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Saturday, December 31, 2016

transcript michigan heaLTH AWARD TO FAZLE ABED 2016

 


TO BE TIDIED

I would venture to say that that influence goes much further.
02:36
Today we honor two extraordinary public health heroes
02:40
who have done so much to improve the world's health.
02:44
The first is the late Thomas Francis Junior who served
02:47
for many years as professor and chair of the Department
02:50
of Epidemiology in the University
02:52
of Michigan School of Public Health.
02:55
He helped save millions of lives worldwide through his work
02:58
on influenza and polio vaccines and his visionary approach
03:03
to the study of infectious and chronic disease.
03:07
Tommy Francis is truly a giant in the field of public health
03:10
and we are immensely proud that the University
03:12
of Michigan has established this medal in his name.
03:16
Our public health hero honored here today is Sir Fazle Hassan
03:21
Abed, founder and chairperson of BRAC.
03:25
I am one of the many individuals throughout the world
03:27
who has been inspired by this remarkable man's leadership
03:30
and vision.
03:32
You're about to see why.
03:34
It t is now my pleasure to introduce a short video
03:37
that highlights far better
03:38
than I can say why Sir Fazle is here today.
03:42
The video introduces us to Sir Fazle
03:44
and to the organization he founded and chairs.
03:48
BRAC is built on the belief
03:50
that poverty does not have one cause and, therefore,
03:53
requires many solutions.
03:55
BRAC's programs draw from a variety
03:58
of disciplines including education, micro-finance,
04:02
skills and job training, healthcare, and empowerment
04:06
to give people, particularly women and children, the tools
04:09
and resources they need to overcome poverty.
04:13
Sir Fazle exemplifies leadership and vision,
04:16
compassion, service and action.
04:19
Through BRAC's programs Sir Fazle has been able
04:22
to reach an estimated 138 million people,
04:27
a record of achievement that is simply extraordinary.
04:31
It is public health at its best.
04:34
How has Sir Fazle achieved this level of global impact?
04:38
Please join me in watching.
10:20
[ Applause ]
10:29
>> Good afternoon everybody, I'm Mark Schlissel, I have the honor
10:32
of serving as the 14th president of the University of Michigan.
10:36
What a remarkable video honoring such a wonderful individual.
10:40
How about another hand for our medalist, Sir Fazle Hassan Abed.
10:44
[ Applause ]
10:50
I also comment Dean Philbert and the faculty and support staff
10:53
of the Francis Medal Selection Advisory Committee.
10:56
Thank you for helping recognize such an inspiring honoree.
11:00
The video gave us a glimpse
11:02
of the dynamic decade-long accomplishments
11:05
of today's medalist.
11:07
But before we bring him to the stage I want
11:09
to congratulate many in attendance
11:11
on a very special milestone.
11:14
Just last week our School
11:15
of Public Health began celebrating its
11:17
75th anniversary.
11:20
Over the generations the school has been
11:23
at the forefront of public health.
11:26
It's where the health insurance plan that led
11:28
to Blue Shield was created, where the idea
11:31
for Earth Day took root, where FluMist was developed,
11:36
and of course was the academic home
11:39
of Dr. Thomas Francis Junior.
11:42
The metal that bears his name gives us the opportunity
11:44
to celebrate his amazing lifesaving legacy.
11:48
In his honor we recognize the true giants
11:51
of global public health whose victories are measured
11:54
on humanity's most cherished scales.
11:58
We recognize those who have saved millions of lives,
12:02
those who have empowered communities around the world,
12:05
and those who have transformed crisis to hope
12:09
through leadership and innovation.
12:12
With this medal we recognize those
12:14
who boldly confront the biggest challenges facing our society
12:19
and those who advance the most noble of causes.
12:22
Today we recognize Sir Fazle Hassan Abed.
12:26
I believe the Francis medal also provides us with an opportunity
12:30
and that's the opportunity to learn from an individual
12:34
who exemplifies the University
12:36
of Michigan's most deeply held values of excellence
12:40
and impact for the public good.
12:42
Sir Fazle's organization believes
12:45
that poverty is systematic
12:47
and thus there is no single answer that will end it.
12:52
As a result, BRAC takes a comprehensive approach
12:55
that crosses multiple disciplines.
12:58
No challenge is too large and no one is overlooked.
13:02
The BRAC approach attacks the many intersecting causes
13:06
of poverty, including health and hygiene, food security
13:10
and finance, justice, diversity and human rights.
13:15
It seeks to leverage the right tools
13:17
and the best intellectual resources
13:19
to achieve its mission, a world free from all forms
13:23
of exploitation and discrimination
13:26
where everyone has the opportunity
13:28
to realize their potential.
13:31
As Dean Philbert has said,
13:33
Dr. Fazle is changing the way we address complex public
13:36
health issues.
13:37
I believe the most pressing challenges we face
13:40
as a society need precisely this type of approach.
13:45
The world's biggest problems don't know what discipline
13:49
they're supposed to fall under they're just problems.
13:52
And tragically, our own state of Michigan is no exception.
13:56
I mentioned the School of Public Health's long history
13:59
of contributions.
14:01
More recently, public health is one major area
14:04
of our institution that's partnered with the University
14:07
of Michigan campus in Flint and the Flint community
14:10
to address the water crisis there
14:12
and its effects on public health.
14:15
Our university has longstanding partnerships in Flint
14:18
and we're committed to the long-term recovery
14:21
of the community and its people.
14:23
The Flint campus has been a resource for 60 years
14:27
and the School of Public Health has had collaborations in place
14:30
for more than 20 years in Flint.
14:33
So as we honor Sir Fazle and his outstanding achievements today I
14:37
hope we'll all remember that there are so many crises
14:40
that demand our attention.
