29 December 2016

Some Predictions for 2017

I gave my regular predictions blog a miss last year.  Given the wild and crazy ride that 2016 was, I suppose any predictions would have been futile.  

For example the night before the June Brexit vote I was in Berlin, and in a brief exchange with a senior politician I asked their opinion about the Brexit vote.  “No worries” said the experienced diplomat, the UK will stay in the EU!

So, despite the futility of making predictions (especially about the future J), here goes for 2017 (in no particular order).  

1.   The truth will matter more than ever.  Supposedly we are in a post truth, no fact, fake news world.  Now we know people make decisions on the basis of lots of things.   Cicero said that people make decisions based on reasoning, experience, necessity and instinct. How true.  At least reasoning and experience are based on research.  Researchers throughout the world have a greater than ever responsibility to speak truth to power and to do it actively rather than passively. 

2.   We will all have to come together to protect women’s health. The forces being lined up against women’s health are formidable.  Most obviously in the sexual and reproductive rights arena with some elements in the new US administration. These rights have to continually be fought for throughout the world.  Those of us in the nutrition community need to continually stress to decision makers the importance of girls staying in school, girls and women marrying when they are ready, giving birth when they consent and to have access to quality health services. All of these are vital to their own health and the health of their families—those that exist and those yet to be born.

3.   The development and humanitarian worlds will move towards each other. The new UN Secretary General, Antonio Guterres, will start on January 1, 2017.  He follows on from Ban Ki Moon.  Given Mr Guterres’ 10 year leadership of the UN High Commission for Refugees, he will undoubtedly bring a fresh perspective to development.  Can he begin to breakdown the barriers between humanitarian action and development action?  I hope so. We should give him all the help we can.

4.   Overseas Development Assistance (aid) flows will come under more stress.  Donors are under pressure from domestic constituencies who think their countries are overrun by immigrants, feel that services are stretched and who live the reality that real wages of low and middle income households have not yet risen to the 2007 levels.  The temptation for donors will be to “process strangle” the life out of those who compete to spend aid.  Spending money on what you said you would is important, but the most important thing is to have impact.  This will also reassure the doubters.  This means investing in “good enough” evaluations, often with a lag (even a few years after the intervention). Donors need to be more willing to do this.

5.   Human gene editing will lead to a reappraisal of GMOs. If human gene editing begins to show positive impacts on human health (in cancer, HIV, sickle cell disease), there will be a reappraisal of GMOs, at least in plants.  I’m not saying GMOs will become any less controversial, but positions—which have seemed ossified since 1999—could shift.  The reappraisal could lead to new possibilities for doing good things to reduce the use of energy, water, fertiliser, pesticide and herbicide or it could lead everyone to double down on entrenched positions.  We shall see.

6.   Social mobilisation for health will be led, increasingly, by those with the health condition.  As social media and internet penetration strengthens, the networks we already see emerging for people with diseases like Crohn’s may well happen with conditions more common in low and middle income countries. When will people experiencing undernutrition become a powerful political force?  Something may well surface this year.

7.   Big business will become emboldened by the new US Administration.  The talk of business deregulation has got some fearing the worst. They may be right, but this is a reason to intensify engagement with businesses rather than to shut them down.  In the absence of strong governmental regulation, civil society will need to fill the vacuum. Sometimes this will mean blocking action, but most often it should be advising, guiding, nudging, praising and, yes, shaming businesses when necessary.

8.   This could be a breakout year for vegetarian diets. See Impossible Burgers.  Does it count if vegetarian meat actually looks and tastes like real meat?  If it reduces land use, greenhouse gas emissions and boosts health, then, er, yes.  The main challenge will be to make the products safe and affordable. In other words, the “ifs” really matter.

9.   Texting will catch on for work purposes. Anthony Weiner jokes aside, I know of colleagues who use WhatsApp to communicate, eschewing email.  They feel it is more personal, more exclusive, more immediate, and more, well, social.  I’m not sure about this one, but I know that for many people work email is beginning to feel like home mail – only adverts and bills.

10.   2017 will defy predictions. It will defy mine, yours, and even Nassim Taleb’s (wait, he doesn’t make predictions—very smart).  With Mr Trump as POTUS and key elections coming up in Europe, Asia, Latin America and Africa, we are in for a rollercoaster year (let’s hope so, at least rollercoasters have some highs).  Again, evidence is going to be key—those of you who still believe in data (J) please remember to wield it.  I leave you with this: the year-ending edition of Time magazine asked populations in a number of countries “what percentage of the people in your country are Muslim?” In the US the answer was close to 20% (the real number is 1%) and in the UK the answer was 15% (the real number is 5%). The pattern was the same for every country asked—even India.  Good data still matter (although I wonder what the Time poll’s margin of error was? Sigh.)

13 December 2016

We Built This City: New WHO-Habitat Global Report on Urban Health

“By far the greatest and most admirable form of wisdom is that needed to plan and beautify cities and human communities.” Socrates

This is one of the key themes of the new WHO-Habitat Global Report on Urban Health: that promoting health in urban contexts goes way beyond the health sector. 

Yes health systems need strengthening, but the way we plan housing, transport, recreational spaces and water, sanitation and energy infrastructure are also vital--maybe more so.  And as the report points out, throughout history most of the worlds cities have not been planned with health in mind. 

I read the intro chapter, the chapter on nutrition and the chapter on governance. 

I thought the governance chapter was the most interesting. This chapter covers participation (important but not so easy to achieve in a sustainable manner), citizen empowerment through information sharing (currently working best in high income cities), intersectoral action (difficult, but maybe easier in "place-based" contexts), equity as a core value (is justice easier to build in cities where citizens are closer to their representative governments?) and public-private partnerships (on healthy infrastructure, on generating demand for healthier products, and as philanthropists).  Businesses are drawn to cities--can they be drawn to greater health generation as a part of the price of admission?

The chapter on nutrition focused on generating sustainable food systems (although the report does not tell us much about how to get sustainable food systems), urban agriculture (not clear why this approach is highlighted when many others are not), food deserts (which is mainly a US phenomenon), the cost of food (the focus in the report is on what the agriculture sector can do to reduce costs, but what about processors, storage facilities, distributors, marketers and retailers?) and local action (may seem like a drop in the ocean, but these can catch on if developed in the aspirational cities). 

My biggest criticism? There is not enough new data in the report (at least the chapters I read).  I was expecting lots of killer facts, but couldn't really find them.  Also while the presentation of the graphics is not business as usual, the graphs are really hard work to understand.  This feels like a bit of a missed opportunity to feed evidence based advocacy. 

Overall though, this is a solid and comprehensive report.  Socrates would have approved.