Stories from the Field: Just and Lasting Change

On May 28^th, Prof. Carl Taylor was honored as the inaugural recipient of the Global Health Council Lifetime Achievement Award for his dedication to improving the health care of the world’s most marginalized people through innovative and sustainable community-based interventions. During his acceptance speech, Dr Taylor discussed the future of global health and that new directions will be required to meet the challenges as globalization takes over. He talked about the need to focus on “peoples self reliant social change” and that the greatest problem is going to be the issue of the “worlds total health ecology”. This is when the “3-way partnership” is important; where in addition to the top down officials and programs, and bottom-up self reliant communities, a new generation of health professionals must emerge that specialize in bringing the top and bottom together to find new patterns for working together. When this is accomplished, Dr Taylor believes that health for all will be possible and mutual empowerment will begin. (Photo by Medora Hebert, Global Health Council)

These concepts are based on decades of work and documented in the book he co-authored with his son, Daniel Taylor-Ide: Just and Lasting Change: When Communities Own Their Futures. The goal is to help communities become empowered – not just one individual but the community as a whole. If the community is dependent on outside aid to continue, then “sustainability is not sustainable”. Additionally, the way in which the donor community behaves can have negative consequences. Creating dependency to gain cooperation has been used in the past which only leads to more bureaucracy. The alternative approach is to conduct training activities to build capacity that preserves the community’s sense of ownership.

In their book, Just and Lasting Change, Carl and Daniel introduce the concept of SEED-SCALE: planting a seed and going to scale. SEED (Self-evaluation for effective decision-making) + SCALE (System for communities to adapt learning and expand) = SEED-SCALE. Scaling-up requires political leadership to work with the community. There are 3 dimensions of scale:

1. Scale One: The seed process at a community level where you have working examples. The success of Scale One includes women’s empowerment.
2. Scale Squared: The establishment of learning centers or clusters of successful communities that can influence an entire region. Potential growth depends upon the network of learning centers – or multiple growth points.
3. Scale Cubed: Includes 1. Setting-up systems for partnership; 2. Top down support that makes the system sustainable.

This sounds complicated but Just and Lasting Change contains plenty of examples to show it works. The key ingredient to its success is the underlying belief that communities deserve respect, and when empowered, they can create a sustainable future for themselves.

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Carl Taylor, M.D., F.R.C.P., Dr.P.H. is a professor emeritus in the Department of International Health at John Hopkins Bloomberg School of Public Health, a Senior Health Advisor for Future Generations, and co-author of Just and Lasting Change: When Communities Own Their Futures. Dr Taylor served as UNICEF director for China from 1984 through 1987, and as a WHO consultant in preparing documents for Alma Ata, a World Conference in 1978 on Primary Health Care.

Stories from the Field: What is your vision 200 years from now?

It’s impossible not to be moved by William Foege, MD, MPH, a leader in public health who continues to educate, motivate and challenge those who are searching for new solutions to complex global issues.  Last week at the Global Health Council’s annual meeting, Dr Foege spoke to individuals interested in pursuing careers in global health.  He chose to share lessons from his years of experience…. lessons we can all learn from.

1. Preparation:  You cannot know everything in advance, public health combines multiple disciplines. Become a generalist and find a specialty that interests you.
2. Possibilities: 10 years ago the options were few, now the possibilities are endless.
3. Set your vision for 200 years from now: The Founding Fathers did not work on 4 year cycles; they planned for future generations – 200 years out. Think like them; create a vision that you can steer towards.
4. Coalitions: Everything takes a coalition, and the key to its success is getting the vision right, describing the last mile and work towards it together.
5. Always ask if there is another way, avoid centering on only one solution.
6. Truly understand “Do No Harm”: know the impact of not doing something. Errors of Omission are equally important.
7. Tenacity: is sometimes the only thing that will get you where you need to be.
8. Global Health Equity: the measure of a civilization is how we treat each other.
9. The need for optimism: keep pessimism out of your life and off your staff.

Dr Foege closed his thoughts with one from Gandhi: “People often become what they believe themselves to be”.  See yourself as a global health professional and you will become one.

