There's a suburb, a slum area, not far South of the town of Nakuru and it always smells bad. Well, perhaps all slums smell bad, but some smell worse than others. As you walk through the main street of Kaptembwa, there are deep trenches at the side of the road, apparently having something to do with the 'sewage system!. But all around, there is stagnant water and raw sewage. When there is a lot of rain, this effluent flows through the streets and even into people's houses. It also mixes with the water supply, such as it is.
I don't know how long Kaptembwa has been like this. People who have been there a long time say there has never been any proper sewage disposal. Now, children play in foul smelling puddles, with terrible consequences for their health. Adults also have to walk through the mess and put up with the smell, the dirt and even the diseases.
Places like Kaptembwa are ideal breeding grounds for water borne diseases. You could vaccinate every child against something like rotavirus and you would still have lots of them sickening and dying of water borne diseases. Both the children and the adults living in such areas need adequate sanitation and reliable supplies of clean water. No amount of vaccine will get rid of the health hazards caused by such conditions.
But also, people are entitled to some level of dignity. They should not have to live in dreadful and threatening conditions. Those who claim to be concerned about their health should consider these conditions first, not the headline grabbing but ultimately weak solution of vaccines or drugs. People shouldn't have to drink water that smells of sewage.
But for some reason, rotavirus vaccine has been much reported recently. Perhaps it's because the Gates Foundation has mentioned the development of the vaccine as one of their primary goals, perhaps it's because the pharmaceutical companies who are behind this lucrative prospect are good at issuing press releases. Journalists are certainly good at citing press releases, regardless of the levels of sales puff they may contain.
Among the three articles I came across today about Gates, Glaxo Smith Kline (and others) and their rotavirus vaccines, all say very little about water and sanitation. They ooze on about how brilliant all this medical technology is but they don't mention, or are not quoted as mentioning, that vaccines will be useless without high levels of spending on water and sanitation infrastructure. It could be wondered if all these groupies care, one way or the other, about how people are forced to live.
One of these articles cites an academic as saying that vaccines "represent the best hope for preventing the severe consequences of rotavirus infection". There is probably a sense in which this 'expert' is right but failing to mention water and sanitation renders the statement hot air. Vague mention is made of water and sanitation in the other articles but the focus is on the vaccine, as if children who are suffering from poor nutrition, multiple vitamin deficiencies and various parasites are going to be magically made healthy by a vaccination for one of the many water borne conditions that are endemic in developing countries.
One of the articles even mentions some the problems of rolling out large scale vaccinations, and the rotavirus vaccine in particular, in countries that have poor health systems and inadequate infrastructure. This article even mentions the high cost of vaccination programmes. Why is it that the Gates Foundation and other institutions don't seem to mind high costs when the main beneficiaries are pharmaceutical companies and other rich establishments?
All the articles list figures for how many lives could be saved by a rotavirus vaccine and the usual sort of stuff. But they don't list the figures for how many lives could be saved by spending money on a cheaper but far more urgent way of reducing deaths from water and sanitation related causes. I can't think why.
Showing posts with label disease. Show all posts
Showing posts with label disease. Show all posts
Saturday, January 30, 2010
Wednesday, March 25, 2009
UNAIDS: a Development Paradox
A recent UNAIDS newsletter demonstrates the paradox of the existence of such an institution as UNAIDS, whose brief is a single, sexually transmitted virus, HIV. The newsletter concentrates on homophobia, harm reduction programmes for drug users, sex work and the role of condoms in reducing HIV transmission (and, presumably, other sexually transmitted infections and unwanted pregnancies).
The paradox stems from the reflection that all these issues predate HIV, they will probably all continue after the HIV pandemic has subsided, if that ever happens, and they are all very important issues in themselves. That is, their importance goes well beyond their connection with the transmission of HIV. Therefore, there were already programmes to address these issues before HIV was even heard of, so where does UNAIDS fit in?
Homophobia, for example, is abhorrent and an infringement on human rights. There are organisations all over the world fighting homophobia. Does the arrival of UNAIDS add to the work that these organisations are doing or does it water the message down? The message seems to become 'homophobia is bad because it plays a part in spreading HIV'. Homophobes may even see this as an endorsement of their position. Perhaps I'm wrong, perhaps UNAIDS strengthens these organisations and has a genuine role to play.