14:43
The sheer size and scope of BRAC's work
14:46
and everything we've seen in Flint give us plenty of evidence
14:49
that there's much more work to do.
14:52
And Sir Fazle has said the realities, struggles,
14:57
aspirations and dreams of poor
15:00
and marginalized people are remarkably similar despite
15:04
cultural differences across countries.
15:08
Let us all be grateful
15:09
that there are public health champions
15:11
like Sir Fazle to inspire us.
15:14
I now invite our guest of honor Sir Fazle Hassan Abed
15:17
to the stage.
15:18
He'll be accompanied by the chair of the University
15:20
of Michigan Board of Regents Dr. Shauna Ryder Diggs.
15:23
Please come forward.
15:25
[ Applause ]
15:34
Dr. Diggs you'll say a few words and then we'll give the medal.
15:38
>> Hello everyone, thank you President Schlissel
15:40
and thank you all for being here with us today.
15:43
The Thomas Francis Junior medal is one
15:45
of the highest honors bestowed by the University of Michigan.
15:49
It is given every few years
15:51
to a recipient whose contributions have advanced
15:54
global public health
15:56
and established a healthier future for society.
16:00
As a graduate of the University
16:02
of Michigan medical school Dr. Francis is one
16:05
of my personal inspirations.
16:07
He's a hero and a central figure in the legacy
16:10
of care we have built at this university
16:13
over our nearly 200 years as a public institution.
16:17
That legacy continues today as we approach our third century
16:22
and we honor another true hero in public health.
16:27
One of my favorite quotes is a pessimist sees the difficulty
16:31
in every opportunity an optimist sees the opportunity
16:36
in every difficulty.
16:38
I want to thank Sir Fazle for his optimism, for his dedication
16:43
to helping those who need it most,
16:44
and for his lifelong pursuit to end poverty.
16:49
I join all of my fellow regents
16:51
in congratulating Sir Fazle Hassan Abed the 2016 recipient
16:57
of the Thomas Francis Junior medal.
17:00
[ Applause ]
17:42
>> It is indeed a great honor for me to be here today
17:45
to receive the Thomas Francis Junior medal
17:49
in global public health.
17:52
This gives me tremendous pleasure
17:54
and I thank the University of Michigan
17:58
for bestowing this prestigious award on me.
18:03
I should like to begin my address by paying tribute
18:08
to Professor Thomas Francis
18:11
and remembering his contribution to global health.
18:16
By all measures Professor Thomas Francis was a great scientist
18:20
and an educator.
18:24
His mentoring of Jonas Salk led
18:28
to the discovery of the polio vaccine.
18:31
The impact of this discovery is now known across the globe
18:35
and polio is now almost a thing of the past.
18:41
When the World Health Organization started the
18:43
eradication program in 1988 polio was endemic
18:50
in 125 countries.
18:53
Now barring Afghanistan
18:55
and Pakistan the world is polio free.
19:00
The number of new cases of the disease has decreased by 99%.
19:07
In 1988, there were around 350,000 cases of polio,
19:13
but it went down to 359 in 2014.
19:19
Because of this discovery and the use
19:22
of polio vaccines millions of people
19:26
who would otherwise have been paralyzed are able
19:30
to walk freely today.
19:34
Not many people have done so much help for humanity.
19:40
My country Bangladesh has also been able to eliminate polio
19:47
through the concerted efforts of the government, NGOs,
19:53
the private sector and the development partners.
19:56
We were able to get rid of this [inaudible] several years ago.
20:01
Bangladesh has done impressively well in most areas
20:05
of socioeconomic development.
20:07
In addition to our polio
20:10
and broader vaccination efforts vaccination coverage has
20:14
increased tremendously since the intensive campaign we carried
20:18
out in the mid-1980s.
20:21
From a mere 2% coverage in 1986 Bangladesh has now one
20:26
of the highest coverage rates in the low
20:29
and middle income countries.
20:31
Because Bangladesh is featured in the international news
20:36
and discourse over the past several years the reason
20:41
Bangladesh is featured in the international news and discourse
20:46
over the past several years the reason is this unprecedented
20:50
progress over the past few decades after being dismissed
20:55
as an international basket case at the time
20:58
of our independence in 1971.
21:01
My country has now turned around.
21:04
In almost every field
21:05
of development we have made good strides.
21:11
Take poverty elimination for example,
21:13
in 1972 Bangladesh was the second poorest country
21:18
in the world after [inaudible], which is now [inaudible].
21:22
With a per capita income of less than $100 now we have moved
21:29
into the lower middle income status
21:32
with a per capita income of over $1,300.
21:36
The proportion of population
21:38
in poverty has also declined significantly.
21:41
In 1991, nearly not 60%
21:44
of our people were below the poverty line according
21:50
to the headcount poverty measure,
21:53
which was reduced to 31% in 2010.
21:59
The latest statistics suggests
22:02
that it has now dropped to even lower to 24%.
22:08
As you see from this slide one,
22:15
Bangladesh has had the steepest decline
22:18
in headcount poverty compared to our south Asian neighbors.
22:28
In the field of education the country has made good progress.
22:34
In terms of schooling over 95% of our children enrolled
22:38
in primary schools compared to about 45%
22:42
at the time of independence.
22:44
More interestingly, it is in the gender difference here
22:50
in 1972 less than half as many girls compared
22:54
to boys were in school.
22:55
Now girls outnumber boys.
22:59
In terms of life expectancy,
23:01
Bangladesh's gain has been very impressive.
23:04
In 1972, our life expectancy at birth was only 46, 45 years,
23:12
now every Bangladeshi live for 70 years.
