive Short Paper Session: Geographic Contexts of Global Health

Abstract

Characteristics of the social and physical environment — the social ecology — can positively or negatively influence the health and well-being of adolescents, including their ability to avoid contracting HIV and other diseases. This environmental/structural view suggests that risk for disease cannot be solely explained by characteristics of individuals, such as knowledge of HIV transmission or attitudes towards risky sexual behavior. The broader social ecology — from micro-level influences such as household resources, neighborhood disorder, and social networks to macro-level factors such as laws and policies — can restrict or enhance individual agency to avoid risk. Thus in developing prevention interventions, it is necessary to understand and address social-ecological factors that influence health in a particular context. This paper will examine the use participatory mapping and geospatial technologies to understand the context of disease and to inform the development of a setting-level HIV prevention intervention in Muhuru Bay, a small fishing village on the shore of Lake Victoria in western Kenya.

Urban Slums: A Millennium Development Success?

Eric P. Green — Thu, 08 Apr 2010 18:59:32 +0000

Cross-posted at Change.org’s Global Poverty Blog.

When the Millennium Development Goals were adopted in 2000, the urban slum population was 767 million. Today, it’s estimated that this figure has increased in absolute terms to 828 million in the last decade. My laptop calculator tells me this is 61 million additional slum dwellers.

In other news, the Millennium Development slum target has been achieved. Exceeded, actually, 10 years ahead of schedule.

Did I lose you with that one?

The United Nations Human Settlement Program, UN-HABITAT, released its newest State of the World’s Cities report at the fifth session of the World Urban Forum in Rio de Janeiro in March, which I was fortunate to attend. This report contains an honest assessment of the progress in reducing the urban divide: the Millennium target was exceeded by at least 2.2 times, 10 years ahead of schedule. Yet existing efforts “are neither satisfactory nor adequate.” That’s honest, but it’s a little confusing. Going twice the distance in half the time is generally a good thing, right?

First, let’s put the “Cities Without Slums” target (a.k.a. Target 11, or Target 4 of Goal 7) in perspective. Unlike what the name implies, this is not a zero-slum game. The target is “significant improvement in the lives of at least 100 million slum dwellers.” In 2001, there were an estimated 924 million urban slum dwellers in the world — almost one third of the total urban population.

Quick, do the math. 100 out of 924. Got it? Now let’s rewrite the “Cities Without Slums” target to better reflect the challenge: Decimate the number of urban slum dwellers, and by that we literally mean cut the rate by approximately one-tenth. Let’s aim to get this done by 2020, 5 years later than most MDG deadlines.

Compare this to the loftier goals set forth by Target 11’s better-known siblings:

Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling.
Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it.
Reduce by two thirds, between 1990 and 2015, the under-five mortality rate.
Halve, between 1990 and 2015, the proportion of people whose income is less than $1 a day.

“Children everywhere?” “Universal access?” 2010 and 2015? What happened when it came time to write Target 11 of 18? Was everyone just too tired after drafting Target 2, “Achieve full and productive employment and decent work for all, including women and young people?”

Was 100 million over 20 years ever really a challenge? Was it even the right metric? UN-HABITAT acknowledges that this target may have been low and “somehow poorly defined,” but suggests that it was “welcome at the time” because the issue of slums did not have a high profile. This is probably true. UN-HABITAT published the first comprehensive report on slums in 2003, The Challenge of Slums.

As the current report indicates, however, the target should not have been defined in absolute terms. Unlike many of the other Millennium targets, the “Cities Without Slums” target was set at a fixed number (i.e., 100 million) for the whole world, not as a proportion (e.g., Reduce by two thirds, between 1990 and 2015, the under-five mortality rate). This absolute benchmark made it “difficult, if not outright impossible” for governments to set country-specific targets for slum reduction.

Yet for all of its shortcomings, is there a lesson in the case of the ’successful’ “Cities Without Slums” target? UN-HABITAT frames it as “low and easily achievable,” but symbolic. That is, this result shows that progress in reducing urban poverty is possible.

What makes for a good Millenium Development Goal? More generally, what is development ’success’? Is it better to set the bar high and come up far short (think gender parity in school enrollment)? Or is it better to set a ’safe’ target and blow it out of the water? Maybe we need a few Target 11’s to fill the MDG love tank that is running low on account of a few other, loftier targets.