Harm reduction for drug users is another issue that has been associated with HIV transmission. Yet, evidence that harm reduction programmes work for injecting drug users has been around for a long time. It's only political pragmatism that has prevented such programmes from being implemented in many countries. Does relating these programmes to HIV reduction strengthen or weaken advocacy for harm reduction programmes?
UNAIDS have embraced the view that there is no single approach to HIV, that each country needs to gather detailed data on how HIV spread in their country and implement different approaches as appropriate to that context. I am one hundred percent in agreement with them as this is one of my own findings. But I saw that as an indication that UNAIDS may therefore be superfluous, however well intended. I think of all development issues are addressed, HIV reduction will not be such an intractable problem.
Commercial sex work (or transactional sex) is surrounded by numerous factors in the transmission of HIV. Sex workers are vulnerable because they are poor, or poorer than their clients, they are unprotected by the law and perhaps even victims of abuse by officers of the law, they are stigmatised by the public, they have little access to health and other social services, stemming from their poverty, lack of those services, their legal position, etc.
Sex workers suffer terribly, they have multiple vulnerabilities and, as a result, they often play an important part in the transmission of HIV. But they have suffered abuse and been denied their rights for as long as anyone can remember. This relates to HIV but HIV transmission stems from many other problems that are not just about HIV. Where does UNAIDS fit in here? Do they become advocates for the decriminalisation of sex work? This would be great but should they join other organisations already involved in such advocacy or is there a niche for them, somewhere?
The (male) condom is something of a symbol of the fight against HIV. They appear on websites about HIV, in particular, on UNAIDS's site. But condoms have been around for a long time and played a significant part in the decades of work carried out by those who believed that development simply meant population control. Those organisations, FHI (Family Health International), PSI (Population Services International), TFGI (The Futures Group International), and others, were spectacularly unsuccessful in getting condoms accepted. However, they were considered the most deserving recipients of hundreds of millions of the dollars that were subsequently ploughed into HIV reduction.
Is UNAIDS going to become one of them, a family planning organisation? There is no doubt that sexual and reproductive health are very important issues; they are also an important part of the fight against HIV but I think UNAIDS see themselves as playing all of the above roles. Yet they are playing all of those roles in an importantly qualified way. It seems that they are playing those roles to the extent that this will reduce HIV transmission.
Every single factor in the transmission of HIV needs to be addressed but also, every single factor that I can think of needs to be addressed, irrespective of its part in HIV transmission. Each factor in the transmission of HIV is also an area of underdevelopment. HIV spread in places where there are high levels of economic and gender inequality, poverty, poor health, low standards of education, low levels of social services, poor infrastructure, especially in the area of water and sanitation. Governance, legal institutions and civil society are also factors in the transmission of HIV.
UNAIDS have some of the best personnel in the HIV world, they have some of the best resources and they have access to pots of money. But I'm still at a loss to understand why HIV has been singled out from all other diseases and development problems and given this special UN institution. Especially as many of these other diseases and development problems played a crucial part in the spread of HIV.
I suppose the paradox is that there is a sense in which UNAIDS is concerned with all of these issues but is, at the same time, only concerned with HIV.
The paradox stems from the reflection that all these issues predate HIV, they will probably all continue after the HIV pandemic has subsided, if that ever happens, and they are all very important issues in themselves. That is, their importance goes well beyond their connection with the transmission of HIV. Therefore, there were already programmes to address these issues before HIV was even heard of, so where does UNAIDS fit in?
Homophobia, for example, is abhorrent and an infringement on human rights. There are organisations all over the world fighting homophobia. Does the arrival of UNAIDS add to the work that these organisations are doing or does it water the message down? The message seems to become 'homophobia is bad because it plays a part in spreading HIV'. Homophobes may even see this as an endorsement of their position. Perhaps I'm wrong, perhaps UNAIDS strengthens these organisations and has a genuine role to play.
Harm reduction for drug users is another issue that has been associated with HIV transmission. Yet, evidence that harm reduction programmes work for injecting drug users has been around for a long time. It's only political pragmatism that has prevented such programmes from being implemented in many countries. Does relating these programmes to HIV reduction strengthen or weaken advocacy for harm reduction programmes?
