Laura Ruch

  1. Can We Craft a Livable Future? – Reflections From the Unite For Sight Conference

    May 7, 2012 by Laura Ruch

    Recently, I visited Connecticut for the first time to attend the annual Unite for Sight Global Health and Innovation Conference at Yale University. If you cannot already tell by the title, the conference covered an extremely broad range of topics – maternal and child health, design and architecture, social media and marketing, health policy, photography, and on and on. By the end of the weekend, I felt rather overwhelmed by the sheer scope of the ideas that I had been presented with. However, one session particularly stood out to me, perhaps because it touched on an issue I have limited knowledge of, yet one that plays a role in many of the most pressing matters of today’s world. It undoubtedly has broad implications for global health. The session discussed “hunger and food,” and admittedly, I chose it over the others because it was the final session of the weekend, and I just wanted to hear about something that was “basic” and “easy to address,” given my exhaustion level. But despite the often-mentioned fact that the world already produces enough food to feed everyone – if only distribution could be evened out – food and hunger issues remain complex, and food production practices, particularly in this country, have a lot of scary consequences for the wider world.

    My favorite speaker of the three in the session was Dr. Robert Lawrence, a professor of environmental health sciences, health policy, and international health and director of the Center for a Livable Future at the Johns Hopkins School of Public Health. He really got me to step back and ask, “Why does food production so often have negative impacts on the environment and on our health? Can this be changed?” I’d say the answers to those two questions are 1) because people have simplified the process – prioritizing product yield and ease of production over protecting consumers and the environment as a whole. Also, governmental policy has over and over promoted harmful food production practices. And 2) Yes, this can absolutely be changed.

    Here’s a list of some sobering facts related to food, health and the environment that I learned at the conference as well as some follow up reading:

    1. Most of the world’s poor are farmers, and most of them are hungry farmers. About 1.3 billion people are small farmers (World Farmers Organization), cultivating less than five acres of land. Farming is by no means a lucrative profession, in wealthy countries and poor countries alike. Farmers depend on an immobile landscape, and the globalization of food has prioritized large-scale producers of cheap, ‘efficient’ food. Farmers have been repeatedly encouraged to engage in harmful practices in order to make a decent income.

    2. Pastures now occupy 70% of previous forested land in the Amazon in Brazil, and feed crops cover a large part of the remainder (Livestock’s Long Shadow: environmental issues and options). The majority of that land farms soybeans, which are not a traditional crop in South America, and are mostly used to meet the demand for soy from China. To get an even broader picture, about half of the land on earth is devoted to farming today.

    3. The loss of species is estimated to be running 50 to 500 times higher than background rates found in the fossil record (Livestock’s Long Shadow: environmental issues and options).  To me, this is simply terrifying. As someone who studies biology, I’m well aware of the often hidden benefits and dependencies species have on each other. When a handful of species disappears, the whole ecosystem suffers, and often in a way that can’t be foreseen. A lot of today’s food production, particularly meat production (and production of livestock feed) uses practices that directly contribute to this species loss, including deforestation, land degradation, pollution, climate change, overfishing… you get the picture.

    4. Global demand of meat and cereal production will largely increase as populations increase in the developing world (the Soil Association). Despite a predicted future decline in the rate of growth of consumption of meat, it will not be enough to offset demand from population growth, and overall there will be a large increase in production. That means that the  environmental impact per unit of livestock production must be reduced by a similar proportion, just to avoid increasing the level of damage beyond its present level.

    5. Agriculture is the largest user of water, accounting for 70% of total freshwater use (Stockholm International Water Institute).  Already more than one billion people do not have sufficient access to clean water. Under a “business as usual” scenario (Rosegrant et al., 2002), global water withdrawal will increase by 22% in 2025.

