An Overview: Exploring Development Aid and Migration

This blog post explores the relationship between the history of international development aid and migration.

My previous posts have focused on high-level meetings and policies used as guidelines to advocate for development effectiveness and cooperation in the international aid and development sector. At a time when the Sustainable Development Goals (SDGs) have been rolled out to countries to make sure “no country is left behind,” nations have a shared framework to guide them and make sure their development policies support activities that lead to outcomes such as poverty alleviation, job creation, and sustainable communities. Additionally, the aim of development effectiveness and cooperation is to provide accountability for donors and financing agencies as countries move forward with their national agendas.

The focus on how to best do development has me wondering why development is necessary in the first place and, furthermore, what role migration plays in this discussion. To start off, the United States Agency on International Development’s (USAID) mission  is to “partner to end extreme poverty and promote resilient, democratic societies while advancing [the United States’] security and prosperity.” When I personally consider the end goal of development, I think about countries across the globe being able to support themselves economically. I envision healthy communities and the elimination of poverty. This is what I envision. However, in order to have a better understanding of development today, its history has to be re-visited.

In the United States, the concept of economic or international development first became widely circulated during the Truman administration, a period where there was a strong belief that science and technology could solve human problems like disease and malnutrition. More specifically, President Truman proposed an international development assistance program in 1949 called the Four Point Program. This development program built on the 1947 Marshall Plan  that focused on rebuilding Europe after WWII and promoting an exchange of U.S goods with European countries. It was also established to prevent vulnerable countries from joining the Communist party. Overall, European countries showed that reconstruction and development were possible in areas of technological and social infrastructure, and such a blueprint could possibly work in developing countries. During the time period of 1952-1962, the plan transitioned into the: Mutual Security Act, Mutual Security Agency, Foreign Operations Administration, International Cooperation Administration, and the U.S Foreign Assistance Act (which led to the creation of USAID). There were a few overarching goals of aid assistance: 1) promote economic development and support democratic societies, and 2) actively apply Rostow’s Modernization Theory to help countries out of poverty and provide the end products of urbanization, technological advances, and durable consumer goods. Other theories, such as the Dependency Theory, proposed that disparities existed not because countries were undeveloped or not “modern enough,” but were underdeveloped as a result of exploitation of human capital and natural resources by Western countries. In conclusion, both theories, in a way, try to explain the cause of disparities between richer and poorer countries. Over time, foreign aid, education, and investments in infrastructure are inputs that have been used by countries to close economic gaps and try to achieve some version of sustainable development.

So, what role does migration have to play in all this? I initially thought that more development gave individuals and families an incentive to remain in their countries of origin due to increased economic opportunity. However, this is not actually the case. In its initial stages, development inspires emigration, especially for those who are more educated. While this benefits destination countries, and even migrants, it often leads to “brain drain” in countries that are initially struggling to produce or maintain an adequate level of economic growth, particularly those below $6,000–8,000 GDP per capita. About half of all countries fall under this threshold. Brain drain can lead to shortages of talent in sectors that are necessary for infrastructure such as engineering, health, and education. Ultimately, these shifts in the population contribute to and perpetuate inequality on a global level. According to the Center for Global Development, there are at least six reasons why development initially causes these disadvantages:

  1. Development is usually accompanied by a demographic transition that favors a corresponding mobility transition
  2. Development means that more people can afford to emigrate
  3. Development means that more people can access the information they need to emigrate
  4. Development tends to disrupt economic structures that keep people immobile
  5. Development shapes domestic inequality in ways that foster migration, and
  6. Development in country A means that people in country B are more likely to give visas to migrants from A.

Although emigration can become beneficial when origin countries are able to retain educated natives, both the development level of the country and probability of emigration have to be just right – not too low and not too high. Emigrants are more likely to return to their countries of origin in response to increased development efforts that are competitive. In light of such data, development assistance programs may not actually be able to bridge the gap between rich and poor countries. In fact, questions have been raised concerning the effectiveness of aid in countries that have been receiving money for years but still remain impoverished.  Another thing to consider about migration is that economic mobility is not the only reason why people migrate. Migration is fueled by what is going on in home countries compared to what is going on in destination countries- political instability and corruption, religious persecution, limited career paths, or lack of economic growth. Ultimately, a combination of push and pull factors that can be related to international development activities make emigration desirable. For example, the initial stages of international development aid in the United States simultaneous occurred during the decolonization of Asian and African countries, some of which are the main recipients of foreign aid. Additionally, wars have continued to contribute to economic and political instability throughout the world.

