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transcript michigan heaLTH AWARD TO FAZLE ABED 2016
TO BE TIDIED
I would venture to say that that influence goes much further.
Today we honor two extraordinary public health heroes
who have done so much to improve the world's health.
The first is the late Thomas Francis Junior who served
for many years as professor and chair of the Department
of Epidemiology in the University
of Michigan School of Public Health.
He helped save millions of lives worldwide through his work
on influenza and polio vaccines and his visionary approach
to the study of infectious and chronic disease.
Tommy Francis is truly a giant in the field of public health
and we are immensely proud that the University
of Michigan has established this medal in his name.
Our public health hero honored here today is Sir Fazle Hassan
Abed, founder and chairperson of BRAC.
I am one of the many individuals throughout the world
who has been inspired by this remarkable man's leadership
You're about to see why.
It t is now my pleasure to introduce a short video
that highlights far better
than I can say why Sir Fazle is here today.
The video introduces us to Sir Fazle
and to the organization he founded and chairs.
BRAC is built on the belief
that poverty does not have one cause and, therefore,
requires many solutions.
BRAC's programs draw from a variety
of disciplines including education, micro-finance,
skills and job training, healthcare, and empowerment
to give people, particularly women and children, the tools
and resources they need to overcome poverty.
Sir Fazle exemplifies leadership and vision,
compassion, service and action.
Through BRAC's programs Sir Fazle has been able
to reach an estimated 138 million people,
a record of achievement that is simply extraordinary.
It is public health at its best.
How has Sir Fazle achieved this level of global impact?
Please join me in watching.
[ Applause ]
>> Good afternoon everybody, I'm Mark Schlissel, I have the honor
of serving as the 14th president of the University of Michigan.
What a remarkable video honoring such a wonderful individual.
How about another hand for our medalist, Sir Fazle Hassan Abed.
[ Applause ]
I also comment Dean Philbert and the faculty and support staff
of the Francis Medal Selection Advisory Committee.
Thank you for helping recognize such an inspiring honoree.
The video gave us a glimpse
of the dynamic decade-long accomplishments
of today's medalist.
But before we bring him to the stage I want
to congratulate many in attendance
on a very special milestone.
Just last week our School
of Public Health began celebrating its
Over the generations the school has been
at the forefront of public health.
It's where the health insurance plan that led
to Blue Shield was created, where the idea
for Earth Day took root, where FluMist was developed,
and of course was the academic home
of Dr. Thomas Francis Junior.
The metal that bears his name gives us the opportunity
to celebrate his amazing lifesaving legacy.
In his honor we recognize the true giants
of global public health whose victories are measured
on humanity's most cherished scales.
We recognize those who have saved millions of lives,
those who have empowered communities around the world,
and those who have transformed crisis to hope
through leadership and innovation.
With this medal we recognize those
who boldly confront the biggest challenges facing our society
and those who advance the most noble of causes.
Today we recognize Sir Fazle Hassan Abed.
I believe the Francis medal also provides us with an opportunity
and that's the opportunity to learn from an individual
who exemplifies the University
of Michigan's most deeply held values of excellence
and impact for the public good.
Sir Fazle's organization believes
that poverty is systematic
and thus there is no single answer that will end it.
As a result, BRAC takes a comprehensive approach
that crosses multiple disciplines.
No challenge is too large and no one is overlooked.
The BRAC approach attacks the many intersecting causes
of poverty, including health and hygiene, food security
and finance, justice, diversity and human rights.
It seeks to leverage the right tools
and the best intellectual resources
to achieve its mission, a world free from all forms
of exploitation and discrimination
where everyone has the opportunity
to realize their potential.
As Dean Philbert has said,
Dr. Fazle is changing the way we address complex public
I believe the most pressing challenges we face
as a society need precisely this type of approach.
The world's biggest problems don't know what discipline
they're supposed to fall under they're just problems.
And tragically, our own state of Michigan is no exception.
I mentioned the School of Public Health's long history
More recently, public health is one major area
of our institution that's partnered with the University
of Michigan campus in Flint and the Flint community
to address the water crisis there
and its effects on public health.
Our university has longstanding partnerships in Flint
and we're committed to the long-term recovery
of the community and its people.
The Flint campus has been a resource for 60 years
and the School of Public Health has had collaborations in place
for more than 20 years in Flint.
So as we honor Sir Fazle and his outstanding achievements today I
hope we'll all remember that there are so many crises
that demand our attention.
