The politics of uneven development

digitalart

With the United Nations Millennium Development Goals (MDGs) set to expire in 2015, the post-2015 agenda is generating a lot of commentary. In the media and among policy makers and civil society organisations,  there are a multitude of ideas about what the agenda should look like – what it lacked before, and where we need to focus our attention now. The MDGs constitute an important framework used to guide the development priorities of national and global bodies. They remind policy makers, heads of State and civil society that things like maternal health, gender equality and universal education are imperative to development. In other words, they highlight the link between people and development, and the importance of maintaining a focus that is not solely on the economic.

One country that has taken development discourse and action to heart is Peru. With its rumbo al desarrollo  or ‘course of development’ platform, the current government under Ollanta Humala has seen Peru positioned in the global spotlight. One of the most mineral-rich countries in the world, Peru’s course of development is grounded largely in the exploitation and exportation of natural resources like copper, silver and gold, and is heavily dependant on foreign investment. In a time of global economic instability, the International Monetary Fund (IMF)  commended Peru on its spectacular economic growth. Bill Gates even referred to it as ‘middle income’, suggesting that it doesn’t need aid the way that some other countries do. Most recently, Peru hosted the World Economic Forum (WEF) on Latin America, where the WEF Senior Director and Head of Latin America proposed that as one of the fastest growing economies in the world, Peru sets an example of the potential inherent to other Latin American nations.

Conflict

At the same time that Peru’s economic growth has been celebrated, the country has born witness to a series of ongoing social conflicts, many of which are located in regions rich in minerals. No small issue, as of August 2012 the Peruvian Human Rights Ombudsman cited 149 social conflicts related to extractive industries dispersed throughout the country. The majority of these conflicts involve indigenous and campesino (farm worker) communities, who have lived on and worked the lands in question for centuries. These communities don’t necessarily share their national government’s conception of development, instead generally envisioning a course based on promoting local agriculture and tourism.

The northern Andean region of Cajamarca is perhaps the most well known example of these social conflicts.  Starting in late 2011, the region gained international media coverage for the  violent and finally fatal clashes between police and the thousands of local citizens who stand in opposition to the proposed Conga gold mine – a reported $4.8 billion dollar project. Cajamarca is already home to the world’s second largest gold mine, Yanacocha, which was founded in the mid-nineties and is owned by the same company currently proposing Conga. Among other reasons, the largely agriculturist locals opposing the new project cite depleted and contaminated water sources due to existing extractive activity, and insist that water is more valuable than gold. Much of the national media voices concern that these social conflicts – and often their originating communities – are ‘holding the country back’ in its rumbo al desarrollo. State level politicians have been explicit in their interpretation of leaders of the Conga opposition as being against regional and national development – no small accusation given the international weight placed on achieving ‘developed country’ status.

Uneven development

What is most apparent to me in these debates is a lack of understanding. A couple of weeks ago I was chatting with an engineer who has worked in the local mining industry for nearly 20 years. He asked me, as a social scientist, to explain to him why locals oppose the Conga project with the determination that they do. He confessed that he really couldn’t imagine what their reasons would be – didn’t they understand that development was good for them?  In response, I cited what locals had mentioned to me, and what I thought was rather obvious. Home to the world’s second largest gold mine, Cajamarca lacks a modern and sanitary central market (a widespread complaint), suffers from water shortages, has roads in desperate need of paving, has a hospital that doesn’t treat cancer, and is constantly suffering a scarcity of teachers in public schools.  Less obviously apparent are the persistence of gendered violence, high rates of maternal mortality and rising childhood malnutrition.

In contrast, the capital city Lima is home to world-class private health clinics and international schools, multi-million dollar homes and offices and immaculately manicured green spaces. In the rural Andes and jungle regions, these things are harder to come by. Twenty years after the Yanacocha gold mine began production, the region of Cajamarca is still one of the poorest in the country, belonging to a group of departments that has a total poverty rate of over 75%. Quite simply, it doesn’t look like what one would imagine a top producer of gold to look like. And the vast majority of locals recognise this, noting the paradoxical nature of their reality.

These glaring contrasts are indicative of an uneven pattern of development and an unequal redistribution of wealth – or otherwise put, the benefits of development. While Peru may be rising the ranks of economically stable countries, this is not the case in measurements of equality. The Humala government has placed greater priority on boosting what it terms ‘social inclusion’. Traditionally marginalised groups are increasingly folded into large state programmes revolving around childhood nutrition and education and the provision of old-age pensions for those in the poorest national quintiles. Despite these investments, in 2012 researchers found that while overall poverty had decreased, inequality – particularly between rural and urban regions – remained the same or even increased. This means that rural communities, like those in Cajamarca, experience unequal – in this case poorer – access to quality health and education services, employment and infrastructure than urban centres like Lima. Social conflicts like those I refer to here arise from the recognition that this situation is unjust.

