Excerpt – Primedic, a primary care medical service provider dedicated to offering low-cost medical consultations to the urban base of the socio-economic pyramid population backed by impact investing venture capital fund IGNIA. Primedic’s model is simple enough, yet innovative. Pay an individual monthly membership fee of about $10 and receive access to unlimited medical consultations with medical specialists in internal medicine, pediatrics and gynecology. As opposed to general practitioners who usually would have to refer a patient to someone with further training for more complex cases, patients at Primedic immediately get access to doctors with a specialty degree. Given the “membership” nature of their product, Primedic seeks to change customer behaviors and incentivize preventive medical care through a low-cost high-quality program.
In the case of Conchita, she purchased her membership and immediately asked to be seen by a doctor. She was seen that same day by a gynecologist who immediately diagnosed something alarming: an ectopic pregnancy, a complication of pregnancy in which the pregnancy implants outside the uterine cavity. Beyond making the pregnancy impossible, Conchita’s life was in severe danger due to internal bleeding. The doctor’s diagnosis gave her less than 24 hours to live if she remained untreated. Given the urgency of the situation, Primedic made the necessary arrangements to put Conchita on an operating table at a local private hospital less than four hours after the initial diagnosis.
In a small clinic in the northern suburbs of Mexico City, a doctor and two nurses are bridging the gap between poor patients and their wealthy neighbours in an unusual way: instead of charging, they pay them to attend.
In exchange for government money each month, mothers come for check-ups before and after the birth of their children, receive nutritional supplements and are provided with health advice, including how to tackle obesity in a country with one of the highest rates in the world. The stipend – often used to buy books or food – continues as long as they ensure that their children are vaccinated and attend school regularly.
The unit is part of the Oportunidades network, a pioneering approach to health and social support that has expanded across Latin America over the past decade, and that more than covers its costs by enhancing the chance that participants become productive members of the workforce.
The project reflects the innovation in healthcare delivery that is taking place in fast-growing cities around the world. There is growing cross-fertilisation of ideas between urban areas in rich and poor regions alike, and between many broader aspects of urban living and those that are most obviously linked to health.
While access to health in rural areas has long been a challenge in developing countries, there is an intensifying focus on urban regions as their importance – and dangers – grows. “We cannot stop urbanisation,” says Jacob Kumaresan, director of the World Health Organisation’s Kobe Centre, which promotes innovation in public health research.
“It’s very clear that a concentration of people promotes economic growth, but that can also result in bad health, violence, crime and mental stress,” he says. “People come to cities because they feel they offer better opportunities, jobs and health. When they arrive, they do not find them and end up living in slums.”
Some countries have tried to stem the pressure on urban services caused by the flow of rural migrants to cities, including Cuba, which has balanced the “stick” of residency permits with the “carrot” of a network of neighbourhood clinics and family doctors extending far into rural areas.
Study of 16 developing countries shows climate change could deepen poverty
WEST LAFAYETTE, Ind. – Urban workers could suffer most from climate change as the cost of food drives them into poverty, according to a new study that quantifies the effects of climate on the world’s poor populations.
A team led by Purdue University researchers examined the potential economic influence of adverse climate events, such as heat waves, drought and heavy rains, on those in 16 developing countries. Urban workers in Bangladesh, Mexico and Zambia were found to be the most at risk.
“Extreme weather affects agricultural productivity and can raise the price of staple foods, such as grains, that are important to poor households in developing countries,” said Noah Diffenbaugh, the associate professor of earth and atmospheric sciences and interim director of Purdue’s Climate Change Research Center who co-led the study. “Studies have shown global warming will likely increase the frequency and intensity of heat waves, drought and floods in many areas. It is important to understand which socioeconomic groups and countries could see changes in poverty rates in order to make informed policy decisions.”
The team used data from the late 20th century and projections for the late 21st century to develop a framework that examined extreme climate events, comparable shocks to grain production and the impact on the number of impoverished people in each country.
Thomas Hertel, a distinguished professor of agricultural economics and co-leader of the study, said that although urban workers only contribute modestly to total poverty rates in the sample countries, they are the most vulnerable group to changes in grains production.
“Food is a major expenditure for the poor and, while those who work in agriculture would have some benefit from higher grains prices, the urban poor would only get the negative effects,” said Hertel, who also is executive director of Purdue’s Center for Global Trade Analysis. “This is an important finding given that the United Nations projects a continuing shift in population concentrations from rural to urban areas in virtually all of these developing countries.”
With nearly 1 billion of the world’s poor living on less than $1 a day, extreme events can have a devastating impact, he said.
