by Jason Bremner, program director, Population, Health, and Environment
Flying over Kenya and into the Nairobi airport, you can see the expansive National Park that abuts the city of more than 3.2 million people. I’m as amazed today as I was 17 years ago when I first came to Kenya for a study abroad program. A short drive from downtown Nairobi, you can still see giraffes, zebras, rhinos, and lions.
A lot has changed in Kenya since 1994. The country’s population has grown from 23.4 million in 1990 to around 40 million today. The economy has also grown 1.7 times since then as well. Most in Nairobi will tell you that one of the most substantial changes has in the number of cars on the road in the city. A city that once seemed sleepy on the busiest days can be choked by traffic despite the expansion of the roads. Construction goes on and with Chinese loans and construction expertise Nairobi is working on a system of bypasses that the locals call “flyovers” since the busiest circles will be replaced with overpasses.
Kenya and other large cities in Africa are facing more than just traffic jams. Municipal governments need to provide water, electricity, sanitation, and adequate housing to networks of streets, houses, and buildings that weren’t exactly located according to a master city plan. This challenge isn’t unique to just the big cities. Most of Africa’s projected doubling of population over the next 40 years will actually take place in small to medium cities that are even less equipped in terms of services, financial resources, and capacity to plan for growth. In part that’s what amazes me about Nairobi National Park. It hasn’t succumbed to the pressure of Nairobi’s expansion. Much like Manhattan’s Central Park, conservation and city planners had the foresight to set aside a natural space. Today’s children, despite the challenges of Nairobi, can still experience Kenya’s splendor. Hopefully, Kenyan’s future generations will have both the urban services they need as well as the same opportunity to see wildlife.
From right to left, Befekadu Refera of MELCA, Haddis Mulugeta, and Roger-Mark De Souza. Photo: Schuyler Null/Wilson Center.
“How are we going to feed all these mouths?” asked Bekele Hambissa, director of the Environmental Protection and Development Organization in Addis, on day two of the PHE Ethiopia Consortium general assembly (read about day one here). Environmental resources are directly tied to Ethiopia’s population growth, said Hambissa, during a discussion of balancing efforts to address population growth, environment, and livelihoods. While poverty alleviation is an important goal of population, health, and environment integration (PHE), it must be environmentally sustainable, he said.
The diversity and scope of the activities presented by eight of the consortium’s most active members was striking.. Each operates in a different part of the country, from the highlands of Tigray region in the north and Oromia in the south and central part of the country, to the coffee-producing Southern Nations and Peoples in the southwest. Though all the programs integrate some aspect of population, health, and environment in their development efforts, each emphasizes different aspects more than others and have differing implementation methods.
Hello from Addis Ababa, where I am blogging from the 5th annual general assembly of the Population, Health, and Environment (PHE) Consortium of Ethiopia. Along with the Philippines, Ethiopia is the largest PHE programmer in the world, both in terms of number of programs and people affected, and for good reason: The country combines dire need, willing donors, and a great deal of local capacity and will.
Ethiopia is currently home to 85 million people – second only to Nigeria as the most populated country in Africa – and the average woman has 5.4 children, according to the Population Reference Bureau. Ethiopia is also extremely rural, with only 16 percent of the population living in cities, which, combined with its rugged terrain, poses challenges for delivering health services and improving land management.
The PHE Ethiopia Consortium is a coordinating body made up of 48 organizations that implement integrated PHE development programs at more than 30 sites across the country. At the general assembly, more than 80 members from around the country reported on their efforts to improve livelihoods and communicate the effectiveness of integrated development.
Jason Bremner of the Population Reference Bureau, speaking on the state of PHE across Africa and globally, showed a data chart created using Hans Rosling’s Gapminder tool that tracks the progress of poverty and life expectancy indicators over the last 50 years. He pointed out that the “world is a better place today in many ways.” But, he said, the PHE community must get better at communicating its successes. “Even by the best case scenario we will be 8 billion by 2050…and if nothing changes…we could be as large as 12 billion,” he said.
Used under Creative Commons from Rainforest Action Network.
“Rural development and MCH [maternal child health] in the most remote, rural areas are going to largely explain the future of Latin American conservation, development, population, and urbanization,” said David Lopez-Carr, associate professor of geography at the University of California, Santa Barbara, at a recent Wilson Center roundtable on “Deforestation, Population, and Development in Latin America.”
