This is a joint post with Alan Whiteside, CIGI Chair in Global Health Policy, BSIA and Professor Emeritus, University of KwaZulu-Natal. Since the first case of Ebola appeared last year, the virus has infected nearly 10,000 people. The epidemic is concentrated in Liberia, Sierra Leone, and Guinea — post-conflict countries with incredibly weak health systems. It stands to have severe health, social, and economic consequences and is arguably the most pressing challenge to global health security the world has faced in decades
Author Archives: CGDev
Momentum seems to be building on Capitol Hill for some kind of West African travel ban as an anti-Ebola measure. It sounds like a simple solution. But here’s why a travel ban is pointless—or could even make us less safe. Zero direct flights. There are no direct flights between the US and the three affected countries.
Pollution has no respect for party lines. In the US, Republican and Democratic districts may differ in many ways but when comes to the carbon emissions heating our planet the differences are much smaller than you might expect. This is one of the most surprising and important findings in a remarkable new working paper from CGD visiting senior associate Kevin Ummel. I’m so excited about this paper I took a short break from my new job at the World Resources Institute to discuss with Kevin the far-reaching implications of his work for the design and politics of US carbon pollution fees.
Kevin’s paper, Who Pollutes? A Household-Level Database of America’s Greenhouse Gas Footprint, is a slender 23 pages that sits on the brawny shoulders of a fresh approach to available data and an muscular number crunching exercise to estimate the greenhouse gas emissions of households all across America.
Kevin tells me that he set out to study the consumption habits of American households based on the recognition that “every kilogram of human-caused emissions can be traced to a consumptive choice on the part of an individual, a household, or in some cases, a government.”
Kevin used data from two massive surveys (the Consumer Expenditure Survey and the American Community Survey) to determine what American households buy with their money. He then combined this survey data with data from the environmental sciences to “translate how people spend their money into an estimate of how much [carbon] pollution they are producing.”
One surprise: the high degree of what Kevin calls “pollution inequality”—the top 10 percent of US polluters are responsible for 25 percent of the country’s carbon footprint, while the least-polluting 40 percent of Americans account for just 20 percent.
Who pollutes most? Low-density, affluent suburbs, where the lifestyle includes big homes, big cars, long commutes and plenty of international air travel. Many of these people also recycle and opt for local produce to reduce their carbon footprint! (Sound like anybody you know?)
High-density cities have the lowest household carbon footprint—especially the poorer neighborhoods that tend to vote for Democrats. More surprisingly, less affluent rural communities that tend to vote Republican also have small carbon footprints.
The new data show that these geographical distinctions are much starker than the differences between the carbon footprints of Republican and Democratic districts, which tend to be “very, very small,” Kevin says.
All this is very good news for the growing number of policy experts and ordinary Americans who see a revenue-carbon pollution fee as the best way to reduce emissions and spark a prosperity-enhancing, poverty-reducing, green technology revolution.
“If the US were to put a carbon tax in place, it’s not the case right off the bat that the members of one party would be disadvantaged relative to the other,” Kevin says.
“The difference in political rhetoric is far greater than the difference in environmental reality,” he adds. “The rhetoric should be: Why are we taxing things we want more of, like income, instead of things we want less of, like pollution?”
It’s the politics, of course. But Kevin doesn’t put all the blame on politicians. Research, he says, can do much more to give policy makers and politicians the tools they need to design a carbon-fee-and-rebate approach that will appeal to voters across the political spectrum.
I heartily agree! I urge you to skim Kevin’s full paper to learn more about his analytical approach and the surprising findings about who pollutes (skip to the Discussion if you are more policy wonk than data nerd). Then, to discover how this could unfold in the political world, read my newly published CGD essay: The Sudden Rise of Carbon Taxes, 2010-2030, a future history.
Last week I participated in the launch of a new Lancet series on universal health coverage (UHC) in Latin America, which aims to showcase and contextualize how the UHC experience has played out to date in the region. And there is a lot to showcase: convergence –as advocated by Larry Summers and colleagues in the Global Health 2035 report – is almost complete in the region, with infant mortality and under-5 mortality similar across many countries with economies of very different sizes. Still, in spite of large increases in public spending, within-country inequalities are still pronounced and out-of-pocket spending remains stubbornly high, even in public health success stories like Brazil. Participants at the event highlighted obstacles to faster progress in these areas, including the fragmentation of risk pools and payment arrangements. Further, citizens’ perceived satisfaction with health systems has remained flat over time, and new pressures associated with growing economies and expectations are increasingly in play.
The Ebola epidemic has made the entire world aware of the importance of hospitals within a health system and the dearth of hospitals altogether in the hardest-hit counties in West Africa. CGD’s Hospitals for Health working group is exploring ways the global community can foster more safe and efficient hospitals in low- and middle-income countries without crowding out investments in primary care. We recently hosted a public consultation session at the Third Global Symposium on Health Systems Research in Cape Town, South Africa, to discuss our draft report and get feedback on its proposal for a Global Hospitals Collaborative. Our distinguished panel featured CEO of Discovery Health, South Africa Jonathan Broomberg, plus Hospitals for Health working group members Jerry La Forgia (World Bank) and Maureen Lewis (Georgetown University).