23:16
Again, it is important to note that the gender difference
23:21
and the changes happening over the years
23:24
until 1980 Bangladesh was one of the few countries in the world
23:30
where women lived shorter lives than men.
23:33
This has now been reversed
23:35
with women living a year longer than men.
23:38
Bangladesh has outstripped our south Asian countries
23:43
in life expectancy.
23:45
As you can see from slide two, Bangladesh has now lived 2
23:49
to 4 years longer than our neighbors.
23:57
Now let's move to some of the health indicators.
24:02
Both the infant mortality rate
24:04
and the maternal mortality ratio are lower in Bangladesh
24:09
as you can see from slide three.
24:11
Of all the rates maternal mortality rate has declined
24:16
fastest since 1990, from about 600 in 1990 to 194 in 2010,
24:26
which has further declined
24:27
to about 170 per 100,000 live births now.
24:38
In addition to our success
24:39
in lowering mortality rates Bangladesh has done exceedingly
24:43
well in reducing fertility.
24:46
At the time of independence the total fertility rate was close
24:52
to seven.
24:54
In slide four you will see
24:55
that it has now been reduced to just over two.
24:59
It is the replacement level.
25:03
A related issue is the use of family planning methods.
25:08
The contraceptive prevalence rate has now reached 60%.
25:12
So in terms of other public health
25:20
and health systems indicators,
25:22
although Bangladesh spends the least among south Asian
25:27
countries, slide five, it has been able
25:30
to bring public health services to the doorstep
25:33
of vast majority, including the poor,
25:37
women and other marginalized groups.
25:39
I have already touched on the vaccination coverage,
25:43
which is over 90% and the same is the case
25:48
with oral rehydration therapy.
25:50
Bangladesh now has the highest oral hydration therapy use rate
25:57
in the world and I shall come to this story shortly.
26:04
Now slide five per capita health expenditure
26:08
in Bangladesh [inaudible] said that it's one of the lowest
26:12
in south Asia and despite that we have done fairly well
26:19
in both water usage, as well as the immunization coverage.
26:27
Many ask what happened in Bangladesh that led
26:33
to such impressive performance.
26:36
The country is still economically poor
26:38
by any standard and it spends the least on healthcare.
26:42
It is what Lancet, the British Medical Journal called
26:47
the paradox.
26:48
In the words of the editors of the Lancet the story
26:53
of Bangladesh is one
26:54
of the greatest mysteries of global health.
26:58
The Lancet published a special series on Bangladesh
27:02
about two years ago, which examined this paradox.
27:06
They identified several explanations for it,
27:08
including the fallout of the liberation war,
27:11
the expanding health sector, and the increased role
27:15
of social determinants of health,
27:17
particularly the empowerment of women.
27:20
And other facilitating factor according
27:22
to the Lancet authors was the role
27:25
of nongovernmental organizations.
27:28
My organization, BRAC, has been at the forefront of many
27:32
of the positive changes is explicitly acknowledged
27:36
in the various papers that Lancet published.
27:40
Let me now turn to the role that BRAC played in Bangladesh,
27:44
particularly in advancing health in Bangladesh.
27:51
We set up BRAC in 1972 in response
27:55
to a humanitarian crisis following the war of liberation.
28:00
The organization has now gone global,
28:04
with development program spread
28:06
across a dozen countries in Asia and Africa.
28:11
The goal of BRAC is poverty elimination
28:15
and empowerment of the poor.
28:18
The way we have defined poverty leads us to address all causes
28:23
of poverty simultaneously in a holistic way.
28:27
Thus, the implement programs on financial inclusion, gender,
28:32
health, nutrition, education and climate change.
28:38
I wish to take this opportunity to share with you one
28:41
of the distinguishing features of BRAC
28:43
that has evolved during our four and half decades of work
28:47
and that is good implementation.
28:51
I will illustrate this through the example of an ORT program
28:56
that we implemented in Bangladesh in 1980's.
29:03
Diarrhea caused by contaminated water is the single greatest
29:08
killer of children in much of the world.
29:10
In 1980's BRAC ran a program
29:14
that helped reduce children's death
29:16
from diarrhea by 80% nationwide.
29:21
The project was fraught with difficulties
29:23
and challenges taking a decade to complete.
29:29
I think the experience offers important lessons
29:32
that apply far beyond Bangladesh and public health.
29:36
There is much talk of the signs of delivery.
29:40
The delivery of services to people in need.
29:45
The development circles -- in development circles today.
29:49
Jim Kim, the World Bank's president says, it is no longer
29:52
so much a question of what to deliver, but how to deliver it.
29:58
Perfecting the science of delivery even
30:01
for the simplest solutions can help us uproot deeply entrenched
30:06
poverty, illiteracy and ill-health.
30:11
Our anti-diarrhea effort was a simple solution in every sense,
30:16
noting nothing but water, sugar and salt given to sick children.
30:24
The Lancet reports on the first trials
30:27
of this oral rehydration therapy in 1968.
30:32
Two American doctors who worked
30:37
in qualitative research laboratory
30:39
in Bangladesh actually did a trial of oral rehydration
30:46
and provided their findings in the Lancet in 1968.
30:52
And one of these two Americans is here today, Dr. Richard Cash,
30:57
who is a member of the Board of BRAC USA.
31:00
He has been a lifelong friend of mine and he is one
31:06
of the discoverers of oral rehydration therapy,
31:09
which has now saved more than 50 million children worldwide.
31:14
So this is one of the great success stories
31:17
of oral rehydration which was discovered in Bangladesh
31:21
and then BRAC took the science to the people, to the mothers,
31:27
the women in Bangladesh who then practiced oral rehydration
31:32
and saved the children.
