Sometimes it’s hard to believe that a disease we’ve been fighting as long as malaria is still serious. Malaria sounds like it should have vanished with the British Raj. But it hasn’t. On World Malaria Day, five truths about malaria’s continuing existence, from the World Health Organization.

1) According to the WHO, in 2010 there were an estimated 216 million cases of malaria, and 655,000 people died–most of them African children.

2) Malaria is growing increasingly resistant to drugs. Resistance to choloroquine, the cheapest, most commonly used malaria drug, is growing in the countries where malaria is most common. Ominously, resistance to the combination treatment of sulfadoxine-pyrimethamine is also growing. It’s present in South America and in Southeast Asia and now emerging in East Africa.

3) The Thailand-Cambodia border is ground zero for resistant forms of malaria. The combination of excellent mosquito habitat and ineffective malaria treatment available over-the-counter means that when new forms of malaria emerge, they emerge there first.

4) Pregnancy and malaria are a fatal combination. Being pregnant makes a woman more likely to get malaria, and more likely to die from it once infected. It also carries serious risk for her unborn child: stillbirth, spontaneous abortion, and premature birth.

5) Finally, mosquito nets work to prevent malaria transmission, but not alone. Mosquito net distribution needs to go along with education to get people to use the nets, and it needs to be accompanied by efforts to kill mosquitoes and destroy their habitats. The WHO recommends removing sources of standing water, and in some cases spraying indoor walls with mosquito-killing pesticides. Supporting these kinds of integrated programs are our best shot for eliminating malaria.

(photo: USAID Kenya)

Doha, Qatar - I just came out of the UNCTAD Interagency Cluster Meeting on Trade and Productive Capacity. Toward the end of the session, the representative from UNCITRAL mentioned that development is grounded in a free and open legal framework for equitably resolving disputes. It’s a good point, but it reminded me of one of the classic chicken and egg dilemmas in development work.

No matter how good your laws are, they are worthless if they’re not enforced in a fair and effective way. Failing to enforce them, or enforcing them only on the powerless and non-privileged, makes your excellent laws useless. Excellent lawmaking needs the backing of rule of law, or it has no effect.

That, of course, brings the question of where you start. Do you start by working on law enforcement and rule of law? Or do you start by improving the quality of the laws that are being enforced? Excellent laws might be worthless without enforcement, but improving the enforcement of bad laws isn’t a good solution either. People won’t believe in and obey laws that are senseless, contradictory, or cruel.

UNCITRAL clearly focuses on model laws and improving lawmaking. I’ve seen other efforts that try to improve policing, or attack government corruption. Some programs try to target everything at once. Like most development work, anything you choose ends up being a compromise of some kind.

I am in Doha this week for the UN Conference on Trade and Development. Disclosure: UNCTAD’s PR firm covered airfare and lodging to allow me to participate in this conference. 

Doha, Qatar -  UNCTAD, the UN Conference on Trade and Development officially opens its 13th meeting in Doha on April 21^st with an opening plenary. In advance of that opening, the conference held a press conference today with the Secretary General of UNCTAD and the President of the 66^th Session of the UN General Assembly.

Secretary General Panitchpakdi presented an impassioned defense of UNCTAD and its mandate. He spoke of the need for global cooperation, and UNCTAD’s role in speaking for the poorest countries. Speaking about globalization, he said “This is a race that should not have winners and losers. This is a race that everyone should win. But everyone cannot win. This is about us being a voice for the people, and nations, that do not win.” He went on to call for more policy space for developing countries to exert government control over their economies. Specifically, Paitchpakdi mentioned the need to nationalize industries.

The Secretary-General also presented four lessons that the global economy must learn from the financial crises of the last few years. 1) “We need to look at regulating markets. The market doesn’t always get development right,” 2) “Look at the role of the state. Governments can’t always rely on taxes when the financial system goes to excess,” 3) “Finance should not only enrich finance-related entities,” and 4) “We need collective efforts to tackle global finance, and we’re not seeing them.”

Panitchpakdi described UNCTAD as an essential forum for economic thought and a body for cooperation that would not otherwise occur. He stated that financial change can’t occur in a single country alone; there are spillover effects. Finally, he called for major changes to financial regulatory systems, “We don’t need to reform financial architecture, we need to invent it.”

Overall, this speech represented many of the themes UNCTAD is best known for. It was an attack on the Washington consensus and a call for a new approach to global finance. Without explicitly mentioned it, the speech also rebutted the efforts of wealthy countries to reduce UNCTAD’s mandate and reserve international financial issues for the World Bank and the IMF.