UNAIDS have embraced the view that there is no single approach to HIV, that each country needs to gather detailed data on how HIV spread in their country and implement different approaches as appropriate to that context. I am one hundred percent in agreement with them as this is one of my own findings. But I saw that as an indication that UNAIDS may therefore be superfluous, however well intended. I think of all development issues are addressed, HIV reduction will not be such an intractable problem.
Commercial sex work (or transactional sex) is surrounded by numerous factors in the transmission of HIV. Sex workers are vulnerable because they are poor, or poorer than their clients, they are unprotected by the law and perhaps even victims of abuse by officers of the law, they are stigmatised by the public, they have little access to health and other social services, stemming from their poverty, lack of those services, their legal position, etc.
Sex workers suffer terribly, they have multiple vulnerabilities and, as a result, they often play an important part in the transmission of HIV. But they have suffered abuse and been denied their rights for as long as anyone can remember. This relates to HIV but HIV transmission stems from many other problems that are not just about HIV. Where does UNAIDS fit in here? Do they become advocates for the decriminalisation of sex work? This would be great but should they join other organisations already involved in such advocacy or is there a niche for them, somewhere?
The (male) condom is something of a symbol of the fight against HIV. They appear on websites about HIV, in particular, on UNAIDS's site. But condoms have been around for a long time and played a significant part in the decades of work carried out by those who believed that development simply meant population control. Those organisations, FHI (Family Health International), PSI (Population Services International), TFGI (The Futures Group International), and others, were spectacularly unsuccessful in getting condoms accepted. However, they were considered the most deserving recipients of hundreds of millions of the dollars that were subsequently ploughed into HIV reduction.
Is UNAIDS going to become one of them, a family planning organisation? There is no doubt that sexual and reproductive health are very important issues; they are also an important part of the fight against HIV but I think UNAIDS see themselves as playing all of the above roles. Yet they are playing all of those roles in an importantly qualified way. It seems that they are playing those roles to the extent that this will reduce HIV transmission.
Every single factor in the transmission of HIV needs to be addressed but also, every single factor that I can think of needs to be addressed, irrespective of its part in HIV transmission. Each factor in the transmission of HIV is also an area of underdevelopment. HIV spread in places where there are high levels of economic and gender inequality, poverty, poor health, low standards of education, low levels of social services, poor infrastructure, especially in the area of water and sanitation. Governance, legal institutions and civil society are also factors in the transmission of HIV.
UNAIDS have some of the best personnel in the HIV world, they have some of the best resources and they have access to pots of money. But I'm still at a loss to understand why HIV has been singled out from all other diseases and development problems and given this special UN institution. Especially as many of these other diseases and development problems played a crucial part in the spread of HIV.
I suppose the paradox is that there is a sense in which UNAIDS is concerned with all of these issues but is, at the same time, only concerned with HIV.
Saturday, February 14, 2009
Alms for the Rich
Every year, pneumonia kills more under fives than HIV/AIDS, TB and malaria. But huge amounts of money are poured into these three diseases, much of it going towards HIV/AIDS alone. Pharmaceutical companies are speculating on these three diseases, which could make them enormously rich. Well, they are already rich but what they have now will be nothing compared with what they could make if they develop a cure for any of these.
Billions of dollars of aid money goes into disease research but only a fraction of it goes into dealing with treatable and curable conditions, such as acute respiratory infections and diarrhoea. Pharmaceutical companies are not betting on these because there are generic products available for them, products that don’t represent enough of a profit for them.
The number of people who suffer from intestinal parasites of some kind is estimated to be in the billions. This is closely related to malnutrition and nutritional deficiencies, something that may also affect billions of people. But cures for these have been around for a long time. And as no big institutions are interested in speculating in them, they receive very little money.
Don’t we in the development community look like fools, spending most donor money on a few diseases while ignoring the ones we could really have an impact on? There are people on antiretrovirals who are dying because they don’t have enough food or clean water. Are pharmaceutical companies willing to distribute pills without ensuring that there people have access to clean water? That’s how it appears, anyhow.
Some of the biggest sources of donor funding ever, the World Bank’s Global Fund, the President’s Emergency Fund for Aids Relief (PEPFAR) and the Bill and Melinda Gates Foundation, concentrate on more or less the same areas. The work done by each fund overlaps with other well funded concerns. There is very little money left for diseases and social problems that have existed for a long time.