Despite push and pull factors and challenges with ensuring that foreign aid actually benefits those it’s supposed to help, education continues to empower individuals and communities to be leaders and brainstorm new ways to create healthy, sustainable communities. Furthermore, educational settings may prove to be an effective bridge to foster relationships between receiving countries and countries of origin that make it easier for emigrants to return and provide human capital that is needed to reach the SDGs.

 

2017 Call for Award Nominations

Recognizing our finest in International Health (IH) through the IH Section Awards

Each year, the International Health (IH) Section of the American Public Health Association (APHA) recognizes outstanding contributions of its members through its Lifetime Achievement Award for Excellence in International Health, its Mid-Career Award in International Health, the Gordon-Wyon Award for Community-Oriented Public Health, Epidemiology and Practice, and the Distinguished Section Service Award. The Section is now seeking nominations for deserving candidates for these awards, to be presented at its Awards Ceremony at the APHA Annual Meeting in Atlanta, Georgia in November 2017.

The Carl Taylor Lifetime Achievement Award in International Health was created by the IH Section to honor the visionaries and leaders in APHA who have shaped the direction of International Health.  The evaluation criteria for the Lifetime Achievement Award include: (1) Quality/creativity/innovativeness of the individual’s contributions to the field of International Health; (2) The individual’s contributions to the development of APHA or the IH Section; (3) Application of the individual’s work to service delivery (as opposed to primarily theoretical value); (4) The individual’s contributions as a leader/visionary/role model; (5) The volunteerism/sacrifice associated with the individual’s contributions; and (6) Membership in APHA (preferably with primary affiliation with the IH Section), a State affiliate, or a national public health association that is a member of the World Federation of Public Health Associations. No self-nomination is allowed.

Prior winners of the Carl Taylor Lifetime Achievement Award in International Health include: Jeanne Foster, Joe Wray, Carl Taylor, Milton Roemer, Warren and Gretchen Berggren, John Wyon, Derrick Jelliffe, Tim Baker, Cicely Williams, Bud Prince, Veronica Elliott, Moye Freymann, Dory Storms, Tom Hall, Samir Banoob, William Reinke, Michael Latham, William Foege, Clarence Pearson, Stanley Newman, Jack Bryant, Richard Morrow, Ray Martin, Miriam Labbok, Douglas Huber, Henry B. Perry, III, and Peter Berman.

The Mid-Career Award in International Health is intended to recognize outstanding young professionals in the IH Section. The evaluation criteria for the Mid-Career Award include: (1) The individual must have committed herself/himself to the promotion and development of primary health care in a cross-cultural setting over a period of 5-15 years [Primary health care is meant here to encompass a broad array of public health issues, including HIV/AIDS prevention and environmental health]; (2) The individual must have demonstrated creativity in expanding the concepts pertinent to the practice of public health with an international focus; and (3) Membership in APHA (preferably primary affiliation with the IH Section), a State affiliate, or a national public health association that is a member of the World Federation of Public Health Associations. No self-nomination is allowed.

Prior winners of the Mid-Career Award in International Health include Laura Chanchien Parajon, Margaret Henning, Elvira Beracochea, Laura Altobelli, Matt Anderson, Padmini Murthy, Gopal Sankaran, Jean Capps, Tim Holtz, Kate Macintyre, Sarah Shannon, Adnan Hyder, Stephen Gloyd, Luis Tam, Marty Makinen, Colleen Conroy, Mary Ann Mercer, Irwin Shorr, Walter K. Patrick, Dory Storms, Clyde “Lanny” Smith and Theresa Shaver.