UPDATE: This was a really popular post this week with some interesting comments from readers. I thought people would enjoy the repost. Please weigh in with your thoughts. As I write, it looks like the Invisible Children Video (embedded below) will have been viewed on YouTube about 55 million times in 4 days. And, now, the Main Stream Media is jumping on board.

Ed note.  Invisible Children’s new advocacy video has caught the social media world by storm. There’s been nearly 2 million views on YouTube since it was posted two days ago, and a raging discussion on Twitter.  I (Mark) asked Alanna to for her thoughts on the video.  She is a fantastic writer and framed the post as “Invisible Children: Saviors or Sensationalists?” I don’t think she or I actually believe they are ALL one or the other, but it’s a great hook and I took the bait.

Alanna comes down more on the latter and I on the former. Have a look and let us know what you think.

Alanah Shaikh: More Sensationalists than Savior. 

Invisible Children, the advocacy group known for its cool-looking t-shirts and aggressive advertising, has suddenly reappeared in social media with a new campaign called KONY2012. Backed by a stunning video, the campaign calls for military intervention to remove Joseph Kony. There’s a website where you can donate, merchandise to buy, and the biggest trending twitter hashtag in the world: #KONY2012. It’s an impressive advocacy effort.

But is it actually a good idea?

I am not a Uganda expert. I’ve heard of Joseph Kony. I know of the LRA. I am not qualified to take on the question of whether Invisible Children is advocating for a useful solution. I am, however, reasonably familiar with aid and NGOs. When I look at the organization, this is what I see:

Their communications are heavy on shock value, light on content. How do they want to eliminate Joseph Kony? What does Invisible Children actually do? It’s so hard to find out that it seems as though they are deliberately obscuring it. The Unmuted blog states that Invisible Children has no Ugandans on its US staff or board of directors. On my first attempt, I couldn’t even tell if that was true. I couldn’t get through the flash-heavy website to find out anything about the organization. I could buy bracelets, though, no problem.

Eventually, I got around the Invisible Children’s front page by using a search engine and found the organization’s staff listing. As far as I can tell, Unmuted is correct. There are no Ugandans on the board of directors or the US staff. That is a big red flag for me. (They also don’t have any women of people of color on their board, but that’s a discussion for another day.)

Percentage of funding spent on overhead is not a good way of judging an organization. That being said, based on IC’s own financials, as far as I can tell they took in $13 million dollars last year and 2.8 million of that went to Uganda. If they’re an advocacy organization, that’s fine. They should be spending their money in Washington and London and Brussels and Beijing, pushing for action.

But that’s not how they package themselves. They package themselves as a group that does advocacy and “gets their hands dirty.” Here’s what they say on their website “We implement and maintain education programs and economic initiatives on the ground in Central Africa. Recovering communities require stability when it comes to education and economic initiatives, but the ever-changing conflict demands innovative solutions and quick mobilization. Our initiatiatives (sic) attempt to meet the region’s need for both stability and flexibility.” But the IRS 990 forms are hard to read. Take a look at the IC form yourself – I may just be missing something here. (One more discussion for another day – when did Uganda move from East Africa to Central?)

Finally, there have been no shortage of efforts to kill Joseph Kony and end the violence in Uganda. The International Crisis Group has a good overview. They fail, and they often do harm. Why does Invisible Children think this is the best solution? Why do they think their approach can succeed where others didn’t? The KONY 2012 campaign doesn’t tell us.

Joseph Kony is a murderer and an awful human being. But there’s blood on the hands of the Ugandan army, too. This is not a conflict with a shortage of atrocities on any side. If Invisible Children wants our support, they need go beyond explaining why Kony is bad. They need to tell us what IC does, what approach they’ll take to removing Kony, why they believe it will work, and what happens after that.

Right now, they’re not giving us that. Right now, they’re giving us a dramatic video and some really well-designed accessories.

Mark: More Savior Than Sensationalist!

I don’t have any grand aspirations that this video will somehow affect whether or not Kony is captured and sent to the ICC.  Ultimately, I don’t think that’s the significance of this video (though the Invisible Children people would probably dispute that claim!) Rather, this campaign is potentially game changing because for the way it nurtures the burgeoning civilian protection/genocide prevention movement here in the United States.

We need to think about the long game. How do we empower a political movement that demystifies some of the tools we have available to prevent mass atrocity?  How do we make US government cooperation with the ICC as uncontroversial as using foreign aid to fight Malaria? How do we  make it so Congressional appropriations over paying US dues to UN peacekeeping are not long, drawn out political battles? How do we secure more funding for security sector reform? Ultimately, all of this requires changing attitudes of our elected officials — which in turn requires a mobilized electorate.