The sheer size and scope of BRAC's work
and everything we've seen in Flint give us plenty of evidence
that there's much more work to do.
And Sir Fazle has said the realities, struggles,
aspirations and dreams of poor
and marginalized people are remarkably similar despite
cultural differences across countries.
Let us all be grateful
that there are public health champions
like Sir Fazle to inspire us.
I now invite our guest of honor Sir Fazle Hassan Abed
to the stage.
He'll be accompanied by the chair of the University
of Michigan Board of Regents Dr. Shauna Ryder Diggs.
Please come forward.
[ Applause ]
Dr. Diggs you'll say a few words and then we'll give the medal.
>> Hello everyone, thank you President Schlissel
and thank you all for being here with us today.
The Thomas Francis Junior medal is one
of the highest honors bestowed by the University of Michigan.
It is given every few years
to a recipient whose contributions have advanced
global public health
and established a healthier future for society.
As a graduate of the University
of Michigan medical school Dr. Francis is one
of my personal inspirations.
He's a hero and a central figure in the legacy
of care we have built at this university
over our nearly 200 years as a public institution.
That legacy continues today as we approach our third century
and we honor another true hero in public health.
One of my favorite quotes is a pessimist sees the difficulty
in every opportunity an optimist sees the opportunity
in every difficulty.
I want to thank Sir Fazle for his optimism, for his dedication
to helping those who need it most,
and for his lifelong pursuit to end poverty.
I join all of my fellow regents
in congratulating Sir Fazle Hassan Abed the 2016 recipient
of the Thomas Francis Junior medal.
[ Applause ]
>> It is indeed a great honor for me to be here today
to receive the Thomas Francis Junior medal
in global public health.
This gives me tremendous pleasure
and I thank the University of Michigan
for bestowing this prestigious award on me.
I should like to begin my address by paying tribute
to Professor Thomas Francis
and remembering his contribution to global health.
By all measures Professor Thomas Francis was a great scientist
and an educator.
His mentoring of Jonas Salk led
to the discovery of the polio vaccine.
The impact of this discovery is now known across the globe
and polio is now almost a thing of the past.
When the World Health Organization started the
eradication program in 1988 polio was endemic
in 125 countries.
Now barring Afghanistan
and Pakistan the world is polio free.
The number of new cases of the disease has decreased by 99%.
In 1988, there were around 350,000 cases of polio,
but it went down to 359 in 2014.
Because of this discovery and the use
of polio vaccines millions of people
who would otherwise have been paralyzed are able
to walk freely today.
Not many people have done so much help for humanity.
My country Bangladesh has also been able to eliminate polio
through the concerted efforts of the government, NGOs,
the private sector and the development partners.
We were able to get rid of this [inaudible] several years ago.
Bangladesh has done impressively well in most areas
of socioeconomic development.
In addition to our polio
and broader vaccination efforts vaccination coverage has
increased tremendously since the intensive campaign we carried
out in the mid-1980s.
From a mere 2% coverage in 1986 Bangladesh has now one
of the highest coverage rates in the low
and middle income countries.
Because Bangladesh is featured in the international news
and discourse over the past several years the reason
Bangladesh is featured in the international news and discourse
over the past several years the reason is this unprecedented
progress over the past few decades after being dismissed
as an international basket case at the time
of our independence in 1971.
My country has now turned around.
In almost every field
of development we have made good strides.
Take poverty elimination for example,
in 1972 Bangladesh was the second poorest country
in the world after [inaudible], which is now [inaudible].
With a per capita income of less than $100 now we have moved
into the lower middle income status
with a per capita income of over $1,300.
The proportion of population
in poverty has also declined significantly.
In 1991, nearly not 60%
of our people were below the poverty line according
to the headcount poverty measure,
which was reduced to 31% in 2010.
The latest statistics suggests
that it has now dropped to even lower to 24%.
As you see from this slide one,
Bangladesh has had the steepest decline
in headcount poverty compared to our south Asian neighbors.
In the field of education the country has made good progress.
In terms of schooling over 95% of our children enrolled
in primary schools compared to about 45%
at the time of independence.
More interestingly, it is in the gender difference here
in 1972 less than half as many girls compared
to boys were in school.
Now girls outnumber boys.
In terms of life expectancy,
Bangladesh's gain has been very impressive.
In 1972, our life expectancy at birth was only 46, 45 years,
now every Bangladeshi live for 70 years.
