Tuesday, September 28, 2010

Not Charity, but Solidarity

I was at a party last week that capped a hectic, but thoroughly fascinating week at the UN MDG Summit. The party was actually a happy-hours MDG gig organized by a forum cheekily called BYOC, or Bring Your Own Cause. After a week of hobnobbing with the who’s who of global health and development (I met Margaret Chan, Director-General of WHO thrice!), this party was a refreshing off-off-UN Plaza affair. Nobody talked about advocacy, nobody uttered ‘leveraged partnerships’ and most importantly, nobody said anything about ‘new money’. It was all very laidback with most people younger than me, bringing with them the youthful enthusiasm that somehow gets diluted the closer one gets to UN Plaza.

Sometime during the evening, I got drawn into conversation with a hulk of a human being. He was German, of course, and standing at well over 6 feet, he literally towered over me. I recall him telling me that he was studying International Affairs, and our conversation drifted to social systems as he was keen to know about the caste system of which India is the unfortunate heir. He then proffered that the class system in Germany wasn’t very much different than the caste system, and it was difficult, if not impossible to rise above the class that you were born into. Of course, I would argue that in India, one gets bogged down by the double whammy of the caste AND class system, but I was intrigued to know that social mobility was a deep concern even in a society as advanced in Western values of individualism and freedom as Germany. My German friend then made an interesting argument, which I thought held its fair share of water. He said that social mobility was difficult because the folks at the top of the pyramid were afraid of relinquishing their top-dog position to those from lower levels. Continuing with the argument, he said that those at the top are all too happy to share their resources with the ones below, as long as their positions are not challenged. When they fear for their own supremacy, their generosity dries up, and they become protectionist and would do all within their power to hold on to the reins of power. Legitimate logic, I thought. He then extrapolated this pattern to international aid. He predicts that with the rise of the Asian powers of India and China, traditional donor countries like the US and Europe would be wary of helping these countries in their ascent and international aid flows would see a precipitous decline. I have to say, I could find no fallacy in his argument, and it sounded pretty convincing at the time.

However, my doubts about continued international aid were soon put to rest by President Obama’s address to the UN General Assembly. They were further allayed as I read through the US Global Development Policy, the first of its kind issued by a US President. It was quite a relief to see that the most powerful man in the world does not view international power politics as a zero-sum game. The Obama administration realizes that there is place for all nations in the evolving global geopolitical landscape, and doesn’t necessarily view the world as a hierarchy, but rather as a comity of nations whose collective prosperity would always surpass the wealth that any one nation could generate for its citizens, acting independently. You may claim that I’m naïve to believe the politically correct posturing of an astute politician, and I realize the validity of that claim. For all we know, perhaps the developed countries may take on a stance of protectionism to hold on to their positions at the top of the ladder in the years to come. That, however, would be their own undoing. The unprecedented prosperity that the developed nations have seen over the last century or so is the result of them allowing each market to feed off the prosperity of the other, thus leading to a hyper-functional system where the whole is more than the sum of its parts. If Adam Smith taught us anything, it’s that an economically formidable partner is more of an asset than a threat. In his speech to the General Assembly, President Obama pointedly asserted that the aid that was being given to the South isn’t really an act of charity, but rather, an act of self-interest. That one line tells me, more than anything, that Obama gets Adam Smith, and is a far cry from the socialist that he is so often accused of being, and that I wish he was. At least, he seems to be the good kind of free-market advocate.

My guess is that seeing developing countries actually developing, the rich nations will drool at the prospect of growing markets for their products thanks to increasing purchasing power, and that will spur them to push the process along even more quickly. So, Holger, rest assured that international aid will not dry up. If anything, it will further increase, continuing the trend that recent years have seen. Your job and mine are secure as long as a market remains to be created; and that shall remain a prospect till kingdom come.

Monday, September 27, 2010

Like Money in the Bank

One of the more interesting, and even, in my eyes, ridiculous events at the MDG Summit last week was a session that was deceptively titled “Innovative Financing for Development”. Always keen to hear about where the fabled “new money” for development would come from, I made it a point to attend this event, in the hope that I could tap into the most radical thinking in terms of generating funds for development. I got to hear radical thoughts, for sure, but of a slightly different nature.

What was touted as a session Innovative Financing turned out to be deliberations (which I felt were self-aggrandizing) on a proposed Currency Transaction Tax. That was it. No talk about the International Finance Facility for Immunization, no talk about optimization of the funds available through the Global Health Initiative. Nothing. Innovative Financing to these folks was levying a Currency Transaction Tax (CTT) on all international currency transactions.