Laura Seay writes, “My basic premise is that the awareness of American college students is NOT a necessary condition for conflict resolution in Africa.” In the short term, she is probably right. Over the long run, though, awareness of American college students can be one part of a larger effort to build a movement to empower our own government and governments around the world to invest in conflict prevention tools.

Campaigns like Invisible Children have an important role to play in this process.

Right now, the 56h session of the Commission on the Status of women is taking place at UN headquarters in New York. The session theme is rural women. The session will last until March 9^th, and it will end with a series of concrete recommendations to governments and civil society.

According to the Commission, rural women make up a quarter of the world’s population. They produce the majority of the world’s food, and perform most unpaid care work in rural areas. They also state that “If rural women had equal access to productive resources, agricultural yields would rise and there would be 100 million to 150 million fewer hungry people.”

Those are big claims, and it’s certainly clear that women play an important role in rural life, a role that I undervalued and under-supported. One wonders, though, how policy recommendations on rural women would differ from policy on supporting urban women. Wouldn’t the gender equality agenda be similar for women in both locations? It is certainly true that women also make up a large proportion of the urban work force, and perform the majority of unpaid care work in urban areas. Access to credit, property ownership, and access to public services also seem to be universal issues for women, no matter where they are located.

I look forward to the Commissions’ report and recommendations, which will be submitted to Ecosoc and made publicly available shortly after the end of the session.

Doctors in India have identified a new form of tuberculosis that is resistant to all drugs. They’re calling it totally drug resistant TB (TDR TB), for obvious reasons. This isn’t good news. Tuberculosis, in my opinion, has now gone from probably the most dangerous infectious disease in the world to definitely the most dangerous infectious disease in the world.

Tuberculosis is a bacterial disease, treated with antibiotics. As has been documented in other places, over time many kinds of bacteria develop resistance to antibiotics. TB bacteria have been especially adept at this. We’ve already seen multi-drug resistant TB, and extensively drug resistant TB. Totally drug resistant tuberculosis was the logical progression, and we’ve reached it.

So far, India doctors have identified at least twelve cases of totally drug resistant TB. That doesn’t sound like much until you discover they were all at the same hospital. That indicates there are probably hundreds more cases being treated in smaller hospitals and clinics which don’t have the capacity to identify totally resistant strains of TB.

This awful news leaves us with a lot of what-do-we-do-next questions. How do we handle the people who have TDR TB? How do we keep it from spreading? Is this a sign we’re taking the wrong approach to fighting the disease?  Here’s hoping we can find some kind of answers.

This year, on World AIDS Day, the scientific promise for the end of HIV is the brightest it’s ever been. We’re seeing radical new uses for antiretroviral drugs – to prevent the transmission of HIV as well as treat its effects. We’re poised, medically, to bring this epidemic to its knees.

In the face of this great opportunity, the global community responded in one voice, “Forget it. We don’t care.” Things are hard all around, you know, and foreigners with HIV don’t vote in domestic elections. The Global Fund to Fight AIDS, TB, and Malaria just canceled its next round of grants. The WHO is laying off staff. Bilateral donors are cutting aid to global health. Instead of breaking the cycle of HIV transmission, developing nations will be lucky if they can protect the people they already have on treatment.

That may sound dramatic, but look at the numbers. The Global Fund asked donors for $20 billion. It received $11.5.  Everyone from Germany to the USA reneged on their pledges of support.

The impact on the ground is immediate. I have spent the last few days attending emergency meetings where we struggle to save HIV programs in this grim new reality. Everyone, from ministries of health to community NGOs, are getting ready to cut programs if there’s no money to continue them. To abandon people with HIV and people at risk. This is not a cutting the fat situation. We’ve being doing that for years. Now we’re cutting bone.

30 years into the AIDS epidemic, we’re at a crossroads. Things are getting harder. Will we stand up for justice – and logic – and invest in ending this plague? Or will we take the short-term approach? Do the minimum, let the suffering drag on, and trade our future for political capital?

I know which road we’re on now. I should apologize to my children.

Good, basic, medical care will save kids’ lives. We knew that already, but an exciting new study in The Lancet makes it extremely clear. According to a new study conducted by Save the Children, “Children treated at home for severe pneumonia by Pakistan’s “Lady Health Workers” were more likely to recover than children referred to health facilities.”

Pneumonia is the biggest killer of children, and we’ve got a low-cost way to fight it. 1.4 million children under age 5 die every year from pneumonia, the vast majority in the developing world. Finding an effective way to save those children is fantastic news for global health.