I am not suggesting a conspiracy by big business to make sure that most donor money is spent on them. This is no secret. The money may be called donor money but it is being used as a de facto subsidy for pharmaceutical and other products. Industry lobbyists make sure that national and international laws favour their products and interests, often blocking moves by generic producers to launch far cheaper products.
Those who stand to gain from generous donor funding want all the money to be spent on them. The fact that more and more people are becoming infected with preventable diseases is irrelevant, except when this fact can be used to help squeeze out a bit more donor funding. If donor money ever becomes available in large amounts for presently neglected diseases, you can be sure that there will be companies soaking it up.
If you visit towns and schools in Kenya and Tanzania you will meet people who know more about avoiding HIV than they do about diarrhoea and colds. Some people can get hold of expensive drugs and condoms free of charge, but they can’t feed themselves or their families. There are children here who could tell you more about safe sex than many Western adults.
HIV in Kenya spread among people who had poor health, education, infrastructure and social services. Public spending was reduced in response to structural adjustment policies, starting in the 1980s. These policies are still in effect and many social indicators have been disimproving constantly for the last three decades.
Despite the concentration on HIV, large numbers of people in Kenya work without any security, for very low wages. Men often spend much of their time away from their families. Many people are reduced to exchanging sex for money, food or other commodities. These circumstances can all result in transmission of HIV and other diseases, in addition to their being social problems in themselves.
If donor money is used to chase after a few current obsessions, conditions for people will continue to decline. HIV is only one problem and whether infection rates go up or down, Kenyan people will face more and more problems as the years pass. This is because all but the most fashionable issues have been the recipients of donor funding and the ultimate recipients have been wealthy companies, not poor people.
Billions of dollars of aid money goes into disease research but only a fraction of it goes into dealing with treatable and curable conditions, such as acute respiratory infections and diarrhoea. Pharmaceutical companies are not betting on these because there are generic products available for them, products that don’t represent enough of a profit for them.
The number of people who suffer from intestinal parasites of some kind is estimated to be in the billions. This is closely related to malnutrition and nutritional deficiencies, something that may also affect billions of people. But cures for these have been around for a long time. And as no big institutions are interested in speculating in them, they receive very little money.
Don’t we in the development community look like fools, spending most donor money on a few diseases while ignoring the ones we could really have an impact on? There are people on antiretrovirals who are dying because they don’t have enough food or clean water. Are pharmaceutical companies willing to distribute pills without ensuring that there people have access to clean water? That’s how it appears, anyhow.
Some of the biggest sources of donor funding ever, the World Bank’s Global Fund, the President’s Emergency Fund for Aids Relief (PEPFAR) and the Bill and Melinda Gates Foundation, concentrate on more or less the same areas. The work done by each fund overlaps with other well funded concerns. There is very little money left for diseases and social problems that have existed for a long time.
I am not suggesting a conspiracy by big business to make sure that most donor money is spent on them. This is no secret. The money may be called donor money but it is being used as a de facto subsidy for pharmaceutical and other products. Industry lobbyists make sure that national and international laws favour their products and interests, often blocking moves by generic producers to launch far cheaper products.
Those who stand to gain from generous donor funding want all the money to be spent on them. The fact that more and more people are becoming infected with preventable diseases is irrelevant, except when this fact can be used to help squeeze out a bit more donor funding. If donor money ever becomes available in large amounts for presently neglected diseases, you can be sure that there will be companies soaking it up.
If you visit towns and schools in Kenya and Tanzania you will meet people who know more about avoiding HIV than they do about diarrhoea and colds. Some people can get hold of expensive drugs and condoms free of charge, but they can’t feed themselves or their families. There are children here who could tell you more about safe sex than many Western adults.
HIV in Kenya spread among people who had poor health, education, infrastructure and social services. Public spending was reduced in response to structural adjustment policies, starting in the 1980s. These policies are still in effect and many social indicators have been disimproving constantly for the last three decades.
Despite the concentration on HIV, large numbers of people in Kenya work without any security, for very low wages. Men often spend much of their time away from their families. Many people are reduced to exchanging sex for money, food or other commodities. These circumstances can all result in transmission of HIV and other diseases, in addition to their being social problems in themselves.