Nearly 80 percent of Latin America’s people live in urban areas, yet the continent’s rural populations have a disproportionate effect on its forests. Panelists Liza Grandia, assistant professor of international development and social change at Clark University, and Jason Bremner, director of population, health, and environment at the Population Reference Bureau, argued that meeting the needs of these communities is therefore key to conserving Latin America’s forests.
by Jason Bremner, program director, Population, Health, and Environment
Photo credit: National Oceanic and Atmospheric Administration (NOAA)
The weather across the United States this winter has been consistently cold, snowy, and icy. It seems like every week the kids have had a snow day, and it makes one start to wonder about whether the earth is really getting warmer. But despite my momentary doubts, NASA and NOAA just released reports on global climate in 2010, and lo and behold it turns out 2010 was the hottest year on record (tied with 2005). In addition 9 of the 10 warmest years on record have occurred since 2001. This nice little figure illustrates global climate data since 1880 and shows that temperatures over the last 30 to 40 years have been consistently above the average for the century and have been consistently increasing. What are the implications for us? Well, warmer global climate doesn’t actually mean an end to cold winters, but climate models do point toward more variable weather (makes a meteorologists work more challenging), stronger and more frequent severe weather events, and both short- and long-term impacts on humans, nature, and our societies. How do we prepare ourselves when it seems like there are only cold snowy days ahead? Well I bought a good snow shovel after last year’s record winter storm, but I’m looking at a good pair of rain boots for this summer’s floods, and was thinking of a rain barrel for the record drought that will most certainly follow.
This month, I will travel to Mali and interview villagers I worked with from 1971 to 1976 for the UN Food & Agriculture Organization (FAO). These interviews will inform a book I’m writing on the impending radical changes in the social and economic structure of African societies. These in-depth interviews will allow me to see how the lives of former trainees affected by FAO projects and their children have changed, and to form my ideas of what may happen in the near future. The Mali case study will become a part of the larger study with data for the region. Blog posts on this Mali fieldwork will be published here over the coming weeks.
The field work in Mali will allow me to see many old friends again; friends I traveled with through the country in a old Land Rover (without air conditioning) in temperatures reacing 128 degrees Fahrenheit, sleeping in huts with agricultural tools, and an occasional mouse making it up on our bamboo beds. Although brief, it was an unforgettable period, and when I think of the cell phones and air-conditioned four-wheel drive cars that will be part of my equipment this time, I feel like I’ll be sitting in the lap of luxury. I’ll have the same companion and translator, Sefa Coulibaly, except that she was 17 when we started working together, and she is now a dignified elderly lady of 57, with numerous offspring. And she is still running the women’s bank that she started 20 years ago.
In the early 1970s, I worked for FAO for three years in Benin (then still called Dahomey) for an agricultural project to support farmers, and then worked in Mali for over four years for a similar assignment. When I left Africa after seven years, I had yet to experience a system of female-led farming since women were not the main farmers in either one of the two countries. In southwest Benin, women were traders and left agriculture to the men. (As an aside, being occupied on a daily basis throughout the year provided women with a steady income. Their husbands, however, received sizable sums of money a few times a year, when the agricultural harvest was marketed. Once the money was spent, they borrowed from their wives, at very high interest rates, and they paid back their debts once they got to the next harvest. That is when I became aware of the prevailing practice of separate budgets within the same household in communities in West Africa.)
In Mali, the pattern was different. Women contributed on a daily basis to agricultural labor throughout the cultivation season, which lasted approximately from April until October, with an interruption of about two months during July and August – the short dry season. Women worked alongside the entire family, with men of all ages and children. Women and their children were supposed to contribute their labor to the family fields in exchange for quite substantial sums of money or in-kind payments given by the husband’s family over time to his (future) wife’s relatives. However, much later, in 1983 when I carried out a survey of 604 women in Burkina Faso, we managed to get a clearer picture of how the household budget really managed in the Sahel region. Again the separation of various budgets within households was common. Women did have the right to keep any money from processing primary products (bean and millet cakes, and “dolo” – the local beer), provided they had bought the raw materials, rather than taking them from the family granary. This pattern of strict separation of various parts of a household’s budget is prevalent throughout the Sahel region.
When I started to work more extensively in the southern part of Africa in the 1980s, I got to see the real female-led farming systems, and I came to the conclusion that African agriculture was basically in the hands of women. Yet, even today, it is hard to find communities in sub-Saharan Africa where women have truly equal access to land, capital, knowledge, and other means of modern agricultural production. If the system continues, this lack of access and control may be the largest constraint on developing Africa’s considerable agricultural potential. This is what I hope to learn more about over the coming weeks.