Again, it is important to note that the gender difference
and the changes happening over the years
until 1980 Bangladesh was one of the few countries in the world
where women lived shorter lives than men.
This has now been reversed
with women living a year longer than men.
Bangladesh has outstripped our south Asian countries
in life expectancy.
As you can see from slide two, Bangladesh has now lived 2
to 4 years longer than our neighbors.
Now let's move to some of the health indicators.
Both the infant mortality rate
and the maternal mortality ratio are lower in Bangladesh
as you can see from slide three.
Of all the rates maternal mortality rate has declined
fastest since 1990, from about 600 in 1990 to 194 in 2010,
which has further declined
to about 170 per 100,000 live births now.
In addition to our success
in lowering mortality rates Bangladesh has done exceedingly
well in reducing fertility.
At the time of independence the total fertility rate was close
In slide four you will see
that it has now been reduced to just over two.
It is the replacement level.
A related issue is the use of family planning methods.
The contraceptive prevalence rate has now reached 60%.
So in terms of other public health
and health systems indicators,
although Bangladesh spends the least among south Asian
countries, slide five, it has been able
to bring public health services to the doorstep
of vast majority, including the poor,
women and other marginalized groups.
I have already touched on the vaccination coverage,
which is over 90% and the same is the case
with oral rehydration therapy.
Bangladesh now has the highest oral hydration therapy use rate
in the world and I shall come to this story shortly.
Now slide five per capita health expenditure
in Bangladesh [inaudible] said that it's one of the lowest
in south Asia and despite that we have done fairly well
in both water usage, as well as the immunization coverage.
Many ask what happened in Bangladesh that led
to such impressive performance.
The country is still economically poor
by any standard and it spends the least on healthcare.
It is what Lancet, the British Medical Journal called
In the words of the editors of the Lancet the story
of Bangladesh is one
of the greatest mysteries of global health.
The Lancet published a special series on Bangladesh
about two years ago, which examined this paradox.
They identified several explanations for it,
including the fallout of the liberation war,
the expanding health sector, and the increased role
of social determinants of health,
particularly the empowerment of women.
And other facilitating factor according
to the Lancet authors was the role
of nongovernmental organizations.
My organization, BRAC, has been at the forefront of many
of the positive changes is explicitly acknowledged
in the various papers that Lancet published.
Let me now turn to the role that BRAC played in Bangladesh,
particularly in advancing health in Bangladesh.
We set up BRAC in 1972 in response
to a humanitarian crisis following the war of liberation.
The organization has now gone global,
with development program spread
across a dozen countries in Asia and Africa.
The goal of BRAC is poverty elimination
and empowerment of the poor.
The way we have defined poverty leads us to address all causes
of poverty simultaneously in a holistic way.
Thus, the implement programs on financial inclusion, gender,
health, nutrition, education and climate change.
I wish to take this opportunity to share with you one
of the distinguishing features of BRAC
that has evolved during our four and half decades of work
and that is good implementation.
I will illustrate this through the example of an ORT program
that we implemented in Bangladesh in 1980's.
Diarrhea caused by contaminated water is the single greatest
killer of children in much of the world.
In 1980's BRAC ran a program
that helped reduce children's death
from diarrhea by 80% nationwide.
The project was fraught with difficulties
and challenges taking a decade to complete.
I think the experience offers important lessons
that apply far beyond Bangladesh and public health.
There is much talk of the signs of delivery.
The delivery of services to people in need.
The development circles -- in development circles today.
Jim Kim, the World Bank's president says, it is no longer
so much a question of what to deliver, but how to deliver it.
Perfecting the science of delivery even
for the simplest solutions can help us uproot deeply entrenched
poverty, illiteracy and ill-health.
Our anti-diarrhea effort was a simple solution in every sense,
noting nothing but water, sugar and salt given to sick children.
The Lancet reports on the first trials
of this oral rehydration therapy in 1968.
Two American doctors who worked
in qualitative research laboratory
in Bangladesh actually did a trial of oral rehydration
and provided their findings in the Lancet in 1968.
And one of these two Americans is here today, Dr. Richard Cash,
who is a member of the Board of BRAC USA.
He has been a lifelong friend of mine and he is one
of the discoverers of oral rehydration therapy,
which has now saved more than 50 million children worldwide.
So this is one of the great success stories
of oral rehydration which was discovered in Bangladesh
and then BRAC took the science to the people, to the mothers,
the women in Bangladesh who then practiced oral rehydration
and saved the children.