To be fair, I have to acknowledge the promise in the idea. International currency flows at mind-boggling volumes from one location to another. In 2010, this volume has swollen to USD 4 trillion a day. Yes, that’s 4 trillion A DAY. The estimate is that a taxation of barely 0.005% on this amount would yield a sum of USD 33 billion a year, which would then be channeled into development efforts throughout the world. I have to hand it to the fairness of the idea of a tax on currency flows that until today have largely been unaccountable to international regulation. The argument continues to state that a proportion as small as 0.005% will have no noticeable effect on the volume of these transactions, which does seem reasonable. Finally, of course, the world of development could do with 33 billion dollars of spare cash.
Now, for the critique. What I found most disturbing at the discussions were the attitudes the panelists and indeed the members of the audience had towards the whole idea. There was such a strong sense of self-righteousness and entitlement that one would have imagined the money that the CTT would yield was something that they themselves had worked hard for. I watched in astonishment as each panelist proceeded to rail against the banking system and the entire financial establishment. They brandished their pitchforks and torches to ferret out the immoral and “criminally obscene” profits that the financial world was making. It’s time “they did their bit” to help an ailing world.

Now, I’m certainly not a Wall Street sympathizer, but there were several things wrong in the approach of the panelists and the audience that day. First, they must realize that they are demanding a pound of flesh from none other than the richest people on the planet outside of Hollywood. These guys got rich not by being conscientious, or socially aware, but rather with their eye on the bottomline. It would be foolhardy to believe that moralistic patronizing would carry water with an organization as far down the road to perdition as Goldman-Sachs. A different approach is required.

My second issue is political. The talk that morning portrayed bankers as monsters capable of no good whatsoever. In talking of the bankers as “the bad guys”, you are immediately making enemies of them, and they are a poor choice of foes. If money makes the world go round, the folks in the banking sector have it spinning like a crazy top. These are powerful people, with powerful friends. If you try to push a tax through without having them on board, you will fail. You will lose a confrontation; so don’t even attempt it. There is another way.

When President Obama was still Candidate Obama, most people on Wall Street knew he would lean further on the left. They knew he’d tax them, and that they’d earn less if he was elected; and yet, Wall Street voted for him, with both hands. Incongruent, you think? Not so, say I. Contrary to how we typically portray them, bankers are not ogres, with greenbacks for irises. They are human beings, and feel the entire range of human emotions, greed being only one of them. They know when a need exists, and they know when they are being called upon to contribute to the health of society as a whole. This is the asset we have, that each one of them is human, and hence, vulnerable to the humanistic agenda we preach. However, we can sell this agenda to them only as long as we have them on our side. The minute we push them away, we lose their sympathy, and more importantly, we lose their money. If we treat them as partners and equals, they would come to the table of discussion and the CTT may yet be passed. All we need to do is convince them. In order to do this, we need to prove to them the legitimacy of our cause. Alas, it is at this point that my third and biggest concern lies.

My final concern is the moral prerogative we have, as the development community, to ask Wall Street to make sacrifices and do its bit. Most of the events around the Summit happened in the most deluxe hotels, and served the finest food and alcohol. Maybe this is just me, and it’s unfortunate if it is, but we do not present the image of being a community with a scarcity of resources. If we need any sort of moral legitimacy in asking the financial world to contribute its share, we need to show some austerity in our own gatherings. I would find it extremely hard to say to somebody in Morgan Stanley that I’d like some of his money – for free – so that I can throw a party for my friends at the Helmsley Hotel. Yet, this is exactly what we seem to be doing. A banker making his way from Wall Street to 3 UN Plaza will hardly be able to see any distinction in the excesses.

Love thy neighbor as, well, thy neighbor

Much has been written and lamented about the failure of the international community to cough up the resources needed to come to Pakistan's aid in order to help with the flood relief effort. India, being a neighbor has been expected to contribute to the relief effort, and in our enthusiasm to be of aid to our whimsical neighbor, India has offered to route the relief material it sends across through the UN, instead of the logistically more appropriate bilateral support we could offer. This, of course, is a reaction to the Pakistani reluctance to be seen as taking aid from arch-enemy India. Oh, the ignominy, Pakistan! Of course, every humanitarian bone in my body screams, gush forth with all you have, India. However, having studied health policy at no less than the Harvard School of Public Health (yes, this blog may one day double up as my CV), I can think of a more devious, and hence, better strategy that India may pursue.