31:34
So that had a big impact on mortality decline
31:37
in Bangladesh of children.
31:41
We saw that the villages and slums where death comes
31:45
in the form of waterborne bacteria,
31:48
intravenous fluid was hard to find.
31:53
Let alone the money to buy it and the expertise needed
31:57
to insert a needle in the vein.
31:59
But we knew that nearly every mother had access
32:02
to water, sugar and salt.
32:05
The hard part was teaching millions how
32:08
to mix the solution correctly close to a hundred percent
32:14
of the time and to understand when and how often
32:18
to give the solution to the sick child.
32:22
When we began in 1979 the World Health Organization opposed our
32:26
efforts, arguing that it would be dangerous to try
32:30
to teach illiterate mothers
32:32
to make their own oral rehydration solution.
32:35
They said that it would be --
32:37
it would put even more children's lives at risks.
32:42
What if the mothers got the proportions wrong or mixed
32:45
up the salt and sugar?
32:47
The attempted cure might kill more people then disease itself
32:52
they said.
32:54
We proved them wrong.
32:55
Our experience showed that even people with no formal schooling
33:00
and zero literacy could retain basic lifesaving health
33:04
knowledge, the ORT, the oral rehydration therapy.
33:10
We eventually reached 14 million mothers each
33:14
of whom received individual instruction.
33:19
As already mentioned, Bangladesh now has the world's highest ORT
33:24
usage rate and we have meanwhile been able
33:27
to address the underlying causes of diarrhea
33:30
by improving hygienic practices and the supply of clean water.
33:36
In the light of this and other experiences,
33:39
the other four lessons that we learned about delivering simple,
33:42
but lifesaving solutions to massive numbers of people.
33:50
One, deliver through the most proximate channels.
33:55
The delivery agents for ORT training were female health
33:59
workers who came from similar villages,
34:04
hundreds of small teams of these workers traveled
34:07
around the country in mobile camps to teach mothers
34:12
to make solutions in person.
34:15
Because the measurements like half a liter
34:17
of water didn't have meaning for many women.
34:22
The trainers began making common household containers
34:26
for reference.
34:27
The trainers began making common household containers
34:30
for reference by marking in the household containers.
34:36
They measured salt by finger and common molasses
34:41
for sugar by the fistful.
34:45
Two, achieve scale through simplicity.
34:50
Deliverers must simplify
34:53
and scrutinize tasks before replicating them.
34:58
Through trial and error we fine-tuned a systemized routine
35:05
of person-to-person contact and frequent iteration
35:10
that ensured maximum [inaudible]
35:12
of knowledge while eliminating unnecessary steps.
35:17
In the end we reduced the core message of ORT
35:21
to seven simple steps that mothers commit to memory.
35:27
Three, create a learning culture
35:31
by embracing feedback and failure.
35:35
The first version of the ORT program was actually a disaster.
35:40
Fewer than 10% of mothers who retained the knowledge necessary
35:44
to make the solution actually used it.
35:48
We found that the trainers themselves did not completely
35:51
believe in the solution.
35:54
At another point we realized
35:55
that we were not adequately engaging the men
35:58
in each village.
36:00
At each stage we redesigned the intervention
36:05
and tested the results again.
36:07
Four, build robust management and monitoring system.
36:14
Although bottom up community involvement was essential we
36:19
also maintained a tight top-down management structure.
36:25
We paid trainer son an incentive system based on the amount
36:29
of knowledge retained by the training one month later.
36:33
At the same time we suspected that some
36:37
of the monitors measuring the retention rates were cheating.
36:41
Filling out forms without visiting trainee households.
36:47
We adjusted the monitoring system
36:48
to have the initial trainer record the name
36:51
of the youngest person
36:52
in the household during the initial training.
36:55
The name was kept from the monitor who had
36:58
to provide it during his report on the follow-up.
37:04
If the names didn't match the monitor obviously hadn't visited
37:09
the household and we had to send quite a number
37:13
of few monitors in the process.
37:16
In those days there was no cell phone that we could find
37:19
out whether they visited or not.
37:21
So these lessons apply to man sectors and countries,
37:28
in education local women with little more
37:31
than high school education themselves can become champion
37:35
schoolteachers and role model for girls.
37:39
Even in more conservative areas of Afghanistan
37:43
and Pakistan it is one of the most cost-effective
37:47
and rapid ways to bring quality schooling to the unreached.
37:51
Following the lessons
37:53
above organizations can massively scale
37:55
up these systems.
37:58
In global development it is not a lack of new bright ideas
38:04
that is impeding progress, but rather our ability
38:09
to implement these ideas well, effectively and at scale.
38:15
Historic advances are not always recognized
38:19
in the present rightly.
38:21
We have as much excitement today about the potential
38:26
of new technology to end human poverty.
38:30
This can make us forget that many solutions already exist.
38:37
We are just missing effective delivery mechanisms.
38:41
We can reach millions more today by focusing less
38:45
on what and more on how.
38:49
Finally, I thank you all for your patient hearing and again
38:54
for honoring me with the Thomas Francis Junior medal
38:59
in global health.
39:01
Thank you.
39:03
[ Applause ]
39:35
>> I'm Mathew Bolton, the senior associate dean
39:36
for Global Public Health in the School of Public Health
39:39
and it's my distinct pleasure
39:41
to introduce this afternoon's panel discussion entitled a
39:45
conversation with Sir Fazle Development as Empowerment.
39:50
I'm especially pleased to be joined today
39:52
by three distinguished colleagues whose many
39:55
professional accomplishments I invite you
39:57
to read about in the program.
40:00
And if they could come down as I introduce them
40:01
and join us on the stage.