The Gordon-Wyon Award for Community-Oriented Public Health, Epidemiology and Practice is intended to reward outstanding achievement in community-oriented public health epidemiology and practice. This award was established in 2006 by the IH Section. It is administered by the Community Based Primary Health Care Working Group. John Gordon and John Wyon were pioneers in this field, so encouraging and recognizing others in this field is one important way of honoring their memory. The evaluation criteria for this award include: (1) The candidate must have had a central role in an outstanding achievement in community-oriented public health and practice; (2) The candidate must have demonstrated creativity in expanding the concepts pertinent to the practice of community-oriented public health with an international focus; and (3) The candidate must have membership in APHA or one of its affiliates (either a State affiliate or a national public health association that is a member of the World Federation of Public Health Associations. No self-nomination is allowed.

Previous winners of the Gordon-Wyon Award for Community-Oriented Public Health, Epidemiology and Practice are Rajnikant Arole, Carl Taylor, Henry B. Perry, Bette Gebrian, Jaime Gofin, Warren and Gretchen Berggren, Tom Davis, Jr., Malcolm Bryant, Sandy Hoar,  William Robert Brieger and Mizan Siddiqi.

In addition, the Distinguished Section Service Award is intended to honor outstanding service to the IH Section. Award criteria are: (1) Dedication to the IH Section mission and goals as demonstrated by continuing exceptional contribution to its activities; (2) Serving on the section elective positions or chairing its committees with remarkable or unusual effort and achievements; (3) Distinguished achievement in the international health field with a remarkable career; (4) Excellence in leadership and strong ability for team work with peers in the IH Section and the APHA.  Current membership in APHA is essential.

Nomination Process

Award nominations should include:
i)      A detailed letter explaining why the individual nominated should receive the award, addressing the criteria for the specific award; and
ii)     A current curriculum vitae of the nominee.

Both documents (the nomination letter and the curriculum vitae) should be forwarded as e-files (Word or pdf). Only nominations with required documentation will be considered for the awards. Nominations should be submitted by email to Gopal Sankaran (gsankaran@wcupa.edu), Chair, Awards Committee, International Heath Section.

Deadline for Nominations

Please submit the required documents by Monday, May 1, 2017.  Late submissions will not be reviewed.

The Dire State of Reproductive Rights Worldwide

Each day, an estimated 830 women die of preventable causes related to pregnancy and childbirth. Disproportionately affected are adolescent girls and women living in rural and impoverished areas. Providing women with universal access to family planning is one important and cost-effective way to help reduce maternal deaths. Doing so would decrease maternal deaths by a third. In developing countries, investing in family planning would lead to 2.4 million fewer unsafe abortions (one of the top causes of maternal deaths worldwide according to the WHO) and 5600 fewer maternal deaths related to unintended pregnancies. In addition, it would decrease infant mortality by anywhere from 10 to 20%.

Availability of family planning services has clear benefits in protecting the health of women and children, but it also offers so much more than that. When women can plan the timing and spacing of their pregnancies, women are more likely to attend and finish school; achieve higher levels of education; gain access to better job opportunities; contribute positively to her community; and improves the chances that she will invest in her children’s health, education, and well-being. In short, when women do better, societies do better.

This is all at grave risk now. As part of Trump’s first executive order, he reinstated the global gag rule which when implemented, states that the US can withhold family planning foreign assistance to any foreign non-governmental organization that so little as provides information on abortions, and that’s even if the organization receives funding from other sources. It’s important to note that the US already prohibits any foreign assistance from funding abortions under the Helms Amendment, which has been in place since 1973.

The re-enactment of the global gag rule comes as no surprise, as historically it has been re-enacted by every Republican president since Reagan then overturned by every Democratic president. Ironically although it has been argued that the gag role was put into place to decrease the number of abortions, a Stanford study found that abortions actually increased in years that the gag rule was in effect. It has also been shown that cutting off family planning funding to these organizations severely limits and in some cases, completely ceases, their ability to provide contraceptives and reproductive health services, thus increasing unintended pregnancies and unsafe abortions and further worsening maternal health outcomes.

The newest reinstatement of this rule however, extends far beyond the scope of the original rule and withholds all US global health assistance, not just family planning foreign assistance, to organizations that perform or provide any counseling, referrals, information, or advocacy on abortions. This revision of the global gag rule will not only hurt the millions of women in some of the poorest areas of the world who heavily rely on US-funded organizations which provide family planning services like contraception, but now impacts vulnerable men, women, and children alike. That’s because many of these organizations provide so much more than reproductive health services. Many of these organizations are hospitals and clinics, which in addition to reproductive health services, provide the full spectrum of medical care including life-saving childhood vaccinations, treatment for survivors of gender-based violence, HIV prevention and care, prenatal and postnatal care, and play a vital role in preventing the spread of infectious diseases like Zika and Ebola.

