May the Roadmap Rise Up to Greet You, May All Your Solutions be Market Driven…

12 Mar

There’s a great new Cochrane Review called ‘Housing improvements for health and associated socioeconomic outcomes’ which looks at the links between poor housing and poor health and the possibilities for improving health through provision of improved housing. This kind of approach would make a welcome change from approaches to health that address one disease, in isolation from all (or almost all) others. The most prominent disease is HIV, but it is sometimes lumped in with tuberculosis and malaria. Other examples that attract the attention of celebrity philanthropists and other donors, sometimes albeit temporarily, are polio, rotavirus and ‘neglected tropical diseases’.

The principle of addressing determinants of health rather than a handful of headline-grabbing diseases is not new, but it doesn’t seem to have attracted very much funding. Insect treated bed nets have, apparently, been successful in some areas. But I’ve never heard of improvements in the design of houses to reduce the number of household pests, including mosquitoes. Indeed, I’ve been in many houses where mosquito nets are in evidence, but there are so many inhabitants in the house, or so little bedding, that they have little effect. Also the condition of the house often means that mosquitoes and other pests have the upper hand.

An interesting exception to the almost entirely vertical approach to health in developing countries is the use of improved cooking methods, especially ones that limit the level of toxic fumes to which women, children and even men, are exposed. Cookstoves are suspiciously hyped at the moment so it’s probably hard to find reliable reports, but the development benefits of clean cookstoves are certainly far more numerous that those of coming up with a separate vaccine for a vast number of diseases (or only coming up with a few and leaving people to die of something else that didn’t hit the headlines). Despite the hype, reducing toxic fumes that people are exposed to in the household is a winner (though there doesn’t seem to be so much enthusiasm for reducing toxic fumes in occupational contexts).

Two of the biggest killers of babies and children are water, sanitation and hygiene, on the one hand, and acute respiratory infections on the other. It’s likely that adequate housing would protect people from both of these, and quite a number of other conditions commonly associated with poverty. Improvements in the broader environments in which people live could add considerably to the gains to be expected from improvements in housing. But for some reason, when big donors are tasked with addressing health they always seem to think of diseases, especially a few diseases that are currently grabbing the CNN moments. I wonder what could persuade those with the money to think about less narrow approaches. Apparently not their expert advisors.

It could be argued that the biggest improvements in developing countries will come from far more traditional ‘goods’, such as water, hygiene, living conditions, security, decent infrastructure, employment, nutrition, agriculture, governance and the like. Yet, so many competitive grants at the moment require ‘innovation’, where that seems to refer to high-tech goods or services. Many development funds expect programs to be partnered with the public sector, as if the public sector is going to (or has ever in the past) sort out all the problems and, at the same time, do so more efficiently and more accountably than any non-public sector recipients of funding. It’s almost as if every development issue can be turned into some kind of profit making venture, through the provision of genetically modified organisms, vaccines, advanced technologies such as mobile phones and cheap laptops and the like, but certainly not through access to human rights. …and may you be in credit half an hour before the donor knows you lied.

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