40:03
First Professor Jake [audio skips], Daniel Katz,
40:07
distinguished University Professor of psychology
40:10
of Afro-American and African studies, and director
40:14
and research professor in the Institute of Social Research.
40:20
And we're going to be joined by Professor Amy Dittmar,
40:23
who's vice Provost for academic and budgetary affairs
40:27
and professor of finance here in the Ross School of Business.
40:32
And finally, Dr. Abdul El-Sayed, executive director
40:36
of public health and health officer for the City
40:38
of Detroit Health Department.
40:40
Please join me in welcoming our panelists.
40:42
[ Applause ]
40:50
If I could share a quick story before we get underway.
40:51
You'll see in your program
40:52
that it's actually entitled a conversation with Sir Abed
40:56
and after it was seen by Dean, Martin Philbert, who was raised
41:03
and educated in the UK he immediately
41:06
and rather snippily pointed out that the appropriate salutation
41:10
for a subject of the realm wo has been knighted by the crown
41:13
or the crown is instead Sir Fazle.
41:16
He then informed if I consulted page 405
41:21
of Robert Hickey's standard text in the field Honor and Respect,
41:25
The Official Guide to Names, Titles and Forms of Address,
41:29
it would help clear
41:30
up my obvious ignorance in this matter.
41:32
And he also mentioned he felt compelled to mention
41:35
that under no circumstances would a knighted American ever
41:39
be called sir.
41:41
He then concluded his e-mail in obvious reference to my lack
41:47
of knowledge about [inaudible] protocol
41:50
with saying you sir are a Philistine
41:53
to which I could only rejoin that's Sir Philistine
41:58
to you buddy.
42:00
So Sir Fazle, now that I -- hearing you speak and reading
42:09
out BRAC one can't help but be overwhelmed
42:14
with the sheer enormity of the scale and scope
42:19
of the organization which as we've heard is generally
42:22
acknowledged as the largest NGO development organization
42:26
in the world today.
42:28
A hundred and ten thousand employees providing services
42:32
to 140 million people in 12 countries
42:35
around the world involving 120,000 community health
42:40
workers, creation of 48,000 schools in expenditures
42:45
of 1 billion US each year.
42:47
It makes me embarrassed and feel inadequate
42:51
that I can barely supervise my staff of 12.
42:55
But clearly the vehicle for much
42:58
of this has been a community empowerment.
43:02
So maybe we can start with Professor Jackson in reflecting
43:08
on Sir Fazle's comments.
43:09
Perhaps help us understand how community empowerment has been
43:16
such an effective instrument
43:18
for delivering lifesaving healthcare, providing education
43:24
and alleviating poverty as part of BRAC's work.
43:28
>> Well this is a remarkable story.
43:31
>> Thank you.
43:31
>> So I just want to make that comment.
43:34
>> Thank you.
43:34
>> Before we even begin
43:35
and in some ways it kind of speaks for itself.
43:38
I was wondering how we would have this conversation
43:41
and get started.
43:42
But let me start in a slightly different place.
43:45
Now I'll arrive there very shortly.
43:48
But what's remarkable about this is the evolution of the notion
43:54
of health being much more than the absence of disease,
43:59
which has become a relatively common thought in public health
44:02
and other places in UNESCO, and in the UN lately.
44:08
But this was a fundamental basis
44:11
of where this started back in 1970.
44:14
And trust me, this was not being thrown about.
44:18
Good health involves all aspects of well-being economic, social,
44:23
psychological, all as well as good physical health.
44:28
And the thing that's remarkable to get
44:30
to your particular point is the fact that this can be achieved
44:36
by the empowerment of people, particularly women and children
44:42
and empowerment of communities.
44:44
And we do that by actually giving them a sense of hope,
44:50
a set of expectations that indeed they can do things
44:54
that can make a difference, and then provided the resources
44:58
to allow them to do this
45:01
and to take responsibility for having done it.
45:06
I think that's the secret of community engagement,
45:09
it's a secret which BRAC has used
45:11
in terms of what it's doing.
45:13
And I think it should have come through very clearly with regard
45:17
to the presentation both at the beginning
45:21
and also Sir Fazle's presentation about BRAC.
45:27
>> Sir Fazle, do you feel
45:29
that community empowerment is a potentially uniformly impactful
45:35
intervention in all community-based settings?
45:41
>> Yes, I think it's important to give people the --
45:48
create enabling conditions for poor people
45:53
to act on their own behalf.
45:56
So enabling conditions are various kinds
45:59
of enabling conditions you can create.
46:00
For example, if you provide financial services micro finance
46:04
for example, the poor people will have access to resources
46:08
and then they can get into business,
46:11
do various things, come out of poverty.
46:13
So most of the hard work has to be done
46:16
with the people themselves.
46:18
So as an organization,
46:20
my organization will provide the enabling condition for people
46:25
to act on their own behalf and then they will come on board.
46:30
So you have to involve people and involve them and the belief
46:34
in their own action is going to change their lives.
46:38
So why we are training volunteers
46:42
in the village is the poor people who have access
46:46
to the volunteer services and faith in their ability
46:51
to change their own condition,
46:53
that's what the community empowerment has been all about.
46:59
That we can change our lives provided we act in the right way
47:03
and we take the right kind of solution to change our lives.
47:13
[ Multiple Speakers ]
47:14
Explain it to you well or not.
47:15
>> Yes, yes I'd like to pick up on your comment
47:17
about micro finance which I think I read is the oldest
47:22
program in BRAC.
47:23
I think for most of us
47:25
when students hear micro finance they think
47:27
about their own bank account, I know I think
47:30
about my monthly check.
47:31
That's not what it is, it's something larger than that
47:35
so perhaps Professor Dittmar you could help us think
47:40
through micro finance and especially the potential
47:44
of micro finance to increase the standard of living for women
47:47
in developing countries.
