Tuesday, September 25, 2007

A Business Model for Global Health

What can business teach public health experts--and everyone else--about how to improve people's health around the world? One idea that's gaining ground around Harvard (and elsewhere) is the use of case studies--and not just the gold standard of scientifically controlled clinical trials--to figure out what works and what doesn't.

Some days I wonder if I'm at the School of Public Health or the Business School. Jim Kim--champion of the 3 x 5 initiative to get more poor people on anti-AIDS therapies--is working with Mike Porter--corporate strategy guru--on developing case studies of what does and doesn't work in global health. They'll both be teaching classes that tap into this approach in January.

Peter Piot, head of UNAIDS, brought up the case-study method in a keynote speech yesterday at, of all places, a symposium on "Meeting Children's Needs in a World with HIV/AIDS." You still need controlled trials, Piot was quick to point out when several journalists spoke with him after his speech. But there may be some ways to use case studies--to learn from past experience--to figure out how best to deliver on the promise found in controlled research studies.

Case studies, for those of us who don't have MBAs, are well-researched 3 or 4 page summaries that lay out a particular real-world problem that a real-world organization faced at some point and then ask the group to put themselves in the place of the chief executive officers or others and propose strategies for going forward.

Of course, case studies aren't going to tell you if a particular antibiotic works or not. That's the realm of a scientifically controlled clinical trial. But a case study may give insight into how to introduce a new antibiotic into the developing world, or decide between a couple of different choices of antibiotics as to which works best in the poorest parts of the world, what kind of health-care infrastructure is needed, what might happen when the antibiotic gets out into the gray market, and whether, on balance, these factors sway you towards one course of action or another.

But the use of case studies is just a piece of this business approach to global health. A more critical look at the costs and benefits of borrowing the business world's tools--which often includes a decidedly anti-government bias (very convenient for academic researchers and NGOs who are not in government)--is beyond the scope of one blog post. But it's definitely something to keep an eye on.

Friday, September 21, 2007

Listening for Sound Bites

Couldn't pick between four events yesterday after classes were over, so went to all four. We'll see how long THAT lasts.

Lots of high-falutin' ideas at MIT's forum on "What is Civic Media?" about whether social networking and distributive intelligence have killed or fostered democracy's "deliberative ideal." (Update: See Ethan Zuckerman's blog post on the "civic media" forum for more detail.) And really scrumptious chocolate cake at the meeting of the pre-med committee at Lowell House as well as great appetizers at the Knight Science Journalism Fellows reception at MIT. (Free food seems to be a theme at a lot of the events I've attended lately.)

But the thought that's still rattling around in my brain this morning as I hurry off to class is something that Ira Magaziner said at last night's student forum at the Kennedy School. I'm paraphrasing here, but basically he said, that if you love what you do, then you don't notice the hours that you put into your job and, by extension, away from your family. Specifically, of course, he was talking about his passion for global health and poverty alleviation in his capacity as chair of the Clinton Foundation HIV/AIDS Initiative. They don't worry too much about individual job satisfaction at the Clinton Foundation, Magaziner said. They're too busy saving lives.

At a minimum, that sounded to me like a recipe for burnout. And the more I thought about it, the more it also seemed like the kind of attitude that lets people off the hook too easily. If you have to be a Mother Teresa to do anything about global poverty or the wide disparity around the world in basic health care, then not much is going to get done. (And lately, we've learned that even Mother Teresa wasn't the kind of saint most people thought she was--she was privately wracked with doubt about both her faith and her mission.)

The point being that there will always be people like Paul Farmer, who was also at the Kennedy School forum, and Ira Magaziner who are driven to do something, driven to the point that their passion consumes their lives. But if we leave the vision of a more just and healthy world to people like this alone, the mission will never be accomplished.

Ordinary folks, the kind who do care about job satisfaction and vacations and having time for family, have to be part of the equation as well or the job won't get done. And it's okay to make room for ordinary folks with ordinary goals.

Wednesday, September 19, 2007

Top Tips from Bangladesh's BRAC

Be realistic about what you can accomplish. Monitor your progress. Learn from your mistakes. Always think about how you're going to scale a project up (preferably to at least the country level), even when you're in the pilot phase. Those are some of the things I took away from a talk at Harvard on Monday afternoon by Fazle Hasan Abed, founder and chair of BRAC, the highly successful poverty alleviation group in Bangladesh.

Abed is not as well known as his fellow countryman Muhammad Yunus, who won the Nobel Peace Prize in 2006 for his work with the Grameen Bank. And indeed, the men are often seen as rivals in the development world. But Abed has never shown any inclination to run for political office, while Yunus recently abandoned plans to create a new political party in Bangladesh. And perhaps that's the most important message I got from Abed's talk: "Stick to your knitting."

Monday, September 17, 2007

First Impressions from Harvard

If the past three weeks are any indication, my year at Harvard as a Nieman Fellow is going to fly by. Among the things I've learned in the first few days:

1) Never bet against the economy. Despite dire predictions in the 1970s, the world's recent unprecedented growth in population has not destroyed the global economy. Effects on environment and social well-being are another story.

2) The gap between rich and poor is not just growing. It's exploding--as even a casual look at the numbers (on life expectancy, fertility, disability and education) shows.

3) We constantly underestimate the importance of things that don't happen. More people have not been born because of China's one-child family policy than died in the Great Flu Pandemic of 1918-1919.

Saturday, September 15, 2007

Kaiser Offers Global Health Mini-Fellowships

Want to cover global health issues in greater depth but can't get your boss to cough up the money to send you to China, India or Zambia or you can't afford to bankroll the trip on your own?

