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).

Haiti: Hurricane Matthew’s Devastating Impact

By Emma Fawcett*

Group of Haitians unpacking supplies

A citizen of Beaumont, Haiti unloads hurricane relief supplies from USAID on October 13, 2016. / U.S. Air Force / Photo by Tech. Sgt. Russ Scalf / Flickr / Creative Commons

Hurricane Matthew, which made landfall on Haiti’s southwestern claw on October 4, devastated citizens’ lives, homes, and businesses – and set back much more across the country.  Some 546 are reported dead, and 128 are still listed as missing.  According to World Bank estimates, the Category 4 hurricane caused nearly $2 billion in damages, including $600 million in the agricultural sector.  The hard-hit southern peninsula provides about one-third of Port-au-Prince’s food supply, and the losses of crops and fishing equipment have long-term implications for food security.  Ninety percent of the homes in the South and Grand’Anse regions were damaged or destroyed, and according to the Environment Ministry, the storm sped up deforestation and has destroyed more recently planted trees.  The relief efforts have been poorly coordinated by Haiti’s interim government, resulting in press reports of looted aid convoys and sporadic protests.

The storm has also set back almost every key initiative underway in Haiti.

  • Just two months after the United Nations finally acknowledged its role in bringing cholera to the country in 2010 (for which it subsequently proposed an aid package that includes restitution to victims), flooding and contaminated water have led to a dramatic increase in the number of cholera cases. An estimated 3,400 new cases have been reported in just the last four weeks.  With help from the World Health Organization, the Haitian Ministry of Health will begin administering 1 million doses of the oral cholera vaccine, but addressing cholera also necessitates serious improvements in access to safe water and sanitation.
  • Haiti’s elections, scheduled for October 9 and already a year overdue, were rescheduled once more due to the hurricane. They are now set for November 20, but foreign observers and candidates alike indicate that major obstacles remain.  More than 770 schools, which are typically used as polling stations, were destroyed by the storm, and roads throughout the south remain impassable.

Once again, it falls to the international community to lend Haiti a hand, but donors have been sluggish.  During a visit in mid-October, UN Secretary General Ban Ki-moon said that he was “disappointed by the response of the international community.”  Less than a third of the UN’s $120 million appeal for immediate hurricane relief has been raised – and the UN was already struggling to raise funds for its separate cholera fund.  Donor fatigue in the United States, where the government contributed several billion in tax dollars and more than half of citizens made private donations following the 2010 earthquake, has been deepened by widespread perceptions that money was wasted.  Poor coordination, wasteful spending by aid agencies, and political stagnation have meant that Haiti has little to show for the $9 billion in earthquake relief.  (The Red Cross, for example, spent $500 million on various projects, but, despite its stated focus on housing, famously built just six permanent homes.)  Canada’s anticipated assumption of leadership of MINUSTAH, the UN peacekeeping mission, from Brazil by the end of the year may help energize aid efforts.  Canada has a large Haitian diaspora population and Prime Minister Trudeau has signaled interest in taking a larger role in Haiti’s recovery, but Canada’s contributions to hurricane relief are still dwarfed by those of the United States.  Once again, Haiti lurches from one crisis to another – and it will continue to until aid and development efforts are better coordinated and the country achieves some measure of political stability.

October 31, 2016

Emma Fawcett recently completed a Ph.D. in International Relations at American University.  Her doctoral thesis focused on the political economy of tourism and development in four Caribbean countries: Haiti, Dominican Republic, Cuba, and the Mexican Caribbean.

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.