It’s especially interesting because of home-care approach. We’ve seen a shift in health care from looking at expensive facilities and equipment to more community based approaches. This is a validation of that focus. Pneumonia was long seen as an illness that mandated hospital care which is expensive for both the health system and the patients who encounter it. Hospital care also carries a risk of getting a secondary infection from someone else in the hospital.

Community based care, on the other hand, is affordable for patients, their family, and the health systems of developing countries. And training parents and community health workers not only benefits children with pneumonia, it also developed community capacity to support health beyond just pneumonia.

The UN has released the 2011 Human Development Report, and it has a theme that is often ignored in international development documents: we can go backward. In this case, the Human Development Report warns that the impact of climate change could mean that all the progress we’ve made could vanish by mid-century, since “people in the poorest countries are disproportionately at risk from climate-driven disasters such as drought and flooding and exposure to air and water pollution.”

The report looks at sustainability and equity. It finds that human development has been deeply unequal within countries, which puts the long term effect of these gains at risk. It also takes a very interesting approach to carbon emissions, particularly about electricity. The report argues that electricity can be provided to the 1.5 billion people who don’t have it, “with investments of about one-eighth of the amount currently spent on fossils fuel subsidies, estimated at US$312 billion worldwide,” and without substantial increases in carbon emissions.

Finally, it finds that in an “‘environmental disaster’ situation—with vast deforestation, dramatic biodiversity declines and increasingly extreme weather—the global HDI would fall 15 percent below the baseline projection for 2050, with the deepest losses in the poorest regions.”

To poke around in the report itself, you can go to the UNDP Human Development Report website. They’re also hosting a live twitter chat about the report, and a live webcast to launch it.

On October 31^st, the UN Population Division has predicted the planet will see its 7 billionth person. In advance of that event, UN Dispatch spoke to William Ryerson about what that kind of population growth means. He’s well placed to answer the question. Mr. Ryerson is the founder and President of Population Media Center, Chairman of Population Institute (Washington DC), fellow at the Post Carbon Institute and recipient of the 2006 Nafis Sadik Prize for Courage.

UND: What happened? How did population go from a non-issue to an issue again?

Population was a huge issue in the 60s and 70s. I have been working on this for 40 years. The first earth day was largely about population growth, then it became taboo. Part of why it become taboo was human rights violations committed by India and China, and partly was because of Ronald Reagan, who said that population growth was a good thing. He was influenced by Julian Simon, who said there was no limit to how many people the planet could support. We saw a negative response to publications like The Limits to Growth, which predicted that in the early part of the current century, we’d run into resource limits.

What is clear now is that oil production has gone flat, no matter how much we spend on trying to find more. And our whole agriculture system is based on cheap oil. The oil component of the price of food is a major component. People were suddenly finding they were unable to buy food. The spike in oil and then food prices led the media to realize there really was a problem.

There was also a major effort by our organization and other organizations to start talking to the media. The Limits to Growth was basically on track in terms of their forecast. We are running into limits on all kinds of resources. Not just oil – water, minerals and metals, too. By ignoring the issue of population we have really failed to take the somewhat simple steps to address this component of what is clearly a demand and supply problem.

For example, at the Cairo population conference – which occurred at a time the US was becoming more conservative – there were great promises of investment into family planning. These promises were not kept. In fact, funding for family planning has been reduced by 50% since the conference. People have not had access to the information and services needed to control their family size. As a result, the UN population division has had to keep raising their population growth estimates because the fertility rates have not come down as fast as was projected a decade ago. That combined with high oil and food prices and growing shortages of fresh water has led to the current situation.

Many optimistic forecasts were made in 1999 based on a lot of progress that had been made, and these forecasts have not come true. The International Energy Agency didn’t expect oil to go past $28 a barrel by 2020, for example. Even with progress in providing family planning and supporting women’s rights, it’s hard to slow the momentum of population growth. This is an aircraft carrier. It’s hard to turn it around. It’s clear right now we are running into all kinds of limits.

UND: What does the worst case scenario look like?

It’s a subject I see debated by experts every day. I hate to paint a very bleak picture, but if oil prices go to double the peak of 2008 – say they go to $280 barrel and we have no alternate energy infrastructure, or the cost of alternative energy is much higher than the traditional price of oil, it could drive the price of food out of the reach of the 1.2 billion people who live on less than $1 a day.

Right now WFP responds to famines in Sahel or East Africa but they have never dealt with a billion people starving all at once. The worst case scenario would be a billion people starving in a few weeks’ time. There would simply be no ability of the donor countries to respond to a situation of this magnitude. It could happen between 2012 and 2015, according to an estimate by the U.S. military. There could be political chaos all over the world as a billion people rampage for food.