When I wished for hiring reform at the World Health Organization on October 7, I got some welcome feedback on the tough politics that need to be solved in order to genuinely reform the WHO. I pointed out in my last post that despite how crucial the job of WHO regional director for Africa is, the position is filled largely behind closed doors, without any public posting or public deliberation over who would best fill it, and I’m not alone in calling for the process to be more transparent and merit-based. As Ebola and WHO’s response to it continue to be on the front page of the news, now would be good opportunity for the organization to reform its hiring.
This blog is co-authored by David Evans, Senior Economist at the World Bank (web page; Twitter). The World Bank on Wednesday released a report titled “The Economic Impact of the 2014 Ebola Epidemic: Short and Medium Term Estimates for West Africa,” which we and other co-authors blogged about yesterday on the World Bank’s site. The report’s results have been summarized with various degrees of detail in the Financial Times, Le Monde, El Pais ,and the Washington Post
On September 23, the Washington Post aired a disagreement between the US Center for Disease Control Ebola experts and the Médecins Sans Frontieres Ebola doctors regarding the value of community Ebola treatment centers staffed with community volunteers for Liberia, Guinea, and Sierra Leone. Frank Mahoney, who is leading the CDC team in Monrovia, is quoted as saying that “this outbreak isn’t going to turn around until we get people out of their homes and into safe places.” His statement reflects the thinking behind the “Community Care Campaign” announced by President Obama and detailed by Nancy Lindborg, the US assistant administrator for democracy, conflict, and humanitarian assistance. (Also see her blog post here.) However, according to the WaPo, Brice de le Vigne, the MSF’s director of operations, “warned that the proposed community care centers could worsen the situation. ‘This is not going to work,’ he said. `To move people in an epidemic is a big responsibility, and it requires huge logistical capabilities’ that the affected countries simply don’t have.” These individuals and their organizations are hugely competent and are working from the same facts about Ebola
On September 17, the World Bank issued a preliminary report on the economic impact of Ebola Viral Disease (hereafter Ebola). (Landing page is here and report is here.) I was one of a team of fourteen people contributing to this initial effort and the only member of the group not from the Bank. Most of the team members are “country economists” whose job is usually to monitor the macroeconomic situation in their assigned countries and to routinely feed these assessments to the rest of the Bank for designing or evaluating projects and programs. Although I thought I knew the Bank pretty well from my 20 years in its Development Economics Research Group (1986-2006), I gained a new appreciation of the skills of the country economists as I watched them gather and assemble tidbits of relevant data about how Ebola is affecting the economies of Liberia, Sierra Leone, and Guinea.
With the threat of antimicrobial resistance on the rise, we are heartened by President Barack Obama’s recent executive order that outlines a national strategy to combat drug resistance, including creation of an inter-agency task force to implement and monitor the plan. The Centers for Disease Control and Prevention estimate that up to 2 million Americans suffer from antibiotic-resistant infections each year and that 23,000 of them die.
I’ve lived a mostly healthy and illness-free life. Still, hospitals are at the center of many of my most important life experiences. I was born in a hospital (New York Hospital in Manhattan, where my mother also worked as a psychiatric resident)
Where do you go when hit with a serious medical condition? “The hospital!” is an obvious answer for people in high income countries, but for people in low-income and emerging market economies, access to a proper hospital is often just a dream. Why are decent hospitals in the developing world so few and far between?
This week I invite senior fellow Amanda Glassman on the Wonkcast to discuss a new CGD Working Group that is studying the problems that result in a lack of effective hospitals in low-income and emerging market countries.
Why focus on hospitals now? While news from the front lines of Ebola has made the entire world aware of the dearth of hospitals in the afflicted countries, Amanda notes that within the global health community the shortage of hospitals in the developing world was already a hot topic.
For years donors have focused their attention and resources on primary care and preventive services—the kinds of help that can be provided at low cost in a village or neighborhood clinic.
“We’ve pretty much picked that low-hanging fruit,” Amanda says. “Now we’re thinking about health systems in a more integral way… Not just the hospital buildings but the but structures and policies that are needed to make hospitals function efficiently, contributing to health.”
What can be done?
CGD’s Hospitals for Health Working Group’s newly released consultation draft of its forthcoming report proposes a “Global Hospitals Collaborative,” an entity that would facilitate a network of individuals and institutions dedicated to fostering improved policymaking, investment, and management for emerging-market hospitals. Specific activities would include setting benchmarks, gathering and sharing data, analyzing the barriers to more and better hospitals—and finding solutions.
“There’s a need to establish some kind of baseline,” Amanda says. Those studying the problem lack the basic information needed find solutions to the problem, she adds.
“A global collaborative could recommend directions for data and analytics, possible reforms, and for learning one from the other,” she adds.
Wouldn’t the World Health Organization (WHO) be the proper home for such an entity?
Amanda thinks not. “Now more than ever the WHO needs to be focused on those global public goods of disease surveillance, control and prevention, as we see in the case of Ebola,” she says.
While she believe the WHO needs to be deeply involved, she also believes such a collaborative would benefit from the greater flexibility available in a less institutionalized setting.
Learn more about why hospitals may be the missing link in developing country health care and how the proposed collaborative could help. Tune into the Wonkcast and read the report!
My thanks to Kristina Wilson for recording and editing the Wonkcast and for a first draft of this blog post.