If donor money is used to chase after a few current obsessions, conditions for people will continue to decline. HIV is only one problem and whether infection rates go up or down, Kenyan people will face more and more problems as the years pass. This is because all but the most fashionable issues have been the recipients of donor funding and the ultimate recipients have been wealthy companies, not poor people.
Friday, January 30, 2009
No Such Number
Out of the eight provinces in Kenya, the two most disadvantaged, using a range of about 50 indicators, are North Eastern and Coast. The two most advantaged are Central and Nairobi. When you compare HIV prevalence, the two provinces with the highest rates are Nyanza and Nairobi and the two with the lowest are North Eastern and Central.
A broad range of advantages does not necessarily mean low HIV prevalence and a broad range of disadvantages does not necessarily mean high HIV prevalence. This is why it is important to look at development as a whole, rather than obsessing about HIV; it's just one disease and for many people, it is not even the worst thing that can happen.
If you look more closely at some districts you get even clearer insights into serious instances of underdevelopment. If you compare urban populations, they appear to have a lot of advantages over rural populations. But if you look at slums, and there are many in Kenya, you get a completely different picture. An estimated 71% of urban dwellers in Kenya live in slums (probably around 2.8 million people in Nairobi alone).
Some of the social indicators (health, education, infrastructure, etc) for slum areas are even poorer than they are in rural areas. Slums are growing, especially now as many IDPs are moving to urban areas. Others are moving from rural areas to find work, so there is particular pressure on urban areas right now.
A report published last year on the burden of disease in two of Nairobi's slums, Korogocho and Viwandani, list many features of these areas that differ from Nairobi as a whole. Although the report does not have the scope to measure HIV prevalence, it suggests that it, too, is higher there than in other parts of the country. Prevalence fell slightly in Nairobi between 2003 and 2008 but this is unlikely to reflect the situation in slums.
The report measures mortality in years of life lost to premature mortality (YLL). It found that under fives had four times the mortality rate of the rest of the population (standing at 692 years per 1,000 person years). The chief causes of death are pneumonia (22.8%) and diarrhoeal diseases (19.5%). It is notable that these two causes can be addressed, in part, by introducing intermediate technologies such as solar cookers and other techniques for sterilising water.
Infant mortality was 96.0, 82.6 and 81.8 per 1,000 live births for the years 2003, 2004 and 2005 respectively (compared to 79 per 1,000 nationally in 2005 and 96 per 1,000 in 1970). Under five mortality is 139.1, 119.1 and 121.4 per 1,000 live births (compared to 120 per 1,000 nationally in 2005 and 156 per 1,000 in 1970). Malnutrition is known to be an underlying cause for more than half of childhood deaths but may be underestimated by this survey methodology. Malnutrition and anaemia account for 8.4% of YLL.
In Nairobi province 20.3% of children are stunted, 6.3% of under fives are underweight and 2.1% suffer from wasting. Poor health and nutrition in children can be related to low maternal education, poverty, lack of food security, etc. Only 69.2% of children have full childhood immunisation. This suggests weak and inaccessible health systems and poor attendance at ante-natal clinics.
It is clear that nearly forty years of development has had little impact on infant and child mortality in Kenya. In fact these figures have mainly been disimproving nationally since the 1970s in Kenya. The HIV epidemic may have had some part in this but the trend started before HIV would have had much impact.
Among those over five years of age, around 50% of mortality is caused by HIV/AIDS and TB. TB has been counted with HIV because deaths caused by either are difficult to distinguish. Mortality in the population as a whole is 205 YLL per 1,000 person years.
Other findings are equally appalling: population density in this area is estimated to be 60,000 per square kilometre. Homicide is the second most common contributor to mortality (12.1%) in those over 5 years old. Road traffic accidents are the third most common (5.8%). These figures are higher than for Sub Saharan Africa as a whole
The ratio of males to females in these areas is similar to much of Nairobi and a large part of the population consists of those from productive age groups. Between the ages of 20 and 35, males outnumber females considerably. Where there are a lot of men relative to women, this can result in high levels of commercial/transactional sex. Nairobi had a particularly high ratio of males to females in the 1980s, a time when HIV was known to have spread very rapidly.