Click here for Pietronella van den Oever’s other posts from Mali.
by Jason Bremner, program director, Population, Health, and Environment
Hillary Clinton recently announced the formation of the Global Alliance for Clean Cookstoves – a United Nations Foundation-led public-private partnership that aims to create a global market for clean cookstoves. More than 20 founding partners (including the U.S. Government, which has committed $50 million) have committed to the target of “100 by 20” or 100 million households adopting clean and efficient stoves and fuels by 2020.
“What’s a clean cookstove?” might be your first question. I’ve always been a huge fan of improved cookstoves since first seeing them in Nepal over a decade ago. The basic idea is to have a closed stove (as opposed to an open fire) that burns fuel more efficiently and ventilates smoke outside the home. There are many different examples, some made with local materials, others that are high-tech, but the main point is to improve the air quality inside the home and reduce the amount of fuelwood that households need to collect. The great thing about this relatively simple technology is that it has multiple benefits for small children, young girls, and women, and potentially on forests and our climate as well.
Used under Creative Commons from Chef Cooke.
Many households in developing countries still cook over traditional cookstoves and open fires with wood, charcoal, or animal dung as their main source of fuel. In Uganda, for example, the 2006 Demographic and Health Survey (DHS) revealed that 99 percent of households rely on wood or charcoal as their main source of fuel. What’s the harm in cooking with wood or charcoal over an open hearth? First, indoor cooking smoke has been associated with a higher risk of acute and chronic respiratory infections, the leading cause of infant mortality. The World Health Organization estimates that 1.9 million people each year die prematurely from exposure to smoke from traditional cookstoves and open fires. Second, the burden for collecting wood and charcoal usually falls to women and girls, and may have multiple short-term and long-term impacts on their health and well-being. Studies reveal that women and girls who spend more time acquiring water and fuel resources for the household are less likely to complete their schooling or participate in the labor force. Finally, in conflict settings, women collecting water and wood face a greater risk of gender-based violence.
Fuelwood collection and charcoal production also affect the local and global environment. Depletion of forests for fuel wood and charcoal can impact local watersheds and thus water availability and also results in the loss of biodiversity. Furthermore, both the burning of fuelwood and charcoal as well as the cutting of forests result in emissions that contribute to climate change. Clean cookstoves burn more efficiently (they produce more heat with less fuel), and thus produce less greenhouse gases and reduce fuelwood needs.
So the benefits are clear, but the challenge is still great. Small-scale efforts to improve cookstoves and create alternative fuels have been going on for decades, but I’ve yet to see anyone take this technology to scale. Some of the challenges have included costs, durability, and reluctance of households because of the cultural importance of the hearth and preferences for smoke-flavored food. The creation of this new alliance, however, seems to have bounded over one of the hurdles — a lack of investment. I for one hope that “100 by 20” can be reached and sustained.
In June 2010, 16 individuals who are leading the way in Population, Health, and Environment (PHE) programs in East Africa gathered in Nairobi to participate in one of PRB’s highly acclaimed policy communications workshops. Through this training, participants learned how to better communicate information about effective PHE interventions and advocate for policy change that promotes PHE linkages and integrated approaches to policymakers in their home countries.
Since 2005, PRB has partnered with the National Coordinating Agency for Population (NCAPD) based in Nairobi, to facilitate these workshops. While the workshop provided participants with a number of take-home messages, three of the main principles of the workshop were: know your audience, use empirical evidence to support your message, and provide specific recommendations that encourage policymakers to act. Workshop activities showed participants how to implement these principles in written formats, when communicating in person, and when providing formal presentations. It was an intensive week-long experience; participants attended panel sessions and group meetings during the day and worked on individual exercises at night.
This year’s workshop, not unlike workshops in years past, brought together a remarkable group of professionals. The participants were from Kenya, Tanzania, and Uganda and they worked on a diverse range of PHE issues, including public health and endangered wildlife, HIV/AIDS and environmental linkages, and reproductive health advocacy as a conservation strategy. Given the incredible resumes and experience of our participants, I was curious to see how they would respond to the workshop activities. Would the experience meet participants’ diverse needs? Would it be challenging to even the most seasoned professionals? And lastly, would it leave participants more confident in their abilities and energized to reach out to decisionmakers?