So that had a big impact on mortality decline
in Bangladesh of children.
We saw that the villages and slums where death comes
in the form of waterborne bacteria,
intravenous fluid was hard to find.
Let alone the money to buy it and the expertise needed
to insert a needle in the vein.
But we knew that nearly every mother had access
to water, sugar and salt.
The hard part was teaching millions how
to mix the solution correctly close to a hundred percent
of the time and to understand when and how often
to give the solution to the sick child.
When we began in 1979 the World Health Organization opposed our
efforts, arguing that it would be dangerous to try
to teach illiterate mothers
to make their own oral rehydration solution.
They said that it would be --
it would put even more children's lives at risks.
What if the mothers got the proportions wrong or mixed
up the salt and sugar?
The attempted cure might kill more people then disease itself
We proved them wrong.
Our experience showed that even people with no formal schooling
and zero literacy could retain basic lifesaving health
knowledge, the ORT, the oral rehydration therapy.
We eventually reached 14 million mothers each
of whom received individual instruction.
As already mentioned, Bangladesh now has the world's highest ORT
usage rate and we have meanwhile been able
to address the underlying causes of diarrhea
by improving hygienic practices and the supply of clean water.
In the light of this and other experiences,
the other four lessons that we learned about delivering simple,
but lifesaving solutions to massive numbers of people.
One, deliver through the most proximate channels.
The delivery agents for ORT training were female health
workers who came from similar villages,
hundreds of small teams of these workers traveled
around the country in mobile camps to teach mothers
to make solutions in person.
Because the measurements like half a liter
of water didn't have meaning for many women.
The trainers began making common household containers
The trainers began making common household containers
for reference by marking in the household containers.
They measured salt by finger and common molasses
for sugar by the fistful.
Two, achieve scale through simplicity.
Deliverers must simplify
and scrutinize tasks before replicating them.
Through trial and error we fine-tuned a systemized routine
of person-to-person contact and frequent iteration
that ensured maximum [inaudible]
of knowledge while eliminating unnecessary steps.
In the end we reduced the core message of ORT
to seven simple steps that mothers commit to memory.
Three, create a learning culture
by embracing feedback and failure.
The first version of the ORT program was actually a disaster.
Fewer than 10% of mothers who retained the knowledge necessary
to make the solution actually used it.
We found that the trainers themselves did not completely
believe in the solution.
At another point we realized
that we were not adequately engaging the men
in each village.
At each stage we redesigned the intervention
and tested the results again.
Four, build robust management and monitoring system.
Although bottom up community involvement was essential we
also maintained a tight top-down management structure.
We paid trainer son an incentive system based on the amount
of knowledge retained by the training one month later.
At the same time we suspected that some
of the monitors measuring the retention rates were cheating.
Filling out forms without visiting trainee households.
We adjusted the monitoring system
to have the initial trainer record the name
of the youngest person
in the household during the initial training.
The name was kept from the monitor who had
to provide it during his report on the follow-up.
If the names didn't match the monitor obviously hadn't visited
the household and we had to send quite a number
of few monitors in the process.
In those days there was no cell phone that we could find
out whether they visited or not.
So these lessons apply to man sectors and countries,
in education local women with little more
than high school education themselves can become champion
schoolteachers and role model for girls.
Even in more conservative areas of Afghanistan
and Pakistan it is one of the most cost-effective
and rapid ways to bring quality schooling to the unreached.
Following the lessons
above organizations can massively scale
up these systems.
In global development it is not a lack of new bright ideas
that is impeding progress, but rather our ability
to implement these ideas well, effectively and at scale.
Historic advances are not always recognized
in the present rightly.
We have as much excitement today about the potential
of new technology to end human poverty.
This can make us forget that many solutions already exist.
We are just missing effective delivery mechanisms.
We can reach millions more today by focusing less
on what and more on how.
Finally, I thank you all for your patient hearing and again
for honoring me with the Thomas Francis Junior medal
in global health.
[ Applause ]
>> I'm Mathew Bolton, the senior associate dean
for Global Public Health in the School of Public Health
and it's my distinct pleasure
to introduce this afternoon's panel discussion entitled a
conversation with Sir Fazle Development as Empowerment.
I'm especially pleased to be joined today
by three distinguished colleagues whose many
professional accomplishments I invite you
to read about in the program.
And if they could come down as I introduce them
and join us on the stage.