The Kaiser Family Foundation has just launched a new awards program of up to ten mini-fellowships--worth as much as $10,000 each--for journalists from North America or Europe interested in doing substantive reporting on topics such as AIDS, TB or malaria. The deadline for applications is November 1, 2007 and reporting needs to be completed by Dec. 31, 2008.

Sunday, September 9, 2007

Global Health News Feeds, Part Two

Global health news tends to fall between the cracks of "world news" (wars, disasters) and "consumer health news" (asthma, heart attacks). Last week, I posted instructions on how to build your own global health news feed using Yahoo Pipes. Here's another option that's a little more hands-on.

In this case, I'm using Google Reader, a news feed aggregator and its "shared item feature" to combine news items generated by RSS feeds from the traditional media with alerts and other posts that I find particularly newsworthy as I surf the Internet.

The advantage: many of these newsy bits of information--like a recent BioMed Central research paper linking diabetes and tuberculosis in India--are typically not covered by the mainstream media.

I capture the surfed items using del.icio.us, a social bookmarking website. And then I subscribe to an RSS feed of my del.icio.us bookmarks with Google Reader.

The big advantage of del.icio.us is, of course, that you can see what others have posted as their favorite items on subjects like tuberculosis, malaria, poverty etc. Many pairs of eyes are sometimes better than one.

A further refinement, I hit the "shared button" on Google Reader only for those del.icio.us items that I think might be interesting to more people than just myself.

So if you want a news feed that combines automatically generated items with some that have been tagged by human hands, then check out my shared global health news items in the Global Health mini-blog on this page at right.

If you want to see more than five items at a time, go directly to a separate web page with my shared global health news items. There's also news feed.

If you get inspired to create your own global health news feed, let me know!

Thursday, September 6, 2007

How to Build Your Own Global Health News Feed

Step-by-step instructions for creating your own RSS feed of global health news items, using Yahoo pipes. No programming knowledge required.

Global health news tends to fall between the cracks of "world news" and "health news," as defined by the traditional media. World news is usually limited to wars, conflicts and humanitarian crises while health news typically focuses on consumer-oriented pieces about losing weight, staying fit, etc. (Good topics but not what we're after in global health.)

So I've been experimenting with building my own global health news feed, using Pipes from Yahoo.

This one, described below, is my favorite so far. It's not perfect but it's simple. Feel free to use these instructions or adapt them to fit your own needs. Let me know through the comments or by e-mail at cgormanhealth[at]gmail[dot]com, if you think of any improvements.

If you want to skip all the work that follows, here's the link for the RSS feed for Christine's custom-built, global-health news feed. (Copy and paste the url into your usual news aggregator, e.g. Bloglines or Google Reader.)

Step One. Get a Yahoo account, if you don't already have one.

Step Two. Log in to pipes.yahoo.com

Step Three. Choose "Create a pipe" from the options at the top of the page. Your screen should look something like this:

Step Four. Go to the pull-down menu on the left that says "Sources." Drag the "Fetch Feed" module into the workspace on the right.

Step Five. Add your favorite RSS feeds, one after another by clicking on the (+) sign and filling in urls like http://globalhealthreport.blogspot.com/feeds/posts/default
or http://rss.news.yahoo.com/rss/aids

Your screen should look something like this:

Step Six. Open the "Operators" tab on the left and drag the "Sort" module to the workspace. Choose sort by "item.published" in "descending order" (very important) from the pulldown menus in the module.

Step Seven. Connect your first module to your second module by clicking on the round circles on the bottom and top of the modules.

Step Eight. Add a "Unique" module from the "Operators" list. Sort by "item.title"

Step Nine. Connect second to third module and third module to "Pipe out."

Step Ten. Click on the debugger link in the frame at the bottom of the page to make sure the feed works.

Step Eleven. Save your pipe (button in the upper right-hand corner) and name it. You should have something that looks like this:

Step Twelve. Click "Run Pipe," which magically appears at the top of the menu (at least on Firefox) after you've saved.

Step Thirteen. Publish your pipe if you want others to see how you created it.

Step Fourteen. Subscribe to your pipe as an RSS feed, or in your favorite newsfeed aggregator.


In my next post, I'll outline a more hands-on approach to aggregating global health news.

Wednesday, September 5, 2007

First Day of School--And Loving It

Yesterday was the first day of classes at the Harvard School of Public Health. I started off in Richard Cash's Introduction to the Practice of Global Health. Cash is one of the people who developed oral rehydration therapy (ORT) for the treatment of severe diarrhea.

ORT doesn't cure the cholera or rotavirus infections that typically cause diarrhea but still saves millions of lives by replacing the salts and fluids the body loses during bouts of these potentially fatal illnesses. And ORT is extremely inexpensive, which is very important in desperately poor parts of the world.

Later in the evening, several of us Nieman Fellows went to the Kennedy Library to hear journalists Charlayne Hunter-Gault and Gwen Ifill talk about civil rights, Africa, the state of news coverage in the U.S. and the fact they are both PKs (Preacher's Kids). I was particularly intrigued by this last point since I'm a PK, too.

"What is it about PKs and journalism?" I later asked Ifill. She said her theory is that we are used to being watched by everyone in the congregation. So we either embrace being in the public eye or flee into hiding. (I confess to a little of both.)

The other touchstone from the evening for me was Hunter-Gault's statement that sub-Saharan Africa is no longer primarily a humanitarian issue for Americans. It's now an energy issue, with a direct effect on the price of the gasoline we put in our cars--something the Chinese government clearly understands, considering its recent ramped up investment in Africa.

"This is what is going to jolt America into understanding her national interest in Africa," Hunter-Gault told a group of several hundred people at the Kennedy Library last night. "It's China. Because China gets it."

And so my Nieman year begins.