Health systems, clearly, are poor in these slum areas. Most people die outside the formal health care system. Verbal autopsy was used for the report in question but this has its limitations. Official death certificates are not common. For Nairobi as a whole, life expectancy is 57; 54.1 for men and 59.8 for women. 40% of people are not expected to survive to over 40, the worst figure for this indicator in the country. 54% of people have poor access to a qualified doctor.
The Human Development Index, a composite index widely used and recognised by the development community, is currently the highest in the country for Nairobi province. But this hides many problems faced by a huge number of the city’s population. The fact that many of the richest people in the country have a residence in Nairobi must distort many of the figures.
Slums are sometimes politely referred to as informal urban settlements or by some similar construction. They are barely alluded to by politicians and few official statistics exist to allow proper evaluation. But they are a reality for an increasing number of Kenyans, a reality that needs to be addressed now.
A broad range of advantages does not necessarily mean low HIV prevalence and a broad range of disadvantages does not necessarily mean high HIV prevalence. This is why it is important to look at development as a whole, rather than obsessing about HIV; it's just one disease and for many people, it is not even the worst thing that can happen.
If you look more closely at some districts you get even clearer insights into serious instances of underdevelopment. If you compare urban populations, they appear to have a lot of advantages over rural populations. But if you look at slums, and there are many in Kenya, you get a completely different picture. An estimated 71% of urban dwellers in Kenya live in slums (probably around 2.8 million people in Nairobi alone).
Some of the social indicators (health, education, infrastructure, etc) for slum areas are even poorer than they are in rural areas. Slums are growing, especially now as many IDPs are moving to urban areas. Others are moving from rural areas to find work, so there is particular pressure on urban areas right now.
A report published last year on the burden of disease in two of Nairobi's slums, Korogocho and Viwandani, list many features of these areas that differ from Nairobi as a whole. Although the report does not have the scope to measure HIV prevalence, it suggests that it, too, is higher there than in other parts of the country. Prevalence fell slightly in Nairobi between 2003 and 2008 but this is unlikely to reflect the situation in slums.
The report measures mortality in years of life lost to premature mortality (YLL). It found that under fives had four times the mortality rate of the rest of the population (standing at 692 years per 1,000 person years). The chief causes of death are pneumonia (22.8%) and diarrhoeal diseases (19.5%). It is notable that these two causes can be addressed, in part, by introducing intermediate technologies such as solar cookers and other techniques for sterilising water.
Infant mortality was 96.0, 82.6 and 81.8 per 1,000 live births for the years 2003, 2004 and 2005 respectively (compared to 79 per 1,000 nationally in 2005 and 96 per 1,000 in 1970). Under five mortality is 139.1, 119.1 and 121.4 per 1,000 live births (compared to 120 per 1,000 nationally in 2005 and 156 per 1,000 in 1970). Malnutrition is known to be an underlying cause for more than half of childhood deaths but may be underestimated by this survey methodology. Malnutrition and anaemia account for 8.4% of YLL.
In Nairobi province 20.3% of children are stunted, 6.3% of under fives are underweight and 2.1% suffer from wasting. Poor health and nutrition in children can be related to low maternal education, poverty, lack of food security, etc. Only 69.2% of children have full childhood immunisation. This suggests weak and inaccessible health systems and poor attendance at ante-natal clinics.
It is clear that nearly forty years of development has had little impact on infant and child mortality in Kenya. In fact these figures have mainly been disimproving nationally since the 1970s in Kenya. The HIV epidemic may have had some part in this but the trend started before HIV would have had much impact.
Among those over five years of age, around 50% of mortality is caused by HIV/AIDS and TB. TB has been counted with HIV because deaths caused by either are difficult to distinguish. Mortality in the population as a whole is 205 YLL per 1,000 person years.
Other findings are equally appalling: population density in this area is estimated to be 60,000 per square kilometre. Homicide is the second most common contributor to mortality (12.1%) in those over 5 years old. Road traffic accidents are the third most common (5.8%). These figures are higher than for Sub Saharan Africa as a whole
The ratio of males to females in these areas is similar to much of Nairobi and a large part of the population consists of those from productive age groups. Between the ages of 20 and 35, males outnumber females considerably. Where there are a lot of men relative to women, this can result in high levels of commercial/transactional sex. Nairobi had a particularly high ratio of males to females in the 1980s, a time when HIV was known to have spread very rapidly.