    6. Policy makers are slow to respond to harmful practices. Environmental laws and programs are usually put in place only after significant damage has already occurred. The focus continues to be placed on protection and restoration, rather than on the more cost-effective approaches of prevention and mitigation. Perhaps this is partially because policy makers don’t realize how important these issues are to the public. I think that my peers, or just people outside of the political realm in general, tend to overlook the power of their political voice. Simple things such as writing a letter to a representative can have a big impact (another thing I learned at the conference).

    7. These issues are about more than just hunger and the environment – they are issues of security as well. By increasing the scarcity of natural resources such as land and water, environmental degradation increases the likelihood of violent conflict, particularly when there is a lack of governing institutions… A Pentagon report (Schwartz and Randall, 2003) suggested that global warming could prove a greater risk to the world than terrorism and could lead to catastrophic droughts, famines, and riots (Yet I wonder how much money has the Pentagon spent since 2003 on fighting terrorism versus address global warming…).

    8. The livestock sector is responsible for an estimated 51% of greenhouse gas emissions measured in CO2 equivalents. This is a higher share than transport (Worldwatch Institute). Virtually every step in the production of livestock contributes to climate change and/or air pollution. These include the livestock respiration, burning fossil fuel to produce mineral fertilizer, methane release from fertilizer and manure breakdown, land degradation, and fossil fuel use during feed and animal production, not to mention production and transport of processed and refrigerated animal products.

    9. Animal foods, as they are produced today, pose a risk to human health. Directly, they can lead to infectious disease. Animal foods are susceptible to pathogens (E. coli, for example) and they often still have chemical residues by the time they make it to a dinner plate. About 75% of recent emerging diseases are zoonotic (passed from animals to humans), according to the CDC. In an indirect way, animal foods (although this is true for other foods as well) increase human exposure to infectious disease due to climate change. Diseases such as malaria, dengue fever, and schistosomiasis are on the rise as the planet warms.

    10. Meat is often times deceptively cheap. Much of the cost of meat goes into externalities – soil degradation, water use, and greenhouse gas production. How much would a McDonald’s hamburger cost if the pricing of land, water, and use of waste sinks were taken into account? What if there were no subsidies that directly encouraged livestock producers to engage in environmentally damaging activities?

    11. “The food system is run by people who know nothing about health, and the health system is run by people who know nothing about food,” says Ken Lee of Lotus Foods (see below). We cannot keep pretending that the obesity epidemic and the increasing incidence of heart disease, diabetes, etc. in this country and most others can be solved solely through behavior change at the consumer level. It will require changes at the source of the issue — in food production as well and in the policies that govern food production, pricing, and distribution.

    Despite the seemingly onerous task of addressing any of the above issues, there are already many individuals involved in the effort to make food production healthier for people and the environment as well as more sustainable. Here are three examples of cool organizations and what they are doing to change the face of agriculture:

    1. Lotus Foods: Ken Lee, co-founder and co-owner of Lotus Foods, introduced his company’s business model, which uses sustainable agriculture practices. Lotus provides exotic rice varieties to small family farms in remote regions of the world, including Bhutan, Bangladesh, China, and the US. Since these heirloom rice varieties are very unique, the global marketplace for them is large, particularly given the superior quality, taste, texture, aroma, color, and nutritional value of some of the rice species. Lotus farmers use a methodology known as “System of Rice Intensification (SRI) or “One Crop per Drop”, pioneered by Cornell International Institute for Food, Agriculture, and Development (CIIFAD) in the mid-1990s. This method of farming reduces the amount of seed, water, chemicals, land, and labor needed to produce a given quantity of rice, and it produces healthier soil, and therefore healthier rice, at a lower cost. Read about SRI here. I really love the way that Lotus sums up the work that they do and their ultimate goals, “Eradicating poverty and promoting social and economic justice has to start with agriculture and it has to be accomplished in a way that protects and restores the natural resources on which all life depends. At the crux of this challenge is rice, which provides a source of living to two billion people, most earning less than $200 a year.”