First Professor Jake [audio skips], Daniel Katz,
distinguished University Professor of psychology
of Afro-American and African studies, and director
and research professor in the Institute of Social Research.
And we're going to be joined by Professor Amy Dittmar,
who's vice Provost for academic and budgetary affairs
and professor of finance here in the Ross School of Business.
And finally, Dr. Abdul El-Sayed, executive director
of public health and health officer for the City
of Detroit Health Department.
Please join me in welcoming our panelists.
[ Applause ]
If I could share a quick story before we get underway.
You'll see in your program
that it's actually entitled a conversation with Sir Abed
and after it was seen by Dean, Martin Philbert, who was raised
and educated in the UK he immediately
and rather snippily pointed out that the appropriate salutation
for a subject of the realm wo has been knighted by the crown
or the crown is instead Sir Fazle.
He then informed if I consulted page 405
of Robert Hickey's standard text in the field Honor and Respect,
The Official Guide to Names, Titles and Forms of Address,
it would help clear
up my obvious ignorance in this matter.
And he also mentioned he felt compelled to mention
that under no circumstances would a knighted American ever
be called sir.
He then concluded his e-mail in obvious reference to my lack
of knowledge about [inaudible] protocol
with saying you sir are a Philistine
to which I could only rejoin that's Sir Philistine
to you buddy.
So Sir Fazle, now that I -- hearing you speak and reading
out BRAC one can't help but be overwhelmed
with the sheer enormity of the scale and scope
of the organization which as we've heard is generally
acknowledged as the largest NGO development organization
in the world today.
A hundred and ten thousand employees providing services
to 140 million people in 12 countries
around the world involving 120,000 community health
workers, creation of 48,000 schools in expenditures
of 1 billion US each year.
It makes me embarrassed and feel inadequate
that I can barely supervise my staff of 12.
But clearly the vehicle for much
of this has been a community empowerment.
So maybe we can start with Professor Jackson in reflecting
on Sir Fazle's comments.
Perhaps help us understand how community empowerment has been
such an effective instrument
for delivering lifesaving healthcare, providing education
and alleviating poverty as part of BRAC's work.
>> Well this is a remarkable story.
>> Thank you.
>> So I just want to make that comment.
>> Thank you.
>> Before we even begin
and in some ways it kind of speaks for itself.
I was wondering how we would have this conversation
and get started.
But let me start in a slightly different place.
Now I'll arrive there very shortly.
But what's remarkable about this is the evolution of the notion
of health being much more than the absence of disease,
which has become a relatively common thought in public health
and other places in UNESCO, and in the UN lately.
But this was a fundamental basis
of where this started back in 1970.
And trust me, this was not being thrown about.
Good health involves all aspects of well-being economic, social,
psychological, all as well as good physical health.
And the thing that's remarkable to get
to your particular point is the fact that this can be achieved
by the empowerment of people, particularly women and children
and empowerment of communities.
And we do that by actually giving them a sense of hope,
a set of expectations that indeed they can do things
that can make a difference, and then provided the resources
to allow them to do this
and to take responsibility for having done it.
I think that's the secret of community engagement,
it's a secret which BRAC has used
in terms of what it's doing.
And I think it should have come through very clearly with regard
to the presentation both at the beginning
and also Sir Fazle's presentation about BRAC.
>> Sir Fazle, do you feel
that community empowerment is a potentially uniformly impactful
intervention in all community-based settings?
>> Yes, I think it's important to give people the --
create enabling conditions for poor people
to act on their own behalf.
So enabling conditions are various kinds
of enabling conditions you can create.
For example, if you provide financial services micro finance
for example, the poor people will have access to resources
and then they can get into business,
do various things, come out of poverty.
So most of the hard work has to be done
with the people themselves.
So as an organization,
my organization will provide the enabling condition for people
to act on their own behalf and then they will come on board.
So you have to involve people and involve them and the belief
in their own action is going to change their lives.
So why we are training volunteers
in the village is the poor people who have access
to the volunteer services and faith in their ability
to change their own condition,
that's what the community empowerment has been all about.
That we can change our lives provided we act in the right way
and we take the right kind of solution to change our lives.
[ Multiple Speakers ]
Explain it to you well or not.
>> Yes, yes I'd like to pick up on your comment
about micro finance which I think I read is the oldest
program in BRAC.
I think for most of us
when students hear micro finance they think
about their own bank account, I know I think
about my monthly check.
