Latin America: Research Can Drive Inclusion

By Judith Sutz and Rodrigo Arocena*

A woman points to a microscope while a man looks on.

Researchers from Uruguay’s Universidad de la República worked with partners from the World Health Organization on a project to prevent dengue fever in Salto, Uruguay. / PAHO / Flickr / Creative Commons

Research programs that address “invisible problems” in society – challenges that are generally overlooked – increase marginalized people’s inclusion far beyond solution of their immediate problems.  Problems lacking “agency” get little or no attention as competing demands for public funding crowd out resources for studying problems suffered by marginalized groups.  The solutions that arise from most research, moreover, are often too expensive and too elaborate for the less fortunate.

  • Many health problems denominated “neglected diseases” fall within what the World Health Organization calls “the 90/10 gap.” Some 90 percent of all the health research done around the world is devoted to the kind of health issues suffered by 10 percent of the world population, while the 90 percent get scant attention.

Money and political will are only part of the problem.  Research to identify a problem is in itself a challenge.  Our research indicates that some initial research is often all that is necessary to make an “invisible problem” explicit enough for policymakers to be forced to pay attention.

  • In Uruguay, a university research program in 2010 uncovered the link between rice workers’ health problems, including early death, and agrochemicals seeping into the water spread at plantations. The link was difficult to detect because their symptoms were all “normal” and had other common explanations, but an interdisciplinary team analyzed epidemiological data to confirm it, which prompted the Ministry of Public Health to take action.

A second challenge is developing new approaches to adapt existing solutions that work for the well off to sectors without resources.  Many times in the past, research stopped when a solution, albeit a costly one, was found – which has the consequence of excluding sectors of modest means.  But we know that new intellectual directions can break through even those technological barriers.

  • Once a vaccine was found for the bacterium Haemophilus influenzae type b (Hib), a dangerous pathogen that causes meningitis and other life-threatening diseases in children under five, the threat disappeared from developed countries. But it remained dangerous elsewhere in the world due to the high cost of the vaccine.  Researchers at the University of Havana explored a new approach and designed a synthetic vaccine with a very low cost of production – which many scientists have hailed as an important success.  Argentinean scientists’ development of a probiotic yogurt – called Yogurito – has provided an affordable solution to provide lactobacilli that children need for digestive health.  These “frugal innovations” yield huge benefits.

An inclusive research agenda – promoted by universities and other thought leaders throughout Latin America – can transform knowledge into a tool for social inclusion if the knowledge produced and diffused in the innovation system is focused on the broadest possible segment of society.  A Copernican shift of research agendas worldwide is unlikely in the short term, but a commitment to human sustainable development will necessarily open spaces for broader agendas over time.  Democratization of access to higher education is one important driver in building “inclusive innovation systems.”  In both developed and underdeveloped societies, “developmental universities” can play a big role in solving problems and, importantly, enfranchising broader segments of the population.  Inequality in knowledge – forgetting people with forgotten problems – is a source of broader inequality the reversal of which will be of benefit to all.  Seeing victims of illness who lack the cures that wealthier citizens have as agents, rather than just as patients, is an important first step.

September 20, 2018

* Judith Sutz is Professor and Academic Coordinator of the University Research Council of the Universidad de la República, Uruguay, and Rodrigo Arocena was the University’s rector.  Their recent book is Developmental Universities in Inclusive Innovation Systems: Alternatives for Knowledge Democratization in the Global South (Palgrave Macmillan, 2018).

The Zika Virus and a New Debate on Reproductive Rights

By Rachel Nadelman*

Zika Women

Photo Credit: Day Donaldson and PresidenciaRD / Flickr / Creative Commons

The call by half a dozen Latin American and Caribbean governments for women to put off pregnancies – as the World Health Organization warns the feared Zika virus is “spreading explosively” – is stimulating a new debate on reproductive rights in the region.  El Salvador’s Health Ministry has urged women to “avoid becoming pregnant this year and next,” and Brazil, Jamaica, Colombia, and others are issuing similar advisories.  A mosquito-borne disease spreading rapidly in the Western Hemisphere for the first time, Zika is blamed for causing devastating neurological birth defects in newborns whose mothers contract the virus during pregnancy.  The U.S. Center on Disease Control has advised pregnant women to avoid travel to the more than 20 Latin American and Caribbean countries now hosting the disease.