The answer to all of these questions was yes. Despite the numerous qualifications and years of experience that participants possessed, the workshop still provided a unique opportunity to spend a concentrated period of time thinking about and practicing communication techniques with constant feedback from policy communication experts and their peers in the field. They learned new skills, built new connections, and reinvigorated their enthusiasm to share evidence and findings with decisionmakers.
On the last day of the workshop, each participant gave a formal presentation to the group. Despite the level of comfort that comes from spending a week together, for some participants, the presentation was still nerve-wracking. The presentations were filmed so that participants could see their own strengths and weaknesses as communicators, and the feedback from the group was honest. Still, every participant rose well beyond the challenge, proving that policy communications is a critical skill that can be cultivated, and that good mentoring, peer support, and hard work pay off. The participants also demonstrated that the process of growing as a communicator is never done. We all can continue to challenge ourselves to be strong policy communicators, and learn new techniques to improve the success of our messages, regardless of where we are in our careers.
Two participants share their thoughts on the workshop:
by Karin Ringheim, senior advisor, International Programs
I first met Henry the Hand at the 2003 Global Health Conference in Washington, DC. Dressed as a giant plush yellow hand with a permanently happy face, Henry, alias Will Saywer MD, attended the annual conference to promote his handwashing message among global health professionals. Will was an amiable presence, but as he attempted to cordially insert himself into conversations, some no doubt found his persistence about handwashing annoying. Weren’t there bigger fish to fry? AIDS, TB, malaria, reproductive health? Henry appeared to be better suited to a children’s fair.
Later that year, as director of research for the Global Health Council, I came across a Council publication summarizing a systematic review on the benefits of handwashing as a deterrent to illness and deaths from diarrhea.I found other research substantiating that handwashing significantly reduced the incidence of pneumonia and other infectious respiratory diseases. If diarrhea and pneumonia, responsible for more than a third of the 9 million deaths to children under five could be so effectively curtailed by handwashing, Henry the Hand was definitely on to something. At the 2004 Global Health Conference, Dr. Will gave me some teaching materials on handwashing for my son, a family practice doctor in Minnesota with three young children. And I more conscientiously began to wash my hands at the end of each metro ride.
Used under Creative Commons license from ESP Indonesia.
In the years since, enough scientific literature has been published about the benefits of handwashing to convince most skeptics that handwashing is a vastly underutilized and potent public health strategy. The importance of handwashing to prevent hospital-acquired infections has been increasingly stressed, as through the installation of hand sanitizers at the entry to hospital rooms. We see the signs in restrooms requiring restaurant workers to wash their hands before returning to work. The threat of the H1-N1 virus made us all more conscious of the need to wash our hands at every opportunity (and for the duration of the Happy Birthday song). Far less attention has been given to the practice of handwashing in the home, the transmission site for much infectious disease. As documented in an extensive 2009 review prepared by the International Scientific Forum on Home Hygiene (IFH), promoting home hygiene – including hand-washing, safe handling of food and disposal of waste – may be the single most cost-effective among all preventive public health measures available to developing countries today.
The Millennium Development Goal target to increase access to improved water and sanitation by 2015 has spurred the construction of water and sanitation treatment facilities, wells, and toilets throughout low-income countries. As worthy and necessary as these measures are, the process is expensive and will require decades. Furthermore, the benefits of improved water and sanitation will not be fully realized unless concurrent effort is put into health education for mothers, children, families, and communities to make handwashing and home hygiene a new norm. As written in The Global Burden of Hygiene-Related Diseases in Relation to the Home and Community: An International Scientific Forum on Home Hygiene Expert Review, not only can “hygiene improvements … prevent the death of a child at only a fraction of the cost of community water supply and sanitation in the developing regions of the world,”but, most fortunately, these benefits are not limited to households with sanitation facilitates. Even in households lacking safe sanitation and where the mother is illiterate, (describing at least 30 million households with children under the age of 5 years), educating mothers about home hygiene and handwashing would prevent an estimated 600,000 to one million deaths per year. On a global scale, the simple strategy of handwashing with soap can prevent millions of deaths due to infectious intestinal and respiratory diseases, especially among children under age five. Every parent deserves to share in this knowledge.