    2. One Acre Fund: Tony Kalm, director of business development, introduced the One Acre Fund, an incredible organization that is changing the lives of “one of the largest groups of ‘forgotten poor’ in the world.” Concentrated on one-acre subsistence farms in Sub-Saharan Africa, the One Acre fund serves small-scale farmers and uses markets to achieve poverty eradication. Their ultimate goal is to make farmers more prosperous. One Acre Fund empowers and educates local farmers, provides environmentally sensitive seeds and fertilizers, facilitates crop handling and storage, and pays farmers in the event of crop loss due to drought or disease. The organization releases performance reports every six months; in the most recent report (fall 2011), 77% of their field costs were covered through farmer repayments on low interest loans. Today they serve 75,000 farm families in Kenya, Rwanda, and Burundi.

    3. The Center for a Livable Future: Directed by Dr. Robert Lawrence, the Center for a Livable Future (CLF) at Johns Hopkins School of Public Health was founded to address the interlocking relationships of diet and health, agriculture and the environment, food equity, and population issues. CLF aims to increase knowledge about these interconnections ‘in order to influence public policy toward more equitable and sustainable systems.’ CLF encourages public health professionals to collaborate and share discoveries to ultimately influence policy. They also raise awareness among individuals and institutions about environmental issues through classroom education as well as public events to ‘effect individual behavior and stimulate societal changes.’ The center puts out a list of research and program ideas for students that could make for some awesome independent study or summer research projects!

    As a recent Northwestern graduate with a degree in biology and global health, I’m left wondering why these issues were if anything a sidenote in my undergraduate coursework. I’m also wondering why my fellow students aren’t more up in arms about these harsh realities. Even more importantly, I’m wondering why I’m still not even sure how I fit into a solution – what I can personally to do be a part of the necessary change as someone who will be going into medicine and not public policy. I think it’s time that food production issues were discussed across departments rather than limited to environmental science and engineering. I know that creating renewable energy sources, a more sustainable environment, and new approaches to global health are all focuses of the 2011 Northwestern strategic plan, and I’m eager to see how the university will increase awareness among students, shaping future leaders who will be a part of the solutions to these urgent problems.

    Note: This post has been edited for accuracy. Many thanks to Jeff Anhang from the Worldwatch Institute for providing some helpful resources. Check out this report from Forbes about an analysis by Jeff Anhang and Robert Goodland if you’re wondering how you can be a part of the solution to climate change. 

  2. Dr. Evan Lyon on current projects at Partners in Health

    March 9, 2012 by Laura Ruch

    “Whatever it takes. Just as we would do if a member of our own family—or we ourselves—were ill.” This mindset lies at the heart of the mission of Partner’s in Health (PIH), a Boston, MA based non-profit health care organization founded in 1987 by Dr. Paul Farmer, Ophelia Dahl, Thomas J. White, Todd McCormack, and Dr. Jim Young Kim. On Thursday, March 1, 2012, Dr. Evan Lyon of PIH spoke to a class of undergraduate and graduate students enrolled in Prof. Michael Diamond’s “Managing Global Health Challenges” course.

    Dr. Evan Lyon - photo courtesy of the Media Co-Op (http://www.mediacoop.ca/)

    Dr. Lyon has been a part of the Boston/Haiti team of PIH for 10 years. He learned HIV medicine in Haiti, where he spent half of his residency. When the January 2012 earthquake struck, Dr. Lyon was working in rural Alabama, although he says that he was immediately pulled back into Haiti after the disaster. While the situation in the Caribbean nation was already very difficult before the earthquake, today the magnitude of the problems – from infrastructure damage to malnutrition, displacement of families to an outbreak of cholera – is much greater. The effects of deforestation include food insecurity, crop destruction, and flooding year after year. In addition, the complete failure of a public health intervention is evident through the prevalence of totally preventable diseases such as tuberculosis, malaria, tetanus, and measles.