Figure. 5-Year Growth Rates of Urban and Urban Slum Populations and the Proportion of the Urban Population Living in Slums in Developing Regions between 1990 and 2010. As shown in this figure, in addition to the 5-year urban and urban slum growth rates, the proportion of urban slum dwellers has been declining since at least 1990 in developing regions, 10 years before the MDGs were adopted (Credit: Green, created from data in the UN-HABITAT’s State of the World’s Cities 2010/2011 report).

Photo Credit: Eric Green

4 Ideas for Smart Global Health

Eric P. Green — Fri, 19 Mar 2010 15:19:52 +0000

Cross-posted at Change.org’s Global Poverty blog (new name for their global health blog).

What do you get when you ask 25 leaders to come up with a 15-year strategic plan for the U.S. on global health?

New ideas for bureaucracy! Well, that plus a number of other thought-provoking recommendations. The Center for Strategic and International Studies (CSIS) asked a broad set of leaders for their best ideas on “smart” U.S. global health policy. Chaired by Retired Navy Admiral William J. Fallon and Helene Gayle, President and CEO of CARE (also a contributor to Change.org), CSIS’s Commission released its final report yesterday.

Here are four points from it to consider:

1. Global health is smart power. “Smart power” is the Goldilocks of contemporary thinking on American power — not too hard, not too soft. Just the right balance of strength and charm. This report positions global health as a key component of American charm and power. As its authors write, Americans understand that “promoting global health advances our basic humanitarian values in saving and enhancing lives.” What’s more, backing global health also helps in “bolstering U.S. national security and building constructive new partnerships.”

Good for us and good for them, or so thinking goes. But not everyone agrees. Bill Easterly gives the “3D approach” — the idea that development, defense, and diplomacy go hand-in-hand — the grand prize for “worst in aid.” To him and other critics, such an approach can skew spending decisions toward countries of strategic and military importance. Just see this pie chart, which wins a grand prize of a different sort.

2. Global health is a matter of national security. In a gross understatement, the report’s authors admit that discussions about improved government coordination and efficiency “rarely excite or inspire the media or the public.” But while their discussion of organizational reform isn’t “exciting” or “inspiring” — not by the terms’ conventional meanings, anyway — it’s still informative. And if implemented, their recommendations will result in a bold shift in the U.S. approach to global health.

Based on my reading of the report, I’ve modified the Commission’s graphic on the U.S. government’s global health architecture (which the Commission modified from this Kaiser Family Foundation report) to show the new proposed organization (oddly, the report does not do this). While the authors note that they are not recommending a new government entity “per se,” they do want to see a revamped structure that centralizes power and decision-making within the National Security Council.

That’s right, not USAID. Not Health and Human Services. Not the CDC or the State Department. The NSC. In their vision, a deputy advisor at the NSC would lead a new “global health management team” that would translate goals into action. This deputy would also oversee a new “Interagency Council for Global Health” that would promote coordination and collaboration across government agencies.

3. The U.S. should double down on programs that target women and children. The Commission calls for doubling U.S. spending on women and children, asserting that $2 billion per year “will catalyze inspiring results.” I suspect it would. This solid recommendation will be tweeted by many global health watchers.

What is most interesting about this announcement, however, is that the Commission proclaims that “direct U.S. investments are best focused on a few core countries in Africa and South Asia where there is clear need.” True as this may be, it will be interesting to watch the tension between need-based and “smart” funding priorities unfold.

4. The demand for global health training on college campuses has exploded in recent years. But are tomorrow’s global health leaders “smart”? Probably not. It is unlikely that freshman global health majors or recent MPH graduates would list a desire to promote U.S. diplomacy or defense interests as a core reason they want to train community health workers or spend hours in a lab researching cures for neglected topical diseases. The topic of American power — soft, hard or smart — is probably not featured prominently (if at all) in most global public health curricula. If the U.S. approach to global health is to be coordinated through the National Security Council and used more explicitly as a tool for promoting American interests and security, doing so might be a smart idea.

This report is a must-read for global health students and practitioners — and anyone interested in the future of the U.S. approach to global health.