Named for the Uganda forest where it was discovered in the late 1940s, Zika is carried and transmitted by the Aedes Aegypti mosquito, best known as the vector for life-threatening viruses like yellow fever and dengue.  Within the Western Hemisphere, the Aedes population has increased drastically in recent years, linked by scientists to changes in climate.  Yet Zika’s arrival in Latin America last year, first documented in Brazil, and subsequent expansion did not attract major attention until the pattern of birth defects emerged.  Zika’s symptoms are sometimes imperceptible or typically mild, including fever, joint aches, and conjunctivitis, so health officials did not consider it a major threat to the general population.  Although definitive clinical proof is still lacking, Zika is now linked to microcephaly, a rare neurological condition that causes children to be born with small heads because of abnormal brain development in the womb or immediately after birth.  The emergence of Zika in Latin America has coincided with a more than 20-fold increase in the incidence of microcephaly.  (Brazil has reported 4,000 cases in the past year, a drastic increase from just 150 in 2014).  The babies suffer from poor brain function and reduced life expectancy.  Doctors are finding traces of the virus in the brains of microcephaly-inflicted babies who were stillborn or died soon after birth.

Warnings and advisories offer no help to the millions of women who live in afflicted countries.  Governments are launching fumigation programs to reduce the Aedes mosquito population and thereby limit disease transmission.  Asking populations to refrain from having children appears a bit facile, if not cynical, in a region with low levels of access to birth control for reasons that range from religious dictates to economic obstacles.  Severely restrictive abortion laws also complicate potential parents’ options.  Five Latin American countries (including Honduras and El Salvador, hard hit by Zika) ban abortion without exception, even to save the mother’s life.  Others criminalize abortion with few allowances.  According to the Guttmacher institute, 95 percent of abortions in Latin America are unsafe, contributing to high maternal mortality rates. It’s not surprising, therefore, that Zika’s link to these devastating birth defects has generated unprecedented public discussion throughout Latin America about women’s and families’ rights and responsibilities for taking control of reproduction.  It is far too early to know if the health advisories will have practical impact on the incidence of microcephaly – or on attitudes toward reproductive rights over the longer term.   

February 1, 2016

* Rachel Nadelman is a PhD candidate in International Relations at the School of International Service.  Her dissertation research focuses on El Salvador’s decision to leave its gold resources unmined.

Latin America’s Emerging Burden of Chronic Non-Communicable Diseases

By Fernando De Maio*

Photo credit: FLICKR.com/diapositivasmentales / Foter.com / CC BY

Photo credit: FLICKR.com/diapositivasmentales / Foter.com / CC BY

Despite significant improvements over the past 30 years in some of the most crucial health indicators – including increases in life expectancy and decreases in infant mortality – Latin America faces an impending epidemic of chronic non-communicable diseases such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes.  The region has avoided the worst effects of the HIV/AIDS epidemic.  Brazil, for example, is now widely accepted by health policy analysts as offering the world valuable lessons for combating the spread of HIV and in ensuring access to life-saving antiretroviral medicine.  But chronic non-communicable diseases are now stretching under-funded and fragmented health care systems, revealing deep lines of social inequality.

The World Health Organization (WHO) has warned of an impending epidemic of such ailments, which are already the leading causes of death in all areas of the world except for sub-Saharan Africa.  In Latin America, chronic diseases account for more than 60 percent of deaths, with some variance between countries (more than 70 percent in Uruguay, more than 60 percent in Argentina and Chile, but less than 40 percent in Bolivia and Paraguay).  The latest data indicate that this burden is growing across the region, driven by increases in some of the most important risk factors (physical inactivity and obesity in particular).  Surveys in the region allow us to disaggregate national data, revealing the social inequalities underlying the problem.