Even if the wealthy countries have lots of food, you can’t ignore what’s underneath. Part of what we saw in Tunisia was triggered by rising food prices. A billion people unable to get food all at once would lead to political and military chaos all around the planet. Combine this with climate change making too much or too little water available, the loss of glaciers, and the overpumping of underground aquifers all of which is leading to loss of farmland. In India the water table is sinking deeper and deeper. Some farmers are giving up on their farms as their farms turn to desert, since they can no longer reach water. All three countries that are our biggest food producers – India, China, and the US – are overpumping. It is keeping people alive but when the water runs out there is going to be disaster. India has over a 100 million being kept alive by overpumping.

The combination of rising oil prices and declining water could lead to a perfect storm where suddenly all these things lead to human catastrophe around the planet. A report that came out in the last couple of months by two biologists looking at global biodiversity has shown that biodiversity is declining globally and the 100,000 preserves that have been set up are doing nothing to protect biodiversity. Spreading human habitation is systematically reducing the life support system of our planet. Cutting down large rainforests is a major aggravator of climate change. It took 3 billion years of evolution to make our planet habitable for humans. Setting up large zoos – which is what reserves are – isn’t going to protect us. We are risking the long term habitability of the planet. Some scientists think that humans could be extinct by the end of the century.

We do have options and the population part of this problem is probably the easiest to solve. Elevating the status of woman, delaying girls’ marriage, providing reproductive health and family planning information, and providing family planning services is a formula that has led to stopping population growth in many countries. This has great potential to reverse the damage and bring about a solution.

UND: Can you speak to the argument that it is a resource issue, not a population number issue? What if we all become vegetarians?

If we double human efficiency of food consumption, go from meat to grain, that kind of thing, it does help. But if you have 5 children and each is 10% more efficient, we are not better off. Population is the multiplier of everything else. Unless we address population issues, it will eat up the progress we make in everything else. Both are important. There is little public demand to consume less or change lifestyles, but there is huge unmet demand for family planning. It is in many ways the easiest thing to address. Some biologists feel that after oil and fossil fuels are gone, the planet could sustain 2 billion people in a Western European lifestyle. At the Ethiopian lifestyle, we could maybe sustain 10 billion people. The question is which kind if life we want.

UND: Why do you think population is such an emotional issue?

It happens for a whole host of reasons. Some religions, like the Catholic Church, forbid contraception. It leads the church to make the argument that population is not an issue.

There are corporations that profit from population growth. A great example is Australia. Australia is a continent with very little water, and the Australian government pays $5000 for every baby born; Australia is growing faster than Indonesia. At the same time they’re asking people to ration water because there’s not enough water to grow crops or fight fires. From the outside it makes no sense, but there are moneyed interests funding politicians to pursue pro-population growth policies that are contrary to long term stability.

There are economists that believe that endless population growth is necessary for economic growth. This is a Ponzi scheme form of economics. It will not last. We must persuade governments to celebrate low fertility rates and declining populations.

UND: Are mainstream economists really arguing that we have to keep growing our populations forever?

They are, and that leaves us eventually occupying every square inch of the planet. This is clearly impossible. In the long term future, the future of economics is sustainable economics. We cannot have endless economic growth. The true measure of human welfare is per capita income, not GDP. If we find a system where we have a declining number of people with more resources per capita as a result, if real estate prices are going down and people have better homes, why upset that to help companies that make their profits from population growth? Most people do not benefit from population growth. We need to find a way to have sustainable welfare for the people that nations already have, not push population growth to maintain the current system.

UND: Can you give us something optimistic to end on?

I’ll talk about the work of Population Media Center. It’s the wave of the future. We’ve gone from 10% of the world’s couples using FP in 1960 to 56% today. However, in sheer numbers we have more non-users because of population growth.

Today’s non-users are not using methods because of informational and cultural barriers – large desired family size, fear of side effects, and so on. But we can address that.

We have soap operas that show mass audiences how to overcome obstacles to change. The media center did a serial drama in Nigeria that was listened to by 72% of the population at least weekly in some very conservative areas. We had 67% of clients coming into clinics naming our program as the reason they came in. Using role models has been a very effective way to achieve sustainable behavior change. You can address a whole range of issues, from family planning to trafficking of women. It’s been very effective in getting people to avoid HIV risk behavior.

This strategy is effective and inexpensive. It is highly successful in bringing about behavior change.  We can get to personal, national and global sustainability with the right tools, and this is one of them.

(photo credit: John Baldock NZ)