Photo Credit: DVIDSHUB

Beer Makes People More Attractive…

Eric P. Green — Fri, 12 Mar 2010 22:52:18 +0000

Cross-posted at Change.org’s Global Health Blog.

…to mosquitoes. That’s the finding of a new study that helps explain why mosquitoes seem more attracted to some people than others. Researchers — who focused on a malaria-endemic area of Burkina Faso — found that volunteers who drank the local brew were more attractive to mosquitoes than volunteers who only drank water.

This study’s goal was to understand how diet, beer in particular, impacts how attractive humans are to malaria’s primary vector in Africa, Anopheles gambiae Giles sensu stricto – or An. gambiae (or mosquito) for short. Diet is thought to be an important part of body odor, which has been shown to provide the female An. gambiae with an olfactory trail to human hosts. Therefore, diet may be an important factor behind variation in human attractiveness to mosquitoes — and possibly malaria risk.

To test this idea, the study’s authors randomly assigned 43 adult males to drink either beer or water. Participants in the beer group drank a local brew called dolo, a homemade concoction of fermented sorghum (reported to be the most widely consumed alcoholic beverage in Burkina Faso). The rest of the volunteers consumed a tall glass of tap water.

So far, so good. But how do you measure “human attractiveness” in the eyes or — more accurately, the nose — of a mosquito? (In other news, scientists have successfully transplanted mosquito ‘noses’ to frog eggs and fruit flies to study what odors set off mosquito olfactory receptors.)

Hungry mosquitoes were reared from a batch of field-collected An. gambiae and denied a “blood meal” prior to the experiment. Researchers set up two outdoor tents connected to a Y-olfactometer and created an air current between the tents and the olfactometer (check out the photos online). After they were released into a downwind box connected to the Y-junction, mosquitoes could either choose to fly upwind toward either the smelly participant tent, or toward a plain outdoor air tent (traps in the olfactometer prevented the mosquitoes from escaping).

The attractiveness of each shirtless participant was tested twice, before and after consuming water or beer. “Attractiveness” was measured according to “activation” (how many mosquitoes flew upwind toward the traps vs. remained in the downwind box) and “orientation” (how many mosquitoes chose the smelly participant path vs. the outdoor air path).

Results indicated that mosquitoes only preferred human-infused air when the humans were beer drinkers. Water consumption had no effect on activation or orientation, both of which were enhanced by beer consumption. Other factors, such as carbon dioxide and body temperature, had no effect.

What does this mean? A crackdown on beer consumption in malaria-endemic areas?

Probably not. While the authors do point out that alcohol consumption contributes to the global burden of disease, and that at a certain level alcohol consumption can suppress one’s immune system, this study only suggests that human odors produced by beer consumption can help us understand why biting patterns vary. Ultimately, this knowledge could inform the development of targeted interventions that focus on the favored victims of mosquitoes, helping to control the spread of malaria.

As a side note, if I were on the Institutional Review Board, I would have argued the wait-list control design should’ve allowed people who simply drank water to later receive the treatment (a beer) after the experiment concluded — you know, in the interest of fairness.

(h/t: Malaria Matters)

Photo Credit: garromeister

Can a Piece of Cloth Keep Girls In School?

Eric P. Green — Fri, 12 Mar 2010 17:08:21 +0000

Cross-posted at Change.org’s Global Health Blog.

We know that poor girls in developing countries often lack access to sanitary napkins. But does a lack of pads actually make it more likely that girls will drop out of school?

That’s the case that Sheryl WuDunn and New York Times columnist Nicholas Kristof make, in an essay adapted from their book Half the Sky: Turning Oppression into Opportunity for Women Worldwide. As they write, “For fear of embarrassing leaks and stains, girls sometimes stay home during their periods, and the absenteeism puts them behind and eventually leads them to drop out.”

Sounds logical. And certainly, the argument has caught on. A few weeks ago, the New York Times featured the good work of Huru International, makers of reusable sanitary napkins. This organization is doing something great by providing young women (mostly in Kenya) with kits that include terry cloth sanitary pads, underwear, soap and educational materials. To top it off, the drawstring bag that holds these supplies can also be used as a backpack.

This is a good idea. Period (no pun intended).

But do pads actually reduce absenteeism among young women? The case isn’t quite so clear.