That's not what it is, it's something larger than that
so perhaps Professor Dittmar you could help us think
through micro finance and especially the potential
of micro finance to increase the standard of living for women
in developing countries.
>> Yes, certainly and I think that what you said
about the bank account is the way a lot of people think
of micro finance and actually it's defined pretty broadly
across the financial community as well.
It can be anything from and I thought about what BRAC is doing
where they are making very small loans to rural individuals,
women, and I'll come back to that
up to I think a more moderate scale, you know,
a small business growing larger.
And while there's a fair amount of capital from banks and such
at that -- we'll call it the larger end of the small,
at the smallest end for the individuals, for the poorest,
for the rural, for the women, there is very limited resources.
There's a gap for different reasons that have
to do with economic models.
So I think that to be able to provide that financing,
which is something that we take for granted
and that might be a loan, it might be the ability
for savings, it might also just be the transfer
of funds between individuals.
When we think of micro finance we first think of loans,
but things that we just take for granted that, you know,
I can write you a check or I can send funds overseas or things
of that sort are something that's not always available
in developing countries.
So when you think about the goals of the organization here
to empower the individuals to have the ability to do
that on your own to self-employ it really is the key.
So I can see why it was that the founding
of the organization or the start.
>> Maybe Sir Fazle you can elaborate
on how micro finance first occurred to you
since that goes all the way back to the 1970's, early 1970's
with the formation of the organization.
>> Yes, we looked at -- I mean the people in poverty
where we came to the realization that the poor are poor
because they are powerless.
Powerless to do anything about their condition,
so we wanted to empower them.
So initially what we -- I remember in 1972 a book came
out from an educator his name was Paulo Freire,
he was a Brazilian educator and his main idea was
to get poor people organized and creates and sort
of [inaudible] them, raising consciousness
about their own situation.
And also give them the tools of how
to change their own condition.
So poor is an individual, poor person is a powerless person,
but if he's organized then he could gather some amount
As the organized poor can become
to exert some power within the community.
And then also if you're mobilizing resources then you
can become powerful.
So we provided resources so that the poor people can change their
own lives, own conditions, work hard on it and then repay loans
and get another big loan
to improve their condition and so on.
So once they realize that that their own action is going
to change their own lives they started acting
in a responsible way and try to change their own condition.
So one of the biggest problems of about poverty elimination is
that most poor people are not -- don't feel empowered,
don't feel that they can change their lives
through their own action.
So that's what I think organizers need to do to try
and provide the kind of sense of self-worth in poor people
and also try to convince them that their own action is going
to change their own lives.
So working hard with the kind of resources being provided
by an organization, working hard to improve their own condition,
own life, own income and so on was very important.
So when we say that we provide micro finance
and we do development,
we are not doing development we are providing
Most of the development, most of the hard work is done
by the poor themselves in improving their own conditions.
So that's what I mean by getting poor people involved
in the solution to their own problems
and that's what BRAC has been able to do to try
and get poor people's involvement in development
of themselves and we created the enabling condition
for them to do it.
So when we set up schools we provide opportunities
for people -- for children or poor people's children who come
to school, poor people be able to give them school
for the children not to be used in the household work,
but send them to school.
And then the children are learning at home and, you know,
working hard on learning.
It's the children, their parents, everybody is sort
of contributing to changing the education scenario
in the countryside, not just the provider BRAC.
>> You know, empowerment and hope, you know,
touch upon issues of social justice and human rights
and that's a strong thread that runs through the work of BRAC.
As President Schlissel mentioned,
we've watched we've watched a tragedy unfold
in a local community here in Michigan, Flint,
Michigan where babies and children,
entire families were exposed to toxic levels of lead
through the drinking water supply.
Largely through government inaction
and certainly an intent to save money.
You know, similarly the issue of social justice
and environmental justice and human rights was raised
at the time of the collapse
of the Rana Plaza garment factory collapse in Bangladesh.
>> So whether we're working in Flint, Michigan or Dhaka,
Bangladesh how do we reconcile what's sometimes perceived
as the competing interests of economic development
with human rights and social justice?
Can we realize equal measures of both in our programs
or does one come at the cost of the other?
And I will invite your comments and comments
from the other panelists.
>> If you look at Rana Plaza for example, what has happened
after that both sides the garment industry owners,
as well as those people who are buying
from these garment industries?