People first

The combination of sustained social conflict and statistics like the aforementioned should be taken to heart. Development cannot be just about economics – how many millions or billions of US dollars in foreign investment an opportunity is worth, what it might do for GDP. It can’t even be mostly about economics. It has to be first and foremost about people. About how people live, about their access to services, their ability to exercise agency on their own behalf, about their quality of life.  And it has to be matched by a commitment to equality, to a wilful desire to see all people benefit from a given economic project or process.

The current debates around the post-2015 development agenda represent an excellent opportunity for all national governments, corporations, organisations and agencies with stakes in development processes at home or abroad to stop and reflect. Where do their development related priorities lie and how does the course they’ve chosen to achieve it measure up in terms of delivering on equality? Are the concerns and issues of all communities, regions and populations similarly represented and attended to? Are issues of a social nature given the same weight as economic growth? The Millennium Development Goals are not perfect, and it is unlikely that what comes out of the post-2015 agenda will be either. However, they are an excellent place to start.

*Tara Cookson [2011] is doing a PhD in Geography. Picture credit: http://www.freedigitalphotos.net and digitalart.

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In science, slow and steady wins the race

dominici

Multiple sclerosis (MS) is a devastating neurological disease where the protective layer around nerves begins to die off, attacked by the body’s own immune system. Without this insulation, the nervous system begins to shut down.  Eventually, many people with MS lose the ability to move, speak and control basic bodily functions.  Patients usually get their diagnosis in the prime of life and there is nothing to be done besides taking drugs that will postpone the progression of symptoms. These treatments are associated with side effects that can be as debilitating as the disease itself and they are hugely expensive. 

So, in 2006 when an Italian physician, Dr Paolo Zamboni, announced a simple method for treating MS, it received international attention.   Zamboni theorised that MS was caused by a lack of blood flow in the brain and that by restoring proper blood flow the disease would dissipate. This was a completely novel idea; most scientists working on MS were investigating the immune system, not the venous system.  Zamboni measured blood flow in MS patients using a Doppler scan technique and showed that MS was associated with extracranial stenosis, the narrowing of blood vessels in the neck. He called this condition chronic cerebrospinal venous insufficiency (CCSVI) and showed that by surgically enlarging the veins, patients got better. 

After this initial research was published, patients clambered to access the treatment – a surgery that could solve their suffering where no matter of expensive pharmaceuticals could help.  Funding Because of the severity of MS and lack of treatments, MS patients are highly active in disease associations and involved in fundraising efforts for research. Patients voiced their desire to access CCSVI surgery and, despite only preliminary evidence of its efficacy from Zamboni’s studies, money started being funnelled into studying the procedure.  The MS Society of Canada, for example, allocated $2.4m for CCSVI research in 2010, and other trials of the procedure were launched around the world. 

However, many patients requested the treatment and paid for the surgery out of their own pockets before any large scale, controlled trials had been completed. CCSVI had received a lot of media attention and patients were eager to benefit from the treatment before it was fully understood.  Opening up veins in the neck is no small task and surgeons were using stents and tools that were not yet approved for use in the neck.  Some people suffered severe adverse events resulting from the surgeries, such as strokes. Other patients died. However, patients were so keen for a cure that, despite relapsing after the surgery, some underwent the same procedure again, in the hope that it would help them.

Fluke
Then, other labs started publishing results of their research on CCSVI.  Most of these studies contradicted Zamboni’s results. There was no difference in the blood flow of MS patients and healthy controls and there was no benefit to the surgery. Doppler measurements of extracranial blood flow were temperamental and unreliable.  It seemed like Zamboni’s CCSVI was a fluke result due to bad experimental techniques or a small sample size.  Zamboni continued to advocate his theory and replicate his results in small studies, but if only one doctor out of many can achieve an effective outcome using a medical treatment, warning bells start to go off.  Large scale, randomised, controlled clinical trials on CCSVI have not yet been completed, but results from these studies will be able to definitively confirm or refute the involvement of CCSVI in MS.  It is astonishing in the meantime that one man’s theory and a few small experiments have resulted in millions of dollars of research funds spent, thousands of scientist hours being wasted and patient health and finances being risked prematurely.