At least one study suggests the answer’s yes. In what was (incorrectly) described as the “first empirical research ever to investigate the question,” researchers at the University of Oxford compared patterns of absenteeism among two groups of girls in Ghana (no ages listed). One group received education about health and hygiene, the other group received the education, as well as sanitary pads. Apparently, among girls who received pads as well as education, average absenteeism dropped from 21% of school days (the pre-intervention rate) to 9% after six months. The study also found that absenteeism dropped among the education-only group, but the effect was described as “delayed,” and no figures have been released yet. (Press release here – no paper yet, to my knowledge).

Evidence from Nepal, though — collected in a strong randomized evaluation — paints a different picture. The study’s authors gave a random selection of girls access to menstrual cups, which they described as a “small, silicone, bell-shaped device used internally during menstruation,” and collected attendance and menstruation data for 15 months. (Girls who weren’t selected to receive the cups for research purposes were provided them at the end of the study.)

The result? First, the girls who did NOT receive the cups were only 2.9 percentage points less likely to attend school during their period. Plus, these girls had their period on only 8% of school days. Taken altogether, we’re talking about only 0.23% of an 180-day school year (0.41 days) – suggesting menstruation actually has a very small effect on school attendance. At best, use of the cup could only improve attendance by 0.41 days, but results suggested no impact.

When asked why they missed school, 44% of girls pointed to one problem that Huru and similar organizations can’t solve with a pad: cramps.

Should efforts to improve the lives of young women by proving access to clean underwear and sanitary pads be lauded? Absolutely. I happened to be visiting a school in western Kenya a few months ago when Huru kits were distributed. The girls were thrilled to have these supplies. Personally, I’m convinced that this work should continue and expand. But I’m also convinced that when we consider these types of programs, we should be careful in evaluating their big claims. Distributing sanitary pads is itself a worthy effort. We don’t need to make the case that doing so stops school dropouts if the data suggest otherwise.

Photo Credit: Eric Green

Blogging at Change.org

Eric P. Green — Thu, 04 Mar 2010 18:53:31 +0000

I am now a weekly contributor to the Change.org Global Health blog. Here is a link to my first post, “Can a piece of cloth keep girls in school?“

Wellbee says: Be well, Be clean, Use a jet of microbe-destroying plasma

Eric P. Green — Mon, 15 Feb 2010 23:49:39 +0000

CDC/Mary Hilpertshauser

Pardon me for blogging about a topic like handwashing outside of the established global health calendar. I just could not wait until the next Global Handwashing Day (Oct 15 if you were wondering).

Diarrhea is a leading cause of death for children under the age of five in developing countries — second only to pneumonia. This 2009 UNICEF report puts it bluntly: diarrhea “kills more young children than AIDS, malaria and measles combined.”

Oral rehydration salts and zinc tablets save lives, but prevention is key to averting 1.5 million under five deaths per year. A whopping 88 percent of all diarrheal deaths worldwide can be linked to water, sanitation, and hygiene. Resources + Environment + Behavior = Health.

Handwashing with soap is one of the most effective prevention tools, but habits are hard to change — everywhere, including U.S. hospitals. The Mayo Clinic recommends 20 seconds of vigorous washing (or two rounds of “Happy Birthday” according to the CDC — and who doesn’t love to sing this classic?). Add on time for rinsing and drying and you approach 2 minutes. Just do the math for health care workers who see 30 patients a day. What a time suck!

But behavior change is only part of the story. For too many people in this world, access to clean water and soap is limited. If only there was a device that slashed handwashing times and eliminated the need for soap and water…

Phil Wilson/NY Times

So predictable, I know. Anne Eisenberg at the New York Times reports on a developing technology that uses electric current to create a plasma (gas) that can inactivate a variety of microorganisms.

The electric current ionizes the oxygen, nitrogen and water vapor in the air…eventually creating the nitric oxide, hydrogen peroxide and particles that are so effective against bacteria, viruses and fungi.

The cost? Less than $100 (probably). Dr. Gregor Morfill at the Max-Planck Institute for Extraterrestrial Physics (think international space station, not aliens) has reportedly developed some very Earthly protypes, including “portable, battery-operated model the size of a large electric toothbrush.”

We’re going to need a new Wellbee poster.