The companies which are based in the United States or Europe
who are also then providing support
to the government industries in order
to make the garment workers' life safe in the sense
of the buildings were all inspected and so
that these buildings were safe enough for people to work in.
So I think all kinds of action was taken from all sides,
from both the garment industry side, industry owner side,
as well as the people who were providing orders
for these industries they also took the responsibility to see
that the workers were, you know, safe enough working
in these garment industries.
So in other words, there has been a number
of different changes that has happened,
the government has also woken up to the inspection --
proper inspection of garment industries as to whether
or not these factories were safe for people to work in.
So I think this disaster has actually now created a condition
in which everybody has taken some responsibility to see
that the workers' conditions were better in terms
of safety standards and so on.
In Flint's case I read it in the papers
that you have got very high levels of lead in the water
and it has been dangerous to children and so on.
So here is what I think is the same thing
for the government there's a failure
in the system of some kind.
Public health system within Flint obviously has failed
to diagnose that the water wasn't safe enough for children.
So there is a failure somewhere that has to be corrected.
>> Dr. El-Sayed, the chief medical officer for the City
of Detroit which is undergoing an economic renaissance.
How do you -- you're in the governmental official
with primary responsibility for the health
of the citizens of Detroit.
How do you deal with striking this balance
between economic development and ensuring health human rights?
>> So I'm going to answer that question,
but before so I just want
to say what struck me both while watching the video
that really nice lays out the incredible work that's been done
and constructed over the past and then listening
to Sir Fazle's comments.
This is a uniquely inspiring operationalization
of this whole idea of social determinants.
Using health as a spear through which you can enter
into a bigger conversation with the community
that at the same time acknowledges powerlessness
and agency right, which seem to become counter-posed
but I think really well thought through here.
Then we were talking a little bit in the talk
that you basically gave us
in four points an operation's lesson and focusing
on it's not just what you do it's also how you do it,
which makes a huge difference.
To get to the question I think oftentimes we think
about this dichotomy between public health and well-being
and economic interest in industry
and I think it's a false dichotomy.
You know, when we think about what do we need
to keep people healthy, people need jobs,
people need to have the means to go out
and to engage the economy.
And oftentimes where we do get this weird dichotomy is the
moment where people are left out of that --
left out of the equation either because the system
by which we produce does not do a good job
of facilitating everybody's engagement
or because the production itself harms folks.
And I think as we think about Detroit as a microcosm
in a space within which this is all happening very quickly,
a Detroit that is healthier.
Just thinking about a healthy Detroit beyond the health
of individuals themselves, but a healthy ecosystem
in Detroit would allow us to see a future where folks are engaged
in industries that produce goods for everybody.
That hasn't always been the case, we have a number
of highly industrialized zones in the city and questions
about who has to bear the consequences of some
of the public baths that they produce.
Things like emissions and pollution.
Those are conversations that need to be had, but I do think
that those conversations about how we correct in the space
where our industry is failing to provide goods and
or providing public baths I think that gets us to the point
where we have a much more inclusive economy moving
So I just -- I think the dichotomy is not one we should
think about, but rather where's the synergy between two aspects
of society that fundamentally have to go hand-in-hand.
>> You know I think it's important to note both
in thinking about Flint and thinking about Bangladesh
that actors whether governments
and others are not necessarily people
who desire social injustices as an outcome.
That is, they don't necessarily desire that.
The problem is the indifference to the plight
of people who are different.
>> That's the issue and that's one of the things
about the beauty of BRAC because you have to be able
to show people that there is a route
by which we can achieve social and economic justice
and it could be done in a way
which is not necessarily overly [inaudible].
>> Right, right.
>> You know to the -- because one of the things
about BRAC that's so interesting is that they also work
on the macro environment.
>> You know, you didn't talk that much
about that particular set of issues, but the notion is is
that you empower people on the one hand and you show them a way
by which they indeed can make changes.
>> But also you do things
on the other side whether it's creating banks
or it's creating universities or it's creating schools
that indeed provide the resources
by which people then indeed can achieve these goals.
But it's also important in terms of showing governments
and other people in power that change is possible right.
>> Yes, yes.
>> And here is a route by which that change can be achieved.
>> Right, right.
>> That's really important.
The idea that we have all these bad people in government
and I even read a story
about how the governor is just a bad person,
you know, and things like that.
I think it's a wrong way to look at it
because I don't think that's really true.
It's just people oftentimes don't see the route
by which they can bring about change
and they have to be shown that.