The war India fights in Kashmir is not a war of choice. It's a war foisted upon her by mischievous elements outside of our borders. Once an externally propelled war, it has now grown to be an externally supported war, with the secessionist movement in Kashmir having taken an alarmingly local character. Of course, the ISI is always seen to lord over all that things militant in Kashmir, and for good reason, but the breakout of violence, and the brazen rejections of Indian calls for dialogue by some leaders of the Kashmiri people only indicate that India only holds Kashmir militarily. The people of Kashmir increasingly view India as an oppressor and an occupying force. India is losing the battle for the soul of Kashmir.

Floods, hundreds of miles away, could change things. India has the economic and logistic clout to be able to be of immensely greater assistance to the people affected by the floods than the insipid Pakistani government ever could. India should ask for its pound of flesh, though. And my proposed pound of flesh won't leave the Pakistani people with a hole in their gut.

India should insist that the aid that is delivered to Pakistan is called what it is- Aid from India. I always appreciate the tag-line of USAID-A gift from the American people. Let the 5 million dollars of aid that India offers to Pakistan be called that- a gift from the Indian people. If we're indeed calling it that, I would suggest, let's give much more than that to Pakistan. In fact, let's pay for this entire relief operation. Let's go in and fill the void that the Pakistani government has failed to do. Before you accuse me of blind brotherhood, let me assert that my suggestion is rooted in explicit self-interest.

India spends the equivalent of more than 20 billion dollars on defense activities. Of course, most of this expenditure goes into thwarting the threat of cross-border terrorism perpetrated quite admittedly, by Pakistan. There are elements within Pakistan whose existence is merely to perpetuate the bad-India story. This is the story that wins them recruits to their cause of cross-border and even global terrorism. Imagine what it would do for their PR campaign if the food cans their recruits ate out of said "A gift from the people of India". I'm not saying it will work for sure, but the next time an Ajmal Kasab has to pull a trigger, he'll know he won't be firing at an oppressive ogre, but somebody who helped put baked beans on his plate during a bleak time. And that may just make the difference.

The right thing for India to do now is to help Pakistan, in whatever way we can. However, making our contribution anonymous would be a strategic mistake in the name of self-sacrifice. Instead, India should stand up and be counted. India should tell the Pakistani people that when they were at their weakest, the Indian people came to their aid. That will save many more Indian lives than it does Pakistani.

Blind Data

“In God we trust. Everybody else must bring data.”- NR Narayana Murthy, Chief Mentor, Infosys Technologies

The stand-out session for me at the recently concluded MDG summit was the one organized by the World Bank and titled, “Impact Evaluation”. The panel included Michael Kremer, Gates professor at Harvard University, who was literally the only person from academia that I met during the entire week at the Summit. The rest of the panel included folks from the World Bank, and was chaired by the very impressive Michael Anderson, Director-General of Policy and International Relations at DFID. The subject of discussion- data, and how it drives policies today.

Each expert presented a point of view from their respective fields of interest. The central theme was the relevance and importance of generating data to drive policy, rather than assumptions and “common sense”. Of course, after one year at Harvard, this manner of thinking wasn’t new to me. There is such a strong emphasis on data that one may be forgiven for the RCTs-for-parachutes jibe that has become part of the lore of research humor. Sitting back, though, it’s quite incredible how radically different this manner of thinking is to me, compared to what I was exposed to in medical school.

India isn’t really the hotbed of research. For all our prowess in math, and chauvinistic claims of having gifted the world the concept of zero, the sad fact is that, as a people, we do not think in terms of numbers. This, however, I have learned, is not a problem restricted to India, or even the subcontinent. It is a problem in Africa, a problem in South America, and definitely a problem in Asia. In fact, it might be interesting to study the relationship between per capita income and the reliance on data in determining policy within a country. My guess is that there will indeed be a correlation, although I’m not so sure about which would be the chicken and which would be the egg.

In the clinical world, the practice of eminence-based medicine rather than evidence-based medicine is the pejorative phrase that’s used to describe the philosophy of “I’m the boss, and I told you so” in designing patient care. Protocols and standard guidelines get thrown out the window while the heuristic practice of policy replaces them. Policy-makers and decision-takers routinely make their choices based on their personal experiences, irrespective of what the published literature suggests. This gives rise to statements like, “In my experience, this works.” Of course, the fallacy of their sample size of one could be pointed out to them, but for somebody with less training in statistical methods than a 3 year old, the argument would be a lost cause.

It’s time this changed. It’s time students were taught to start thinking in terms of numbers and hard evidence. I’ve previously blogged about my attempts to rectify the anomaly by setting up IMPULSE. The enthusiasm of the uptake of this effective intervention shows great promise for replication on a larger-scale, and as a community, the development world would do very well to sell the idea to schools and colleges in the developing world. This would enable us to develop the in-country expertise of generating data required to formulate sound policy, without having to resort to the expert advice of expensive consultants. Indeed, local capacity building is the most effective means of cost-cutting in international development.