This is an unprecedented setback for the global health community and a huge threat to the advances that we have made in the fight against emerging infectious diseases, HIV/AIDS, and maternal and child mortality to name a few. We cannot let the progress we’ve worked so hard for be eradicated. Let us always remember that progress is something we must work for everyday, a call to action that is becoming more imperative in the precarious times ahead of us.

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US support for family planning foreign assistance currently stands at $575 million to 40 countries. With the institution of this new rule, $9 billion of global health assistance to 60 countries is currently at stake.

Here are a few ways to get involved:

Read APHA’s statement opposing reinstatement of the global gag rule.

 

Review abstract submissions for the Section’s 2017 Annual Meeting program!

The following is a message from Jirair Ratevosian, the IH Section’s Program Committee Chair.


APHA’s 2017 Annual Meeting and Expo brings together more than 13,000 attendees and features 1,000 scientific presentations highlighting the latest in research and policy.

Are you interested in helping the Program Committee review abstracts in 2017?

As a reviewer, you will be assigned 3-10 abstracts to review. All abstracts are reviewed by three reviewers, and your score is tallied with the other two reviewers to help determine which programs should be accepted. Time commitment is typically 1-3 hours.

Deadline to sign up: January 31
Membership: Must be a current APHA member
Reviewing Begins: March 7

Please sign up to register here.

As a time-limited commitment, reviewing abstracts is a great opportunity for students and early career professionals to learn more about the abstract writing process, as well as the inner workings of the Annual Meeting. It is also a superb way to be active in the IH Section and help the Program Committee present a science-strong program in 2017.

Global News Round Up

Politics & Policies

Leading up to the Inauguration of President-elect Trump, experts have made the case for why global health should be a top priority for the new administration. Global health has a long history of bipartisan support and is, frankly, good business.

U.S. President-elect Donald Trump aims to replace Obamacare with a plan that would envisage “insurance for everybody,” he said in an interview with the Washington Post published on Sunday night.

Tuberculosis’ recent surpassing of HIV/AIDS as the leading infectious killer globally has not been met with anything close to equal funding for relief.

George W. Bush’s signature PEPFAR (President’s Emergency Plan for AIDS Relief) program, which helped 11.5 million people in sub-Saharan Africa get access to antiretroviral drugs, could be in jeopardy under Trump’s administration.

The BRICS bloc of nations — Brazil, Russia, India, China, and South Africa — is a leading intergovernmental forum for cooperation of five large, fast-growing economies with significant influence on international issues, including global health.

Programs, Grants & Awards

The Coalition for Epidemic Preparedness Innovation (CEPI), funded with an initial investment of $460 million from Germany, Japan, Norway, the Wellcome Trust and the Gates foundation, aims to develop vaccines against known infectious disease threats that could be deployed to contain outbreaks before they become global health emergencies.

January is cervical health awareness month.  For most people, HPV clears on its own. But for others who don’t clear the virus, HPV can lead to certain diseases, like cervical cancer, as well as vaginal, vulvar and anal cancer and genital warts.

Health experts from across the world will meet again in Cumbria to work on new ways to improve health and social care for communities everywhere.

Research

Airborne transmission of extensively drug-resistant tuberculosis (XDR-TB) is likely behind the majority of new cases in South Africa, according to an article just published in The New England Journal of Medicine.

Severe obesity among American Indian tribal youth in the Southwest.

Forecasting Zika incidence in the 2016 Latin America outbreak combining traditional disease surveillance with search, social media, and news report data.

Up to 70 percent of hysterectomies in the United States, a quarter of knee replacements in Spain and more than half the antibiotics prescribed in China are inappropriate, overused healthcare, researchers said on Monday.

Metabolic syndrome and depressive  symptoms among rural Northeast general population in China.

Prevalence of Chagas disease in a US population of Latin American immigrants with conduction abnormalities on electrocardiogram.

Funding and publication of gun violence research are disproportionately low compared to other leading causes of death in the United States, according to new research.