>> That this can be done.
>> That it can be done right, that's what I think at least.
>> I would say on that one thing that I think
about this very well that maybe Flint
in the process they didn't do is to have a very clear mission.
I mean you said it very early
in your talk the poverty elimination and the empowerment
of the poor and then you have kind
of like the key principles of how to get there.
And so I don't think these things have to be dichotomous
where you have the economic on one side
and the social good on the other.
If you see the economics as a way to achieve those principles.
And those guiding principles I think is probably what's kept
the organization inline being the medical, I mean the health
and the well-being, as well as the education
and having those principles going
on because I think that's what brings them together.
>> In thinking about [inaudible] talk and the work of BRAC
for the panelists what do you think would most importantly
inform the work of public health improving health
in our own country from what you've seen and heard
about the work of BRAC in Bangladesh and other countries?
>> So A, it's possible.
I stepped into my role in Detroit seven months ago
and I don't know if you guys you saw the cover
of Newsweek this week, but the cover story is Detroit makes
And there's nothing that takes the wind out of your sails
than Newsweek telling you that your city makes people sick.
But, you know, work on this scale that BRAC has enabled
that takes a lot of time, that's a lifetime of work.
But it's possible and it's worth working for.
And then the other point is to go back to this point
on operations, operations, operations.
Oftentimes we focus on the individuals in the right
or the wrong, but being able to build a system
that accomplishes a set of ends in the way that BRAC has
so efficiently been able to do
that is a conversation that's often missed.
You know, we often think about people doing bad things,
but normally that's because people are in systems
that are failing and actively failing.
And the ways that you think about tinkering with a system
to create the kinds of amazing outcomes that you've been able
to that is, you know, to me the moral of the story
that it's possible and it's about thinking systematically
through the challenge.
And then the last one is that, you know,
oftentimes it's really easy to silo ourselves and to focus
on particular outcomes.
We in Detroit have made a conscious effort not to get back
into business of providing direct healthcare
because we believe the best way of promoting health
in the city is to use health as an entry point into all
of the other issues that challenge the lives
and livelihoods of the people who live in our city.
And that's about using health to contextualize
and frame a much bigger conversation about well-being,
which I really appreciated the point
and I think you guys illustrated that incredibly well
through the work and just deeply inspiring, so thank you.
>> I know this wasn't the intent of BRAC and not the intent
of Sir Fazle which was to embarrass the United States.
>> No, no.
>> But I'll tell you what they've been able to achieve
in Bangladeshi and other places
and impacting 138 million people should shame us
in a very rich country, which has tremendous resources
that we are not employing fully in order to bring
about changes in this country.
Now poor people in this country remember, you know,
the issue of wealth and inequality
and so on is relative.
So it's very difficult to make these particular kind
of comparisons across country borders.
More people here are better all than poor people in Bangladesh.
>> Right we just need to really be able
to understand it, but it's relative.
And what people feel here
in this particular society is they feel as bad as people
in Bangladesh do in comparison to people
who have better kinds of outcomes.
We could do better.
This is a model for us to look at and to see what can be done
with relatively small amounts of resources.
If indeed, judiciously used and pinpointed to the kinds
of problems that we have and so that's --
but I know you didn't start [inaudible],
you didn't mean to be.
But it should do that for us.
>> No, I have always thought
that in Bangladesh right now we have got
to maternal mortality rate of 170 per 100,000 births.
In the United States it's about 20
to 25 deaths per 100,000 births.
In Norway is 3, 3 deaths per 100,000 births.
Right, so what can Bangladesh do to bring
about its maternal mortality rate from 170 to 3,
that's their target, the best is 3.
Now so we, I've been thinking about what is different
between Norway and Bangladesh is
that Norway has got a per capita income of $50,000,
Bangladesh has got only 1,300.
Obviously, all the births in Norway takes place in a hospital
where there is an obstetrician and an anesthetist and nurse
and everybody is available.
In Bangladesh the births take place mostly in the household,
there's no trained birth attendants as a result
and they're obstructed deliveries cannot be handled
by everybody unless you send them
to tertiary hospitals, so it can't be done.
So what can be done in intermediate --
in the next 10 years what could BRAC do in order to bring
down mortality rate of 170 to 30, that's what my target is.
So we have decided now to start training midwives
after high school three years of training as midwives
and deploy 10,000 midwives in rural Bangladesh
in the next 15 years, which will be able to then attend births
that are taking place in the household.