    About 9 million people live in Haiti, and while the country lies very close to the US proximally, it is quite unique intellectually, politically, and culturally. To understand Haiti today, one must understand Haiti’s unique history. For about a century, from 1697 until 1804, Haiti was a colony of France, and many of the people living on the island were African slaves imported by French colonists. After the revolution, France began demanding “reparations” under threat of invasion, and Haiti was forced to borrow cash (from France) to repay this debt because no one else was willing to trade with a “combatant” country. This is the first example in history of foreign indebtedness, and it meant that Haiti had less control over its own development. The Haitian economy was created with financial policies geared toward the export industry instead of trying to protect the health and well being of the country’s own citizens. Considering years of other setbacks, including US occupations, a US backed Duvalier dictatorship, coups in 1991 and 2004, as well as repeated embargos and manipulation, one can understand why Haiti is in its current position.

    Dr. Lyon, unlike the majority of physicians in the US, strongly believes in the idea that “illness and most suffering that goes along with illness comes from the social conditions that push someone to be vulnerable and unhealthy.” Social and economic conditions are closely tied with health, and “social medicine” seeks to understand this relationship. “From a health point of view,” Dr. Lyon said, “medicine is a relatively weak tool…there is much we can learn from the social sciences.”  In addition, when the outcome of social and economic structures is greater suffering and early, unnecessary death, “it is right to call this violence,” said Dr. Lyon. “If the forces are unavoidable, as in they can’t move away from it—then it’s a structural thing.”

    Partners in Health started in Cange and more recently has expanded in the Artibonite river valley. At the heart of its model is a commitment to serving the poor through the public sector, granting access to basic primary health care, and removing barriers to health care and education for the poor. The organization will see about 2 million patient visits this year, and it employs 5,000 people, half of whom are community health workers. As the largest health care provider in Haiti, PIH also provides jobs for Haitians. 99% of PIH employees in Haiti are from the country. While PIH is Boston-based, it’s partner organization, Zanmi Lastante, is run entirely by local Haitian leadership. For the last decade, everything that the organizations have been doing has been in collaboration with the Haitian government and the Ministry of Health. Haitian leadership decides where the priorities lie for the organization.

    PIH has put heavy investment in community health work and a delivery mechanism that provides for people within the context that they are living. Rather than focusing on creating new technologies, PIH believes in the idea that there are many great technologies out there that aren’t reaching the poor because of delivery problems – not because those technologies are too high-tech. The idea of “accompaniment”, or sticking with a patient while they are sick or until they can stand on their own feet, is a central philosophy of PIH. Rather than having patients trek to the clinic when they are sick or need medicine, PIH employs local Haitians who know the patients and their community, who can get to their house every day, deliver medicine, make sure they take it, and check in with the patient. In this way a physical and emotional connection is created as PIH works side-by-side with they people they serve. This system also provides great adherence for following a drug regimen, and it provides a safety net so that sicknesses can be caught in their early stages before they become a major problem.

    Currently, the organization is creating a new teaching hospital in Mirebalais. After the earthquake destroyed many of the existing hospitals, the government asked PIH to make the existing project bigger. The hospital will include an ER, trauma center, and cancer care, among other types of care. It will provide high quality education for the future generation of health care providers in Haiti. The hospital’s electricity will be provided through 400kW photovoltaic roof-mounted solar collectors. “Really, this is all happening because of the leadership of the Haitian government and the generosity of donors,” said Dr. Lyon.

    Another current project is a cholera vaccination program aimed at easing the burden for the current outbreak. Nearly half a million cases have been reported in Haiti in 2011, and 6,600 Haitians have died since the onset of the outbreak. In addition to long-term solutions, such as providing chlorinated water, introducing hygiene measures, and improving the sanitation system, PIH decided to start an oral vaccine program in January of 2012. While there has been some apprehension about the program from other public health organizations – particularly because the vaccine has a limited supply and is not 100% effective— Dr. Lyon addressed this by pointing out that “If there was a cholera outbreak in Evanston, IL, there would be no question. You would get the vaccine. It’s one more tool that we have that will save lives.” Indeed, PIH sees the their friends in Haiti as deserving of the same standard of medical care as people receive in the states.

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