It must have been a thrill for Dr. Will to witness the launch in 2008 of the first Global Hand Washing Day. The potential of this effort to succeed should not be undermined by the cost of a bar of soap. In a squatter settlement in Pakistan, the introduction of handwashing with soap cut pneumonia and diarrheal diseases in half, but half of the residents lived on less than 50 cents per day and were too poor to buy soap.The Disease Control Priority Project highlights handwashing with soap as a particularly cost-effective and affordable global health strategy: for only US $1 per capita, excellent results can be achieved. Let’s ensure that the most inexpensive means to help keep children alive and well, handwashing with soap, is universally known and freely available to the poor.
And Henry, for being persistent and ahead of your time, here is a well-deserved pat on that giant plush hand.
As the tragedy of the Haitian earthquake unfolded, I coincidentally was in Ethiopia attending two meetings on disaster risk science: an African regional workshop on building educator-practitioner networks in Africa focused on Disaster Risk Science Scholarship and Sustainable Development, and a national conference on Enhancing Disaster Risk Management for Reducing the Impact of Climate Change in Ethiopia. My challenge was to find appropriate entry points for incorporating population dimensions into disaster risk science using reliable data. As a professor of Population and Development in Ethiopia who had been seconded to government’s Disaster Prevention and Preparedness Commission’s (DPPC) Research Division for four years, this struggle was not unfamiliar to me.
The key framework in disaster risk science has been well documented in the UN’s Hyogo Framework for Action on Disaster Reduction. The assembled African experts in Bahr Dar last month identified capacity building as one of the most crucial needs for research, training, and public outreach, and for strengthening educator-practitioner networks in Disaster Risk Science/Management in Africa. The subsequent national conference aimed at strengthening community resilience and local adaptive capacity to climate change in Ethiopia – well-timed, in light of the government’s new and comprehensive Disaster Risk Management Policy.
Population pressure on a mountain in the densely populated and disaster-prone Southern Region of Ethiopia. Photo: Charles Teller.
So, where were the demographic dimensions in the trend analysis of increased risk and vulnerability to drought and climate change? After I presented a holistic model of the interactions of demographic, socioeconomic, environmental, technological, and policy/governance variables with hazards, responses, and adaptation, I was asked: Why has the number of disaster-risk prone Ethiopians actually increased since the terrible famines of the mid 1980s? Is the increase in the number of highly vulnerable Ethiopians (13-15 million chronic and acute food insecure in 2009) due mainly to high fertility, rapid population growth and resulting population pressure on the land?
I felt that was too simplistic and passive an assessment. While population growth has occurred, changes in coping, resilience, adaptation, and productive capabilities have also been happening. Moreover, even in the face of annual population growth rates of nearly 3 percent, infant and child mortality rates have plummeted since 1990, and education and health coverage has greatly increased and are on track for meeting many of the MDG targets. However, the lack of sufficient progress in urban development, land reform, agricultural intensification, economic diversification, and technology has induced an increasing movement of temporary off-farm laborers and permanent migrants to search for greener pastures (if any pasture at all). The pressure of continuing to maintain the overwhelming majority (84 percent) of the population on the land is tremendous, depresses the younger generations’ aspirations, and should be alleviated through off-farm employment, planned small market towns, and urban development
As a result of rural population pressure, a system of demographic change and response to natural and human hazards and climate variability appears to be functioning, and researchers have tried to monitor these through demographic and health surveillance, famine early warning, livelihood information, and vulnerability profiling. We know from years of research at DPPC and Addis Ababa University on drought risk, hazards and vulnerability that certain demographic characteristics are associated with high vulnerability: female or elderly-headed households; larger number of young dependents; and land scarcity (less than half-hectare of arable land per household). The most adaptive rural households are those with available adult labor for off-farm and diversified employment, or marketable urban skills
However, these risk and vulnerability factors vary widely across this very diverse country, from the cold, eroded highlands to the hot and dry lowlands. There really are two Ethiopian worlds: traditional rural Ethiopia and cosmopolitan Addis Ababa. The major research problem we face is the lack of reliable, seasonal, local area data and information systems for monitoring and evaluating these trends, demographic responses, and human development capabilities. Even when the data are available, constraints to access, analyze, and communicate these to policymakers who make decisions about disaster risk mitigation are formidable.
In the context of social change and sustainable development, demographics matter. The new field of Disaster Risk Science needs to include in its modeling the measurement of risk of mortality, the vulnerability of population pressure and household characteristics, and the adaptive capacities embedded in multiple migratory processes. To do so, we need to update our micro-level models, insert the missing demographic dimensions, and ensure that reliable data especially on both temporary and permanent migration, are generated and analyzed.