Medical associations have begun to discount CCSVI now that more evidence has emerged, but the story of CCSVI serves as an important example of the need for rigorous, randomised, controlled clinical trials of medical treatments before they are unleashed on a desperate patient population.  Patients suffering from chronic diseases and their families are anxious to try anything to get better. CCSVI was the next big thing and it was exciting, but it moved too fast based on too little evidence. Resources were diverted away from the scientists, doctors and patients working hard to find effective treatments for MS, potentially delaying real research progress. 

The FDA in the US, the MHRA in the UK and similar regulatory bodies around the world exist to protect patients from undue risks. While many may complain about the bureaucracy of these organisations and the delays they cause in the approval process for new treatments, without these checks, many patients would risk their lives on snake oil. Medical research can seem slow and boring in comparison to one doctor’s miraculous claims, but to find safe and clinically proven cures for diseases like MS, patience, hard work and a lot of double checking will be necessary.

*Emily Jordan [2009] recently completed a PhD in Experimental Psychology. Picture credit: David Castillo Dominici and http://www.freedigitalphotos.net.

The complex challenge of malnutrition

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This week’s G8 summit has turned global attention to combatting malnutrition. It is a long-overdue opportunity to reinvigorate agricultural development, funding for which has been largely stagnant for two decades. Yet to succeed, approaches must set aside their yen for technological ‘silver bullets’ whilst remembering two truths: malnutrition is rarely about not having enough food and food is not all that agriculture delivers.

Academic scholarship has highlighted that food insecurity is often due not to inadequate food availability, but rather impeded access and utilisation, often poverty-based. Upping production will not decrease hunger if political, social, and financial barriers constrain access for the disenfranchised. The food-price riots of 2007/8 showed how international market dynamics can elevate prices beyond the poor’s purchasing power. Even if accessible, food must be the right kind: millions worldwide suffer from the ‘hidden hunger’ of micronutrient deficiencies. Even with calorie-sufficient diets, limited proteins, fruits, and vegetables leave millions deficient in vitamins and minerals. In addition to direct effects (such as blindness and stunting), these deficiencies increase infectious disease mortality. By impinging on child development, they perpetuate lasting health inequalities across generations – even amidst bountiful staple grain harvests.

Further, the farmer harvesting this grain gains not only food. Smallholder farming is the major income source for many food-insecure households – paying tuition for the next generation to escape poverty, for example. As a livelihood, agriculture imparts great pride: crops and livestock meet cultural needs, as well as economic ones, providing personal and social meaning. The ‘cultural’ can thus not be isolated from agricultural decisions. Furthermore, agriculture embodies complex human-and-ecosystem interactions – yields are fundamentally dependent on natural resources, which farmers’ actions invariably impact (for both good and ill). The improved seeds, pesticides, and fertilisers that fuelled Asia’s ‘Green Revolution’ have thus far failed to take root in variable, risky African soils and increased agriculture’s environmental footprint to about 1/3 of global greenhouse-gas emissions. Production gains must now be reached against a backdrop of water scarcity, soil depletion, and climate change, expected to seriously challenge (though also create opportunities for) agriculture.

These dual truths make ‘silver bullets’ elusive in agricultural development (versus, for example, global health, where a single shot can make a life-saving difference). A host of interventions, thinking shifts, and policies will be needed to end food insecurity. Foremost, efforts should focus on smallholders: supplying 80% of the developing world’s food, their poverty is the root of most global hunger. Efforts should seek to enhance overall resilience of livelihoods, enabling access to more nutritious food – with the knowledge required to utilise it. One key example is crop diversification: educating and supporting farmers to grow wider ranges of crops and livestock, including local varieties, can diversify diets, improving micronutrient deficiencies. It can increase profits in marketing, potentially opening new markets, though this requires both education and improved supply chains (about 1/3 of global output is lost post-harvest). Diverse farms can be more resilient to environmental stresses, such as pests. Yet polices such as grain/fertiliser subsidies and over-emphasis on cash (export) crops can incentivise monocultures. Such programmes must be rethought.

Multifaceted problems need multi-pronged solutions. Education initiatives (for instance, promoting proper nutrition in a child’s crucial first 1,000 days) impart the understanding needed for action. Private-sector partners, particularly multinational buyers of commodities like cocoa, have potential to provide training and certification schemes that can benefit both smallholder suppliers and company bottom-lines by securing sustainable, high-quality production. Technology can help bridge physical infrastructure gaps, for example, using mobiles to disseminate climate forecasts.

