join us at astra.place to vote on which eu leaders are sustainable -othe covid meta - eg mayo
scandals 20 years in making - how govs underinvested in basic mnra research ...also 20 years ago i was lucky to meet a professor of nature at bath uni -i am terrified by what he knows but top down medical bureaucrats dont

1 twitter smart virus lists v0 v2 ==

rsvp chris.macrae@yahoo.co.uk sources by and for all -why experts in ebola are not in covid

close encounters:
of healthy kind, of servant leader kind, of food security, of education kind, of credit kind, of solar kind, of other machine intel kind
37th year of economist debate- who will get last mile in time forpost-covid's sdg generation?- biden?, africa?, bangladesh?, far east islands, rest asia continent, euro, latinam, womens lives, colored lives...my second most exciting moment in life- meeting sir fazle abed 1 2- he had designed a rural health service for one of the ten most populous nations from scratch? which do you think sir fazle need more help from health genii or financial genii? -more here

2020 telehealth hinge moment
our biggest challenge in 2020s is not the virus it is failing to unite around designing a world so next girl or boy born has a joyful chance at a productive life- that depends on 3 skills thriving in ever community - the health servant (economisthealth.com), the livelihood educator (economistuniversity.com) and the financial servant (economistbank.com.)
however we have known since the end of world war 2 that we need new maps than those that 8 largest empires had ruled planet with - and that 4 new technologies and types of mediation will multiply this sustainably up or crashing down until mother natures selects us as next dod- more at girlsworldbank.com
who published 13 global health challenges 1/13/2020 - help update them -related search malaria : fda -messy https://www.the-scientist.com/news-opinion/nih-cancels-funding-for-bat-coronavirus-research-project-67486

virus unknowns help unwomens list some twitter dialogues 1 2 3 chris.macrae@yahoo.co.uk
ByeBye human race unless you can help us find medical word's top 10 World Record Jobs Creators 9 8 7 ...Ironically knowledge of the curriculum of entrepreneurial revolution - as the net generation's opportunity to collaborate in human sustainability peaked in 1984 - unless you can help World Record Jobs Creators retrieve it now - thanks chris macrae wash dc text 240 316 8157 EconomistDiary.com ERworld.tv amychina.net Anyone seriously transparent about affordable global health and sustainability needs to develop segments of health services and then decide whether an integrated service is still to have place boundaries. THE BLOCKCHAIN WARS. New media is always a battle between the forces for evil who linkin fast and those who needed to open space for a deeper social order (which takes time). Understanding blockchain mapping will also be absolutely essential: it may be how sustainability's last call is won by little sisters or lost to big brothers. these are the most exciting times to be alive.. 4 markets human sustainability depends on health & . linkedin UNwomens - question collab blog editors: chris.macrae@yahoo.co.uk washington DC

china; Qatar bangladesh and asean ghana france india

usa CHINA UNICORNS

good news china's robot teachers assistants will soon be better at diagnosis than 99% of docs. china
............



online library of norman macrae...world record jobs creators: sir fazle abed .. jim kim.JKU. larry brilliant.. gerge soros..paul farmer .leana wen .BillionGirlsBoys network
health.nutrition.edu.green.job


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