Health systems, clearly, are poor in these slum areas. Most people die outside the formal health care system. Verbal autopsy was used for the report in question but this has its limitations. Official death certificates are not common. For Nairobi as a whole, life expectancy is 57; 54.1 for men and 59.8 for women. 40% of people are not expected to survive to over 40, the worst figure for this indicator in the country. 54% of people have poor access to a qualified doctor.
The Human Development Index, a composite index widely used and recognised by the development community, is currently the highest in the country for Nairobi province. But this hides many problems faced by a huge number of the city’s population. The fact that many of the richest people in the country have a residence in Nairobi must distort many of the figures.
Slums are sometimes politely referred to as informal urban settlements or by some similar construction. They are barely alluded to by politicians and few official statistics exist to allow proper evaluation. But they are a reality for an increasing number of Kenyans, a reality that needs to be addressed now.
Saturday, January 17, 2009
The Right to Trivia
On Friday the 9th of January, newspapers announced that the government was warning that up to 3 million people faced starvation because of growing food shortages. That's more than 10% of the population. By the following monday, the number had risen to 10 million, in excess of 25% of the population. There was no analysis of why the figures had changed so profoundly.
Yesterday, Friday the 16th, famine was not to be found, unless you count passing references in articles on unrelated matters. There is mention of millions facing starvation on page 6 of The Nation in an article on senior politicians spending large amounts of public money on a trip to the inauguration of the president of a foreign country. These politicians were not invited so taxpayers (which doesn't include politicians, because they don't pay tax) are going to pay for an expensive trip to watch the event on TV.
Perhaps they don't trust their own media to cover the event adequately. Their own media is far more interested in signs of disagreement in the coalition government. That's front page news today. After all, these signs of disagreement are so hard to discern, right? There is a a small amount of interest in various scandals that involve various politicians and other senior public figures but interest in these is currently waning.
But there is little interest in the matters that affect individual people, especially poor people. For example, why do water supplies only reach wealthier neighbourhoods and where does the water sold to poorer people at such high prices come from? Where did all the recently imported maize, intended to avert famine, go to? What has been happening to fuel that has been distributed to outlets, allegedly, but doesn't seem to have reached them?
One quarter of the country's population facing starvation didn't make the front page today. Nor did the fact that child death rates are up, again. Child death rates have been rising almost constantly since the 1980s, so this is not a recent trend. It's a trend that cannot be blamed on the HIV epidemic, the water, fuel or food crisis, global warming or any other issue. There is a long running crisis in health, education and other social services.
Of course, it's difficult to assess figures like those from the UN 2009 State of the World's Children report, showing that 121 out of every 1000 live births recorded result in death, mostly in the first year of a child's life. Difficult to assess because an estimated 40% of births are not recorded. The figure could higher or lower but it's difficult to know how many births have not been recorded!
It's not that political wranglings are not important or that the coalition shouldn't be urged to settle their differences and start running the country, these are important. But it's because of their failure to run the country that child mortality and maternal mortality figures, to name but a few, are so high. It's because of the government's failures that people are starving, have no water, are dying of preventable diseases.
Behind the shortage of maize, in addition to the cartels that may or may not exist, there are government plans to sell and/or lease land so that foreign countries can grow sugar for biofuels and food crops for their own people. This is land that is currently farmed by Kenyans or, at least, owned by Kenyans. It could be used to grow food.
The government says it is building a port in Lamu with the money they make from the land. This port will take many years to build, as Raila Odinga reminded us when he gave a figure of five years for enhancements to Mombasa Port.
So what's wrong with using the land to grow food that should be available after one season? In five years time, if the port is really built, will Kenya have any money left to import anything through a new port in Lamu?
More importantly, how many people will have died, unnecessarily, by the time this 'vital' port is built? Water and food cannot wait till political wranglings are sorted out. These wranglings, in many cases, date back to the earliest days of the Kenyan Republic. Death from lack of water and food is very fast. Some will already have died by the time the politicians who went, uninvited to party in the US, have returned.
It's not politicians who die in civil unrest, famine or epidemics; politicians children don't die of preventable diseases and their wives don't usually die in childbirth. They are completely divorced from the pain, although they may see it all on TV. That's if the media bothers to cover it. And if they are not watching US TV, in the US.