47:49
>> Yes, certainly and I think that what you said
47:51
about the bank account is the way a lot of people think
47:53
of micro finance and actually it's defined pretty broadly
47:56
across the financial community as well.
47:59
It can be anything from and I thought about what BRAC is doing
48:03
where they are making very small loans to rural individuals,
48:07
women, and I'll come back to that
48:09
up to I think a more moderate scale, you know,
48:12
a small business growing larger.
48:14
And while there's a fair amount of capital from banks and such
48:17
at that -- we'll call it the larger end of the small,
48:20
at the smallest end for the individuals, for the poorest,
48:23
for the rural, for the women, there is very limited resources.
48:27
There's a gap for different reasons that have
48:30
to do with economic models.
48:31
So I think that to be able to provide that financing,
48:35
which is something that we take for granted
48:37
and that might be a loan, it might be the ability
48:41
for savings, it might also just be the transfer
48:43
of funds between individuals.
48:45
When we think of micro finance we first think of loans,
48:48
but things that we just take for granted that, you know,
48:52
I can write you a check or I can send funds overseas or things
48:56
of that sort are something that's not always available
48:59
in developing countries.
49:00
So when you think about the goals of the organization here
49:04
to empower the individuals to have the ability to do
49:06
that on your own to self-employ it really is the key.
49:11
So I can see why it was that the founding
49:13
of the organization or the start.
49:16
>> Maybe Sir Fazle you can elaborate
49:20
on how micro finance first occurred to you
49:22
since that goes all the way back to the 1970's, early 1970's
49:26
with the formation of the organization.
49:29
>> Yes, we looked at -- I mean the people in poverty
49:33
where we came to the realization that the poor are poor
49:38
because they are powerless.
49:40
Powerless to do anything about their condition,
49:43
so we wanted to empower them.
49:45
So initially what we -- I remember in 1972 a book came
49:52
out from an educator his name was Paulo Freire,
49:58
he was a Brazilian educator and his main idea was
50:03
to get poor people organized and creates and sort
50:11
of [inaudible] them, raising consciousness
50:13
about their own situation.
50:16
And also give them the tools of how
50:18
to change their own condition.
50:21
So poor is an individual, poor person is a powerless person,
50:24
but if he's organized then he could gather some amount
50:29
of power.
50:29
As the organized poor can become
50:32
to exert some power within the community.
50:35
And then also if you're mobilizing resources then you
50:40
can become powerful.
50:41
So we provided resources so that the poor people can change their
50:46
own lives, own conditions, work hard on it and then repay loans
50:52
and get another big loan
50:53
to improve their condition and so on.
50:56
So once they realize that that their own action is going
50:59
to change their own lives they started acting
51:03
in a responsible way and try to change their own condition.
51:07
So one of the biggest problems of about poverty elimination is
51:12
that most poor people are not -- don't feel empowered,
51:17
don't feel that they can change their lives
51:19
through their own action.
51:21
So that's what I think organizers need to do to try
51:25
and provide the kind of sense of self-worth in poor people
51:30
and also try to convince them that their own action is going
51:34
to change their own lives.
51:36
So working hard with the kind of resources being provided
51:41
by an organization, working hard to improve their own condition,
51:44
own life, own income and so on was very important.
51:50
So when we say that we provide micro finance
51:54
and we do development,
51:56
we are not doing development we are providing
51:58
certain conditions.
51:59
Most of the development, most of the hard work is done
52:02
by the poor themselves in improving their own conditions.
52:07
So that's what I mean by getting poor people involved
52:11
in the solution to their own problems
52:15
and that's what BRAC has been able to do to try
52:17
and get poor people's involvement in development
52:21
of themselves and we created the enabling condition
52:24
for them to do it.
52:25
So when we set up schools we provide opportunities
52:28
for people -- for children or poor people's children who come
52:33
to school, poor people be able to give them school
52:39
for the children not to be used in the household work,
52:42
but send them to school.
52:45
And then the children are learning at home and, you know,
52:52
working hard on learning.
52:54
It's the children, their parents, everybody is sort
53:00
of contributing to changing the education scenario
53:04
in the countryside, not just the provider BRAC.
53:08
>> You know, empowerment and hope, you know,
53:11
touch upon issues of social justice and human rights
53:15
and that's a strong thread that runs through the work of BRAC.
53:18
As President Schlissel mentioned,
53:21
we've watched we've watched a tragedy unfold
53:24
in a local community here in Michigan, Flint,
53:26
Michigan where babies and children,
53:29
entire families were exposed to toxic levels of lead
53:34
through the drinking water supply.
53:36
Largely through government inaction
53:39
and certainly an intent to save money.
53:44
You know, similarly the issue of social justice
53:47
and environmental justice and human rights was raised
53:52
at the time of the collapse
53:53
of the Rana Plaza garment factory collapse in Bangladesh.
53:58
>> Right.
53:58
>> So whether we're working in Flint, Michigan or Dhaka,
54:00
Bangladesh how do we reconcile what's sometimes perceived
54:06
as the competing interests of economic development
54:11
with human rights and social justice?
54:14
Can we realize equal measures of both in our programs
54:18
or does one come at the cost of the other?
54:21
And I will invite your comments and comments
54:23
from the other panelists.
54:24
>> If you look at Rana Plaza for example, what has happened
54:33
after that both sides the garment industry owners,
54:39
as well as those people who are buying
54:41
from these garment industries?
54:43
The companies which are based in the United States or Europe
54:48
who are also then providing support
54:51
to the government industries in order
54:52
to make the garment workers' life safe in the sense
54:58
of the buildings were all inspected and so
55:02
that these buildings were safe enough for people to work in.
