Happy but Tired

Wow, where to even begin? Over the past 48 hours I have been fortunate enough to enjoy talks from President Jimmy Carter, UN High Commissioner for Human Rights Mary Robinson, National Organization for Women president Kim Gandy, and UN Special Rapporteur on the Right to Health Paul Hunt. And tonight I'm hanging out with Doctors for Global Health founder Lannie Smith (his invitation included the Emma Goldman quote, "If I can't dance I don't want to join your revolution.").

Carter
started with a joke about a man who finds himself at the pearly gates, talking to St. Peter. I've been a good man, a good Christian, he says. I said nice things about people and talked about equality and justice. But what have you actually done to help another person? St. Peter asks. And the man thinks a while and says well, one time my wife and I gave a sandwich to a homeless person. That's good, replies St. Peter, about what monetary amount would you assign to that action? And the man says, oh, I guess about 50 cents. And then this other time my neighbor's house burned down and I gave him a spare table that I wasn't using, since he lost all his furniture in the fire. Ok, says St. Peter, and about how much was that worth? Well, I guess another 50 cents says the man. Well, says St. Peter, I'll have to consult a higher authority to determine whether or not you get to come in. And he comes back a while later and says, he told me to give you back your dollar and tell you to go to hell!
So Carter goes on to talk about human rights and building latrines (I've been president, and now I'm an expert latrine builder! The Carter Center works on neglected diseases, one of which is trachoma, the most common form of preventable blindness, it's caused by flies, and one way to prevent it is to build latrines, which reduces the fly population) and then he works back around to the amount of foreign aid provided by the united states. Want to guess how much we spend per 100 dollars? 18 cents. And that's broadly categorized as "international development funds." So that 18 cents for every 100 dollars is split between things like military support and healthcare and housing development and education and whatnot. And Carter talks about how much other countries are spending (not much more, but some) and how much it has been estimated would be needed to start really solving the world's hunger, health, and general poverty problems (44 cents for every 100 dollars) and how other countries have pledged to increase their amounts by 2018 and whatnot. And then he ends with his own punchline - I hope Americans don't find themselves at the pearly gates one day only to hear, take your 18 cents and go to hell!

Mary Robinson
continued the tsunami point of reference that has been used numerous times during the conference, saying that 30,000 children die every day from hunger and other preventable diseases, in a "silent tsunami." It's not that members of the public health community don't think we should help the tsunami victims, or that they're so uncreative they keep using the same reference. I just think they're all wondering the same thing I asked last month - how do we somehow convince people to feel the same sort of empathy for other groups of people in need? What was so fundamentally different about the tsunami that 1/3 of American households generously responded with some sort of aid, and yet many of those same people can't be bothered to take action for people dying in Sudan or Rwanda or their own inner cities?

I won't go into the details of Paul Hunt's talk, except to mention that I actually got to meet him at a later session, where Dabney presented the paper we've been working on and he said, "You've done some really interesting work." Validation from one of my heroes! Amazing. Also, during the Q&A session someone said how nice it is to be in a room full of "practical dreamers." Indeed it is.

So, just like APHA back in November, it seems I'm very lucky in that these kinds of conferences magically come around when I need them most. One more day tomorrow.

The Kim Gandy talk wasn't even associated with the conference, it just happened that she was on campus last night. She was awesome, but primarily preaching to the choir. However, she did provide an explanation of social security that made sense. I have no idea how accurate this is, but here it is, as I understood it:

Originally, we (as a society) put as much money into social security as we took out. But around 1970, when the Boomers started entering the work force we suddenly had more going in than going out. But someone realized that eventually the Boomers would retire and the situation would be reversed, and so they started paying into the (infamous) trust fund. Now that fund has been growing for about 3 decades and in 2012 when the majority of the boomers start retiring, we'll be paying out more money than is going in. But that's ok, because we'll be paying out the trust fund that has been building for 30 years. Then, in 2042, when, let's face it, most of the Boomers will be dead, the trust fund will be spent and we'll go back to paying in as much as we pay out. All of which is based on the conservative estimate that the economy grows at 3% between now and 2042. Over the past 50 years the economy has grown at an average of 3.6%.