Data is the final leveler. Whether you conduct your research in the finest labs of Harvard, or in the most trying circumstances on the field, in India, as long as your data and methodology is sound, you have the upper hand. It’s very encouraging that the world has now started to think robustly in terms of using data as the prime determinant of policy. The chair of the World Bank panel remarked with satisfaction that he was surprised that not a single member of his audience stood up, and claimed that data should be second to on-field experience in determining policy, as he expected. Mr. Director-General, I believe our trends are promising, but your sample was skewed. New York City is a world away from the chaos that is Mumbai. You should know; you work in New Delhi.

Superstar advocacy

The Global Health Initiative lists the centrality of women and girls in its agenda as one of its guiding principles. President Obama and Secretary Hillary Clinton have repeatedly asserted that an important focus should be placed on the rights on women. The recently concluded MDG Summit talked expansively about the need to put the rights of women and girls at the center of the development agenda. All of these are the right noises. Yet, I believe, these noises are being made in places that are so high up in the stratosphere that they fail to impact the very people for whom these noises are made- the girl in India, the pregnant woman in South Africa. The noises that people are hearing there are, in fact, very disturbing.

I had the opportunity-if one may call it that- to watch the Bollywood film Dabbang, starring Salman Khan. For those who don’t know Salman Khan (which planet have you been hiding on?), he is arguably the biggest, most bankable star in the Indian movie industry. His legions of fans and the instant recognition and credibility he brings to his films make him an important person in the cultural landscape of India. His film Dabbang broke box office records, and it portrays him as a police officer fighting against a corrupt system, while somehow mired in it (Bollywood logic, don’t look at me!). During the course of his exploits – and there are many – he settles his desires on a stereotypical village girl, complete with the beautiful face, deferential attitude and abusive father. He, of course, has to rescue her from the misery that is her life. But first, he has to win her heart. He does so by literally eve-teasing her and harassing her to the extent that he gets her to come to the police station by leveling false charges against her drunken father. Of course, the film does this to try to be funny, although I hardly laughed. My complaint, however, isn’t against bad cinema; it’s against how this film – and others – depict women.

Primarily, it shows the woman as somebody to be saved, somebody who does not have the power or control over her own life that she needs a man to come out and rescue her. While this may reflect reality in many Indian homes where women are afraid to stand up for their rights, all the film does is perpetuate this cycle of oppression. More disturbing though, is Salman’s methods to woo his woman. Salman is a role model to many in India; people look up to him and imitate his mannerisms and actions. His celebrity burdens him with great responsibility. An impressionable youth sitting in a cinema house in India watches Dabbang, and thinks, “I want to be just like him. If Salman harasses a girl he likes, it can’t be wrong. Maybe I should try that on the ‘object’ of my fancy too.” The outcome is all too apparent to somebody who has lived for an extended period of time in India, especially in the unruly north. The worst part is, this phenomenon of legitimizing the suppression of women’s right to a decent life isn’t limited to Dabbang. I remember having been disturbed over and over by Bollywood with so many of the films I’ve seen. The objectification and demeaning of women is simply disgusting.

No matter how many syllables the international community packs into words like advocacy, the sad fact is that, on the ground, those who should be the real advocates of women’s rights, are exactly the opposite- the purveyors of a bankrupt culture that puts women in second place. Whether this is in India, or in South Africa, where the polygamist President Jacob Zuma gets away with rape by claiming that his culture demanded that he should not leave an aroused woman “unsatisfied”, the noises on the ground are all the wrong ones. No matter how many meeting are held at the UN Plaza, and no matter how loudly Bono croons, people’s and partner government’s attitudes will remain calcified unless the thought leaders within local communities and cultures show a sensitivity and maturity in dealing with these issues which are so important to the agenda of the MDGs. After all, this is a battle of sensitivities. The transgressions in Dabbang, I would proffer, seem to be the outcome of the absence of somebody sitting with a sanitizing brush and making sure that the film isn’t socially harmful. Salman Khan, I believe, is an earnest man, and the film is honest in its intentions. After all, in one fleeting scene, Salman Khan makes a very obvious reference to the pulse polio campaign in India, and the importance of vaccinating children. The development community clearly has an ally in Salman Khan. We now need to align him with each of our agendas. Advocacy couldn’t be nearly as useful at the Millennium Plaza Hotel as it could be at the office of Salman Khan, Bollywood superstar extraordinaire.