The press who appealed so recently to the electorate to protect them from government excesses is now little moved by the plight of ordinary Kenyans. Millions of people facing starvation and children dying in large numbers should be front page news, so should reportage covering what the government intends to do about it. And when the government says what they intend to do, their actions need to be followed until they show some result. Why is the press so obsessed with triviality?
Of course, government wranglings can turn to riots and many lives can be lost. But far more people die from malnutrition, starvation, water shortage, preventable disease and various other things than from civil distrubances. When these issues have been resolved there will be time enough to cover the many political farces but meantime, perhaps the press will reconsider its priorities.
Yesterday, Friday the 16th, famine was not to be found, unless you count passing references in articles on unrelated matters. There is mention of millions facing starvation on page 6 of The Nation in an article on senior politicians spending large amounts of public money on a trip to the inauguration of the president of a foreign country. These politicians were not invited so taxpayers (which doesn't include politicians, because they don't pay tax) are going to pay for an expensive trip to watch the event on TV.
Perhaps they don't trust their own media to cover the event adequately. Their own media is far more interested in signs of disagreement in the coalition government. That's front page news today. After all, these signs of disagreement are so hard to discern, right? There is a a small amount of interest in various scandals that involve various politicians and other senior public figures but interest in these is currently waning.
But there is little interest in the matters that affect individual people, especially poor people. For example, why do water supplies only reach wealthier neighbourhoods and where does the water sold to poorer people at such high prices come from? Where did all the recently imported maize, intended to avert famine, go to? What has been happening to fuel that has been distributed to outlets, allegedly, but doesn't seem to have reached them?
One quarter of the country's population facing starvation didn't make the front page today. Nor did the fact that child death rates are up, again. Child death rates have been rising almost constantly since the 1980s, so this is not a recent trend. It's a trend that cannot be blamed on the HIV epidemic, the water, fuel or food crisis, global warming or any other issue. There is a long running crisis in health, education and other social services.
Of course, it's difficult to assess figures like those from the UN 2009 State of the World's Children report, showing that 121 out of every 1000 live births recorded result in death, mostly in the first year of a child's life. Difficult to assess because an estimated 40% of births are not recorded. The figure could higher or lower but it's difficult to know how many births have not been recorded!
It's not that political wranglings are not important or that the coalition shouldn't be urged to settle their differences and start running the country, these are important. But it's because of their failure to run the country that child mortality and maternal mortality figures, to name but a few, are so high. It's because of the government's failures that people are starving, have no water, are dying of preventable diseases.
Behind the shortage of maize, in addition to the cartels that may or may not exist, there are government plans to sell and/or lease land so that foreign countries can grow sugar for biofuels and food crops for their own people. This is land that is currently farmed by Kenyans or, at least, owned by Kenyans. It could be used to grow food.
The government says it is building a port in Lamu with the money they make from the land. This port will take many years to build, as Raila Odinga reminded us when he gave a figure of five years for enhancements to Mombasa Port.
So what's wrong with using the land to grow food that should be available after one season? In five years time, if the port is really built, will Kenya have any money left to import anything through a new port in Lamu?
More importantly, how many people will have died, unnecessarily, by the time this 'vital' port is built? Water and food cannot wait till political wranglings are sorted out. These wranglings, in many cases, date back to the earliest days of the Kenyan Republic. Death from lack of water and food is very fast. Some will already have died by the time the politicians who went, uninvited to party in the US, have returned.
It's not politicians who die in civil unrest, famine or epidemics; politicians children don't die of preventable diseases and their wives don't usually die in childbirth. They are completely divorced from the pain, although they may see it all on TV. That's if the media bothers to cover it. And if they are not watching US TV, in the US.
The press who appealed so recently to the electorate to protect them from government excesses is now little moved by the plight of ordinary Kenyans. Millions of people facing starvation and children dying in large numbers should be front page news, so should reportage covering what the government intends to do about it. And when the government says what they intend to do, their actions need to be followed until they show some result. Why is the press so obsessed with triviality?
Of course, government wranglings can turn to riots and many lives can be lost. But far more people die from malnutrition, starvation, water shortage, preventable disease and various other things than from civil distrubances. When these issues have been resolved there will be time enough to cover the many political farces but meantime, perhaps the press will reconsider its priorities.
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