Scientifically bred crops, including bio-fortified contributions like ‘golden rice’, will likely play a role – but those heralding a new Green Revolution should heed lessons of the first, in terms of environmental impact, implications for farmers’ rights, and inability to transfer to African contexts. Such efforts should recognise farmers’ considerable knowledge and experience managing complex agro-ecological conditions – this has worth that ‘new seeds’ cannot (and should not) supplant. Successful approaches must leverage both.

Shining the global spotlight on malnutrition, David Cameron is emphasising one of the most crucial areas of development, but also one of the messiest. Improving nutrition through agriculture requires long-term, sustained interest and investment – not just weekend photo ops. Let’s hope world leadership can stomach this commitment; in so doing, they can make freedom from hunger a global human right.

*Stella Nordhagen [2008] is doing a PhD in Land Economy,  focussed on crop choice, climate change, and agricultural development in Ethiopia and Papua New Guinea; her past expertise is in public health, and she also holds a Cambridge MPhil. in Environmental Policy and Economics. After completing her PhD she will be taking up a fellowship with the US Congressional Hunger Center to work on issues of crop diversity, food security, and nutrition in West Africa in conjunction with the NGO Helen Keller International.

 

Team spirit

brielle

I never would have guessed that I’d be coming to Cambridge to begin my PhD work as a Gates Scholar. I wanted to uphold the message of the Gates Scholarship of  having an impact on society and I also wanted to thrive in the wonderful environment of Cambridge. The choice to trial for a coxing place within the Cambridge University Women’s Boat Club (CUWBC) was a tough one. I have been a coxswain since my first year at University, in the States, but was not sure that I would continue at the University level when coming to Cambridge as I was worried that a commitment to CUWBC would leave me incapable of fulfilling my role as a Gates Scholar and beginning my PhD work.

I chose to take the plunge and committed to CUWBC. For the better period of six months, I arose before dawn. My alarm rang during the week at 5:18AM, and on weekends at 6AM, at which point I struggled to find warm enough clothes, pack my things for the day and cycle to the train station. I hopped on the train bound for Ely to join my team mates in an often chilly and fog-laden training session on the river.

As a cox, my role might encompass being particularly motivational or upbeat to overcome the 6AM fatigue. I may need to be very analytical about the start and finish times of several hard pieces that we’re doing or focused on perfecting a technique change in the boat. I may need to steer into gale force winds and through blanketing fog, having to split my focus between motivating, intuitively feeling the boat and making technique changes and trying to calculate the subtle movement of the rudder that will move us away from the bank but not throw off the balance of the boat.

All throughout our gruelling training sessions, my rowers, as lightweights, had the particular challenge of maintaining power while dropping weight to reach 59kg and I myself had to drop nearly 10kg to be as light as possible for race day. In all, we committed, mentally and physically, to the better part of 22 hours per week together.

We competed in races against some of the best crews in the country, defeating even heavyweight crews in competitions such as British Universities & College Sports Head.

Suddenly, we found ourselves at the 2013 Henley Lightweight Women’s Boat Race, competing against Oxford. The wind chill that day was -5C, with a crosswind of 25+ miles per hour. Off the starting line, we maintained a four-seat lead, though despite our best efforts, Oxford made their way clear of us, moving to win the race by a good-sized margin.

One would think that at the end of this race, when all was said and done, my thoughts would’ve been this: six months I trained for this. I balanced a clinical neuroscience PhD, my first year in Cambridge, weight loss, competition within the squad, early freezing mornings…

I never thought one of those things. Coming across the finish line, and in the moments after, my thoughts were these:

There was nowhere I would rather be, on that incredibly cold, blustering day, than in the boat, amongst the eight women who had selected and trusted me to motivate and steer them against Oxford.

That I had made mistakes throughout the year, but that I had ultimately become a better person for overcoming them.

That I was able commit to countless practices, training camps and races without sacrificing my life/work balance.

As we came into the changing room, having just lost the boat race, the nine of us hugged. We embraced for a long time. There was sadness, but, above all, the team that huddled together in the changing room that day, frozen and completely exhausted, knew that they had achieved the greatest objective of any team: the creation of an irreplaceable, once-in-a-lifetime bond.

I came to Cambridge as a Gates Scholar to be a part of something special, to have my life changed by others, and to make my own contribution to society. Coxing the lightweight women of CUWBC has been an integral part of my Cambridge and Gates experience and is something I will cherish forever.

*Brielle Stark [2012] is doing a PhD in Clinical Neurosciences.