55:06
So I think all kinds of action was taken from all sides,
55:12
from both the garment industry side, industry owner side,
55:17
as well as the people who were providing orders
55:22
for these industries they also took the responsibility to see
55:26
that the workers were, you know, safe enough working
55:31
in these garment industries.
55:33
So in other words, there has been a number
55:36
of different changes that has happened,
55:38
the government has also woken up to the inspection --
55:41
proper inspection of garment industries as to whether
55:44
or not these factories were safe for people to work in.
55:49
So I think this disaster has actually now created a condition
55:56
in which everybody has taken some responsibility to see
55:59
that the workers' conditions were better in terms
56:05
of safety standards and so on.
56:09
In Flint's case I read it in the papers
56:14
that you have got very high levels of lead in the water
56:19
and it has been dangerous to children and so on.
56:25
So here is what I think is the same thing
56:28
for the government there's a failure
56:31
in the system of some kind.
56:33
Public health system within Flint obviously has failed
56:39
to diagnose that the water wasn't safe enough for children.
56:44
So there is a failure somewhere that has to be corrected.
56:49
Yes.
56:50
>> Dr. El-Sayed, the chief medical officer for the City
56:54
of Detroit which is undergoing an economic renaissance.
56:58
How do you -- you're in the governmental official
57:00
with primary responsibility for the health
57:02
of the citizens of Detroit.
57:04
How do you deal with striking this balance
57:07
between economic development and ensuring health human rights?
57:12
>> So I'm going to answer that question,
57:14
but before so I just want
57:18
to say what struck me both while watching the video
57:23
that really nice lays out the incredible work that's been done
57:28
and constructed over the past and then listening
57:30
to Sir Fazle's comments.
57:33
This is a uniquely inspiring operationalization
57:39
of this whole idea of social determinants.
57:42
Using health as a spear through which you can enter
57:47
into a bigger conversation with the community
57:49
that at the same time acknowledges powerlessness
57:53
and agency right, which seem to become counter-posed
57:56
but I think really well thought through here.
57:58
Then we were talking a little bit in the talk
58:02
that you basically gave us
58:03
in four points an operation's lesson and focusing
58:06
on it's not just what you do it's also how you do it,
58:11
which makes a huge difference.
58:12
To get to the question I think oftentimes we think
58:16
about this dichotomy between public health and well-being
58:20
and economic interest in industry
58:24
and I think it's a false dichotomy.
58:27
You know, when we think about what do we need
58:30
to keep people healthy, people need jobs,
58:32
people need to have the means to go out
58:36
and to engage the economy.
58:39
And oftentimes where we do get this weird dichotomy is the
58:42
moment where people are left out of that --
58:44
left out of the equation either because the system
58:48
by which we produce does not do a good job
58:52
of facilitating everybody's engagement
58:54
or because the production itself harms folks.
58:57
And I think as we think about Detroit as a microcosm
59:01
in a space within which this is all happening very quickly,
59:05
a Detroit that is healthier.
59:08
Just thinking about a healthy Detroit beyond the health
59:10
of individuals themselves, but a healthy ecosystem
59:13
in Detroit would allow us to see a future where folks are engaged
59:19
in industries that produce goods for everybody.
59:24
That hasn't always been the case, we have a number
59:26
of highly industrialized zones in the city and questions
59:29
about who has to bear the consequences of some
59:32
of the public baths that they produce.
59:34
Things like emissions and pollution.
59:38
Those are conversations that need to be had, but I do think
59:41
that those conversations about how we correct in the space
59:44
where our industry is failing to provide goods and
59:48
or providing public baths I think that gets us to the point
59:51
where we have a much more inclusive economy moving
59:54
forward anyway.
59:55
So I just -- I think the dichotomy is not one we should
59:58
think about, but rather where's the synergy between two aspects
60:02
of society that fundamentally have to go hand-in-hand.
60:06
>> You know I think it's important to note both
60:09
in thinking about Flint and thinking about Bangladesh
60:14
that actors whether governments
60:18
and others are not necessarily people
60:21
who desire social injustices as an outcome.
60:26
That is, they don't necessarily desire that.
60:29
The problem is the indifference to the plight
60:33
of people who are different.
60:35
>> Right.
60:36
>> That's the issue and that's one of the things
60:38
about the beauty of BRAC because you have to be able
60:41
to show people that there is a route
60:44
by which we can achieve social and economic justice
60:49
and it could be done in a way
60:50
which is not necessarily overly [inaudible].
60:53
>> Right, right.
60:54
>> You know to the -- because one of the things
60:57
about BRAC that's so interesting is that they also work
61:00
on the macro environment.
61:02
>> Right.
61:02
>> You know, you didn't talk that much
61:04
about that particular set of issues, but the notion is is
61:08
that you empower people on the one hand and you show them a way
61:13
by which they indeed can make changes.
61:15
>> Right.
61:15
>> But also you do things
61:17
on the other side whether it's creating banks
61:20
or it's creating universities or it's creating schools
61:23
that indeed provide the resources
61:26
by which people then indeed can achieve these goals.
61:29
But it's also important in terms of showing governments
61:32
and other people in power that change is possible right.
61:36
>> Yes, yes.
61:37
>> And here is a route by which that change can be achieved.
61:40
>> Right, right.
61:40
>> That's really important.
61:41
The idea that we have all these bad people in government
61:45
and I even read a story
61:47
about how the governor is just a bad person,
61:49
you know, and things like that.
61:52
I think it's a wrong way to look at it
61:54
because I don't think that's really true.
61:56
It's just people oftentimes don't see the route
61:59
by which they can bring about change
62:02
and they have to be shown that.