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Dr Foege is a Senior Fellow at the Bill & Melinda Gates Foundation, a professor emeritus in the Department of International Health at Emory University’s Rollins School of Public Health and serves on the Board of Directors for the Global Health Council.

 

The University of Washington has two of Dr Foege’s lectures available via podcasts:

“Global Health: A Voyage of Discovery.” Download lecture (34 minutes runtime, 16MB)

 “Global Health: Looking for Shortcuts.” Download lecture (58 minutes runtime, 27MB)

 

Thank you for voting!

Thank you for casting your vote to elect new officers for the International Health Section! Results will be posted on the section’s homepage.
Your IH Section leadership!

Which Top Family Planning Research Findings should be put into Practice? Vote!

Which are the most important family planning research findings that should be put into practice? Authors for an upcoming Population Reports issue on the topic invite you to vote for the top three findings from a list of seven. For example, WHO recommends that family planning clients receive up to a year’s supply of pills, or as many pill packs as feasible, at the first visit. Research finds that women who get a full year’s supply of pills are more likely to use the method effectively, without interruption. This practice is rare in many countries, however. Have a more urgent finding that should become a practice? Vote and then write a comment on INFO’s Blog.

Are Millennium Development Goals (MDGs) Unfair to Africa?

“At the midway point between their adoption in 2000 and the 2015 target date for achieving the Millennium Development Goals, sub-Saharan Africa is not on track to achieve any of the Goals”. http://www.un.org/millenniumgoals/docs/MDGafrica07.pdf

Yes, according to William Easterly, author of “The White Man’s Burden”, at a February 6 event, Africa was set up to fail by the way MDG targets were set and indicators defined (http://www.brookings.edu/events/2008/0206_africa.aspx). With wit and by taking occasional cheap shots at those who developed the MDG goals and targets, Easterly held the attention of a large audience. Using data and trends, he made a compelling case why MDGs did not give sub-Saharan Africa credit for its considerable progress, thus contributing to the stereotype of “Africa’s failure”. In his response, Danny Leipziger of the World Bank took issue with many of Easterly’s claims pointing out, for example, that Tanzania was treated no different from Nepal for most MDG goals. Here is the question: Do you believe that MDGs are fair or unfair to Africa?

Who decides what to evaluate, how and when?

A systematic review of the United Nations Children’s Fund (UNICEF) estimated that 15 percent of all its reports included impact assessments, but noted that “many evaluations were unable to properly assess impact because of methodological shortcomings” (Victora 1995). A review of 127 studies of 258 community health financing programs found that only two studies were able to derive robust conclusions about the impact on access to health services (ILO 2002).

International consensus is growing that more and better impact evaluations are needed. Only by applying scientific rigor can development programs show that they produce results and offer a good return on the investment. The World Bank has made considerable investments in evaluating the impact of many of its development programs. Other donors like the UK and the Netherlands are joining forces. However, impact evaluations are expensive and not all programs need them. Here is the question: How to decide which programs should have an impact evaluation, who should decide and when? Let us know what you think!

Are you interested in the APHA Trade and Health Forum?

The APHA Trade and Health Forum was formed last April.  Some of you have asked for an update as to what the forum is, what it has done, and plans for the coming year.   

This past year’s APHA conference in Washington DC included the first face-to-face business meeting of the new Forum on Trade and Health. Over 25 people from a variety of sections gathered to discuss how global trade affects public health, and what we can do about it. The Forum sponsored three oral sessions and one poster session, and co-sponsored several other events. The Forum welcomes new participants from any section!

Hello APHA International Health Section Members and Friends!

It is a New Year and a new beginning for communicating among members of the International Health Section of the American Public Health Association. What is new?

• Our website has a new look. Please check it out at http://www.apha.org/membergroups/sections/aphasections/intlhealth/
• This “IH Blog”. It is a new tool (for us) to hear members about their concerns and issues related to global health.

 I would like to invite you to write for the IH Blog. If you have any suggestions concerning topics that you would like to discuss, feel free to comment.