Ok, that's all for now, I've got to sack out for a bit before tackling some homework and then partying with all the other idealistic public health dorks.

My People

This Thur-Sat is the human rights conference here in Atlanta (officially "Lessons Learned from Rights Based Approaches to Health") and tonight was the social/mixer kick-off thing so I got to stand around for hours and drink wine and eat chocolate and generally practice hero worship. The timing is perfect too - with burn-out setting in so hard this semester, I needed to be reminded of why I'm here in the first place and to get all fired up and pissed off again. I wish I had brought my little notebook with me tonight, so many excellent, inspiring, upsetting things were said. But the only one I remember is this - worldwide, the number of deaths from HIV/AIDS, TB, and malaria combined are the equivalent of one tsunami every two weeks. Every month. Every year.

Ok, I remember some other things too. One of the speakers, who's name and organization I'm kicking myself for not remembering, spoke about cost effectiveness and how public health needs to move away from this as a criteria. I had a lot of mixed feelings throughout her talk. She made so many good points, but I couldn't prevent the cynical space in my brain arguing, but if you don't look at cost effectiveness and sustainability, how will we convince people to support our work? How will we make progress? How do you justify one life if it costs 50 in the long run? With the exception of the last question, I have to admit, she answered the first two quite convincingly (and somewhat more cynically). The answer is, our work is currently (largely) unsupported. We aren't making the progress that needs to be made. So if we're already fighting a losing battle, why should we play by "their" rules? Where "they" are the ones insisting on cost effectiveness to prove the worth of our programs. The worth of our programs should be measured by the patients we save. Sure, that's an idealistic measurement, and perhaps not the best one in the long run. But as this speaker pointed out, her example with multi-drug resistant TB proved "them" wrong. Her group was told just to let those patients die. That it wasn't cost effective and would siphon money away from other, regular TB programs. But the thing is, there wasn't any money to siphon off! So once the group determined that all programs were being underfunded and undersupported, they decided to treat the patients in front of them. Who happened to have MDR-TB. And you know what? It worked. I don't have the stats on hand, but their program revolutionized the way MDR-TB is treated, by showing that these patients can get better and are worth treating. She said we need to stop asking how best to carve up the small pie public health has been allotted and start asking for a bigger pie (or at least why we have such a small pie to start with). Yes, realistically, we have to operate within the paradigm we're given. But there's no reason to stop trying to change that paradigm while simultaneously working within it. Once you start talking about cost-effectiveness you have to ask, in what context? If you only do interventions in developing countries that are cost effective for that country's national budget, you're essentially saying that those citizens don't get to live. In many countries the national health budget amounts to less than $2 per person per year. Infant immunization costs more than $2. So do you just not immunize anyone because it isn't "cost effective"?

This is why I have a personality problem with one of my profs. We're supposed to have this big research project and presentation due today. We've all been killing ourselves over it and few of us slept more than a few hours last night, trying to get everything wrapped up. Then, at 8:23 this morning (our class is at 10) she sends out a totally impersonal e-mail saying class is cancelled because she has jury duty. No apologies for the late notice. No heads up that we won't have to present this morning. And it's not like they call you that morning for jury duty, so she obviously knew about this at least a day in advance. And couldn't be troubled to tell us. Now I could go back and get a couple more hours of sleep, but I'm too pissed off to fall asleep!

Another great quote, via Dad:

"Electricity was not discovered by incremental improvements to the candle."

<>- Mildred S. Dresselhaus, MIT

She gave a keynote address to the 2005 Pittcon Conference. She was discussing that we CAN solve "the energy situation", but it will require creativity and new approaches. She's a professor of physics and electrical engineering.