62:04
>> That this can be done.
62:05
>> That it can be done right, that's what I think at least.
62:09
>> Right.
62:09
>> I would say on that one thing that I think
62:11
about this very well that maybe Flint
62:14
in the process they didn't do is to have a very clear mission.
62:17
I mean you said it very early
62:18
in your talk the poverty elimination and the empowerment
62:21
of the poor and then you have kind
62:23
of like the key principles of how to get there.
62:25
And so I don't think these things have to be dichotomous
62:28
where you have the economic on one side
62:30
and the social good on the other.
62:31
If you see the economics as a way to achieve those principles.
62:35
And those guiding principles I think is probably what's kept
62:38
the organization inline being the medical, I mean the health
62:41
and the well-being, as well as the education
62:45
and having those principles going
62:47
on because I think that's what brings them together.
62:52
>> In thinking about [inaudible] talk and the work of BRAC
62:57
for the panelists what do you think would most importantly
63:02
inform the work of public health improving health
63:05
in our own country from what you've seen and heard
63:08
about the work of BRAC in Bangladesh and other countries?
63:11
>> So A, it's possible.
63:13
I stepped into my role in Detroit seven months ago
63:17
and I don't know if you guys you saw the cover
63:20
of Newsweek this week, but the cover story is Detroit makes
63:23
you sick.
63:24
And there's nothing that takes the wind out of your sails
63:30
than Newsweek telling you that your city makes people sick.
63:33
But, you know, work on this scale that BRAC has enabled
63:40
that takes a lot of time, that's a lifetime of work.
63:44
But it's possible and it's worth working for.
63:46
And then the other point is to go back to this point
63:48
on operations, operations, operations.
63:51
Oftentimes we focus on the individuals in the right
63:56
or the wrong, but being able to build a system
63:58
that accomplishes a set of ends in the way that BRAC has
64:02
so efficiently been able to do
64:04
that is a conversation that's often missed.
64:08
You know, we often think about people doing bad things,
64:11
but normally that's because people are in systems
64:13
that are failing and actively failing.
64:15
And the ways that you think about tinkering with a system
64:19
to create the kinds of amazing outcomes that you've been able
64:23
to that is, you know, to me the moral of the story
64:26
that it's possible and it's about thinking systematically
64:29
through the challenge.
64:30
And then the last one is that, you know,
64:33
oftentimes it's really easy to silo ourselves and to focus
64:36
on particular outcomes.
64:38
We in Detroit have made a conscious effort not to get back
64:42
into business of providing direct healthcare
64:44
because we believe the best way of promoting health
64:46
in the city is to use health as an entry point into all
64:49
of the other issues that challenge the lives
64:52
and livelihoods of the people who live in our city.
64:56
And that's about using health to contextualize
64:59
and frame a much bigger conversation about well-being,
65:02
which I really appreciated the point
65:03
and I think you guys illustrated that incredibly well
65:06
through the work and just deeply inspiring, so thank you.
65:11
>> I know this wasn't the intent of BRAC and not the intent
65:15
of Sir Fazle which was to embarrass the United States.
65:19
>> No, no.
65:21
>> But I'll tell you what they've been able to achieve
65:25
in Bangladeshi and other places
65:27
and impacting 138 million people should shame us
65:31
in a very rich country, which has tremendous resources
65:36
that we are not employing fully in order to bring
65:41
about changes in this country.
65:43
Now poor people in this country remember, you know,
65:46
the issue of wealth and inequality
65:48
and so on is relative.
65:51
So it's very difficult to make these particular kind
65:53
of comparisons across country borders.
65:56
More people here are better all than poor people in Bangladesh.
66:00
>> Bangladesh.
66:01
>> Right we just need to really be able
66:03
to understand it, but it's relative.
66:05
And what people feel here
66:07
in this particular society is they feel as bad as people
66:11
in Bangladesh do in comparison to people
66:14
who have better kinds of outcomes.
66:17
We could do better.
66:18
This is a model for us to look at and to see what can be done
66:22
with relatively small amounts of resources.
66:26
If indeed, judiciously used and pinpointed to the kinds
66:31
of problems that we have and so that's --
66:33
but I know you didn't start [inaudible],
66:36
you didn't mean to be.
66:38
But it should do that for us.
66:40
>> No, I have always thought
66:41
that in Bangladesh right now we have got
66:46
to maternal mortality rate of 170 per 100,000 births.
66:53
In the United States it's about 20
66:57
to 25 deaths per 100,000 births.
67:02
In Norway is 3, 3 deaths per 100,000 births.
67:09
Right, so what can Bangladesh do to bring
67:12
about its maternal mortality rate from 170 to 3,
67:18
that's their target, the best is 3.
67:24
Now so we, I've been thinking about what is different
67:29
between Norway and Bangladesh is
67:30
that Norway has got a per capita income of $50,000,
67:34
Bangladesh has got only 1,300.
67:37
Obviously, all the births in Norway takes place in a hospital
67:41
where there is an obstetrician and an anesthetist and nurse
67:45
and everybody is available.
67:47
In Bangladesh the births take place mostly in the household,
67:54
there's no trained birth attendants as a result
67:58
and they're obstructed deliveries cannot be handled
68:02
by everybody unless you send them
68:04
to tertiary hospitals, so it can't be done.
68:08
So what can be done in intermediate --
68:11
in the next 10 years what could BRAC do in order to bring
68:15
down mortality rate of 170 to 30, that's what my target is.
68:21
So we have decided now to start training midwives
68:25
after high school three years of training as midwives
68:30
and deploy 10,000 midwives in rural Bangladesh
68:33
in the next 15 years, which will be able to then attend births
68:38
that are taking place in the household.