In Argentina, we have used the National Risk Factor Surveys from 2005 and 2009 to examine how social gradients are changing:

  • Physical inactivity – an important risk factor for cardiovascular disease – has increased substantially (from 46 to 55 percent).  The further down we go in the socioeconomic hierarchy, the more this important risk factor seems to be increasing.
  • Obesity has also increased in this four-year period (from 14 to 18 percent), with a steepening social gradient for women.
  • Data on diabetes from these surveys are mixed.  The percentage of the adult population told they have diabetes or high blood sugar has risen (8.4 to 9.6 percent), but experts believe the increase reflects both increases in diabetes in the population and an in access to health care resulting in more cases being detected.
  • Some good news may be found in preventive cancer screening: rates of mammograms and pap smears have increased, and social gradients for mammograms are decreasing, raising the hope of diminished inequalities in cancer mortality in the future.

The WHO’s Commission on the Social Determinants of Health recently concluded that “reducing health inequalities is… an ethical imperative.  Social injustice is killing people on a grand scale.”  Among its recommendations is a call for the routine monitoring of health inequalities.  The growing body of data documents the linkage between inequality and the occurrence of chronic non-communicable diseases – demonstrating that, fundamentally, it is a question of social justice.  Social inequalities in physical inactivity, obesity, diabetes – and, crucially, tobacco consumption – are not natural but socially and politically produced.  Empirical research in the coming years will need not only to document the rise of chronic non-communicable diseases in aggregate terms, but also to closely monitor the inequalities embedded in national figures.  Policy analysis will likewise need to examine not just the national-level effects of new initiatives, such as new taxes on tobacco products or new standards for salt consumption, but, at a disaggregated level of analysis, examine how new initiatives affect people across the socioeconomic spectrum.

* Dr. De Maio is a professor in the Department of Sociology at DePaul University.

 

The Consequences of Deferring “Deferred Action”

Photo by Larry Engel

The Obama administration’s recent announcement of a sweeping initiative designed to remove the shadow of deportation from the lives of nearly 800,000 undocumented immigrants residing in the U.S. is the latest twist in the dual saga of immigration policy reform and enforcement. According to government sources, including the Secretary of the Department of Homeland Security (DHS) Janet Napolitano, the carefully worded policy of “deferred action” is not an attempt on the part of the administration to sidestep a deadlocked Congress, an example of executive overreach, nor a strategic campaign maneuver during an election year in which the Hispanic vote could be decisive. It is simply the “right thing to do.”

The disparity between this morally grounded, high-level rhetoric and actual immigration law enforcement practices—which last year resulted in a record 400,000 deportations—has sent mixed signals about the current administration’s sincerity. It seems that the rising rate of deportations, touted last year as a “step in the right direction,” is beginning to be viewed within the administration as an unfortunate miss-step. Nonetheless, to many advocacy groups who lobbied in support of the DREAM Act and against blind enforcement of immigration laws, this Friday’s announcement by the Department of Homeland Security provoked a case of déjà vu. Only a year ago, in June 2011, U.S. Immigration and Customs Enforcement Director John Morton enthusiastically revived the policy of “prosecutorial discretion,” promising to scale back the removals of young students, military service members, and others. However, as of May 29 of this year, only 4,363 cases —a mere two percent of the 232,000 backlogged cases under review—had been administratively closed or dismissed.

Beyond questions of electoral politics and policy implementation, one thing is certain: for many undocumented immigrants and their U.S.-based families, deferred action has come too late. A recent report from DHS cited that during the first six months of 2011 alone, over 46,000 parents of U.S. citizen children were forcibly removed—a statistic that raises serious concerns about the health and social impacts of deportation on U.S. Latino communities. As the current administration seeks to hammer out a consensus regarding a long-term solution to the country’s broken immigration system, it is crucial that such a consensus be informed about the consequences of political miss-steps.