Diseases & Disasters

A group of 22 pharmaceutical companies have announced a new initiative aimed at tackling noncommunicable diseases and better assessing their individual, and collective, work to enable better access to care in developing countries.

Looking back on 2016, there may not seem to be much to celebrate. In terms of global health alone, the year appeared to be one of unrelenting tragedy.  But, as we begin 2017, there are plenty of reasons to be hopeful.

Following the recent Zika outbreak in Miami-Dade County, a multidisciplinary team of physicians has published a case study describing in detail the nation’s first locally-transmitted case of Zika.

A mouse study, published in Nature, showed altering the immune system slowed the spread of skin cancers to the lungs.

The Philippines has long remained shielded from the global HIV epidemic, but things have changed in the last decade: the country has one of the fastest-growing HIV transmission rates in the world.

Technology

At the first Digital Life Summit, iCarbonX founder Jun Wang announced that seven companies have joined iCarbonX’s Digital Life Alliance and will collaborate to give people a deeper understanding of the medical, behavioral and environmental factors that can accelerate disease or optimize health.

Environmental Health

Chile, Latin America’s leader in solar energy, is starting the new year with an innovative step: the development of the country’s first citizens solar power plant.

Our ability to solve the challenge of climate change, which is also a challenge of energy, food security, immigration, health and fair economic growth, especially for the world’s most vulnerable people, is very strong.

Equity & Disparities

According to David Nabarro, one of the nominees for director-general of the World Health Organization, the issue that most concerns him is how to ensure that there is equity in health throughout the world.  He also believes the disparities in health in our world today are big and to quite a significant extent increasing.

Bolsa Família reaches 11 million families, more than 46 million people, a major portion of the country’s low-income population. The model emerged in Brazil more than a decade ago and has been refined since then.

Maternal, Neonatal & Children’s Health

The U.S. government is leading a wide-ranging and groundbreaking effort to support girls with a comprehensive approach, focusing diplomatic efforts and foreign assistance programs on improving the systems that can make or break outcomes for adolescent girls: education, health, safety, and economic security.

If Nikki Haley is confirmed as Donald Trump’s ambassador to the United Nations, the strong opponent of abortion rights could be caught up in controversy over whether to define contraception and safe abortions as a human right for women, especially in developing countries.

A year after abandoning the “one-child” policy, the Chinese government is hoping to make it up to millions of women by removing their IUDs, free of charge.  But the offer, made without even a hint of an apology, has provoked incredulous outrage.

Growing up in poverty exposes children to greater levels of stress, which can lead to psychological problems later in life, a new study suggests.

The United Nations today announced that it plans to strengthen its approach to preventing and responding to sexual exploitation and abuse by creating a high-level task force that will develop a “clear, game-changing strategy” to achieve “visible and measurable further improvement.”

Babies should be given peanut early – some at four months old – in order to reduce the risk of allergy, according to new US guidance.

 

A big thank you to all who helped with the IH Global Health Mentoring Program!

The Mentoring Committee would like to thank the following IH Section members for their assistance during the development of the Round 2 Pilot of the Global Health Mentoring Program:

Erick Amick
Abimola Williams
Chelsea Alex
Brittany Roth
Dr. Nur Onvural
Giancarlo Atassi
Maliha Ahmed

This Pilot would not have happened without your hard work and dedication. Thank you for volunteering your time to make this program a success.

Theresa Majeski
Chair, Mentoring Committee

Webinar on Breastfeeding in Limited Resource Settings Presented by Samaritan’s Purse and CCIH

All are invited to attend a special Samaritan’s Purse International Health Forum on Jan 11th at 12 PM (EST) presented in partnership with Christian Connections for International Health.

Julie Tanaka, MPH, MBA, will present Breastfeeding in Limited-Resource Settings: What Every Clinician Needs to Know. Julie is the Senior International Nutrition Advisor for Samaritan’s Purse and previously served as the Maternal and Child Health Program Manager in Haiti. Julie graduated from the University of California, Berkeley with a B.A. in Development Studies and Loma Linda University with a Masters in Public Health and Masters in Business Administration.

To sign up for the forum, click here. One hour of Category 1 CME will be available to all participants.