“Bangladesh, Mexico and Zambia showed the greatest percentage of the population entering poverty in the wake of extreme drought, with an additional 1.4 percent, 1.8 percent and 4.6 percent of their populations being impoverished by future climate extremes, respectively,” Hertel said. “This translates to an additional 1.8 million people impoverished per country for Bangladesh and Mexico and an additional half million people in Zambia.”
A paper detailing the work will be published in Thursday’s (Aug. 20) issue of Environmental Research Letters. In addition to Diffenbaugh and Hertel, Syud Amer Ahmed, a recent Purdue graduate and a member of the development research group for The World Bank, co-authored the paper. The World Bank’s Trust Fund for Environmentally and Socially Sustainable Development funded the research.
The team identified the maximum rainfall, drought and heat wave for the 30-year periods of 1971-2000 and 2071-2100 and then compared the maximums for the two time periods.
The global climate model experiments developed by the Intergovernmental Panel on Climate Change, or IPCC, were used for the future projections of extreme events. The team used an IPCC scenario that has greenhouse gas emissions continuing to follow the current trend, Diffenbaugh said.
“The occurrence and magnitude of what are currently the 30-year-maximum values for wet, dry and hot extremes are projected to substantially increase for much of the world,” he said. “Heat waves and drought in the Mediterranean showed a potential 2700 percent and 800 percent increase in occurrence, respectively, and extreme rainfall in Southeast Asia was projected to potentially increase by 900 percent.”
In addition, Southeast Asia showed a projected 40 percent increase in the magnitude of the worst rainfall; central Africa showed a projected 1000 percent increase in the magnitude of the worst heat wave; and the Mediterranean showed a projected 60 percent increase in the worst drought.
A statistical analysis was used to determine grain productivity shocks that would correspond in magnitude to the climate extremes, and then the economic impact of the supply shock was determined. Future predicted extreme climate events were compared to historical agricultural productivity extremes in order to assess the likely impact on agricultural production, prices and wages. Because the projected changes in extreme rainfall and heat wave events were too large for the current model to accept, only the extreme drought events were incorporated into the economic projections, making the projected poverty impacts a conservative estimate, he said.
To assess the potential economic impact of a given change in wages and grains prices, the team used data from each country’s household survey. The estimates of likely wage and price changes following an extreme climate event were obtained from a global trade model, called the Global Trade Analysis Project, or GTAP, which is maintained by Purdue’s agricultural economics department.
Purdue’s GTAP framework is supported by an international consortium of 27 national and international agencies and is used by a network of 6,500 researchers in 140 countries.
Large reductions in grains productivity due to extreme climate events are supported by historical data. In 1991 grains productivity in Malawi and Zambia declined by about 50 percent when southern Africa experienced a severe drought.
Diffenbaugh said this is an initial quantification of how poverty is tied to climate fluctuations, and the team is working to improve the modeling and analysis system in order to enable more comprehensive assessments of the link between climate volatility and poverty vulnerability.
BERKELEY — Replacing dirt floors with cement in the homes of urban slums makes for more comfortable living – but more importantly, it significantly improves children’s health by interrupting the transmission of intestinal parasites and boosts youngsters’ cognitive abilities, according to a new study conducted for the University of California, Berkeley’s Center of Evaluation for Global Action (CEGA).
Professor Paul Gertler, the Li Ka Shing Professor of Economics in the Haas School of Business and the School of Public Health at UC Berkeley, led the investigation. The study, detailed in the article, “Housing, Health and Happiness,” in the February American Economic Journal: Economic Policy, concludes that replacing dirt floors with cement appears to be at least as effective for health as nutritional supplements and as helpful for brain development as early childhood development programs.
Not only are young children better off when their homes have concrete rather than dirt floors, but the study also found that their mothers are less depressed, less stressed and happier.
“The reasons adults are happier may have to do with the fact that they are living in a better environment and that their children are healthier,” says the report. “These results also indicate that housing has a significant effect on welfare, which would not be captured by standard monetary indicators such as income, consumption or assets, or by the types of health outcomes used in this study.”
The CEGA researchers note that inadequate housing poses serious health risks around the globe for 600 million urban residents, almost half of them living in slums. These problems also contribute to the deaths of 3 million children every year from parasitic infections associated with diarrhea, malnutrition and micronutrient deficiencies such as anemia, a widespread problem that slows cognitive development.
The economists say their findings offer an important direction for the cost-effective allocation of public resources by countries seeking to upgrade slums and improve housing for the poor.
They tracked a Mexican government program, “Piso Firme” or “firm floor,” that sought to improve living standards and health in high-density, low-income communities by offering homeowners with dirt floors up to 538 square feet of concrete flooring. The program cost the government about $150 per home. The owners prepared and laid the new flooring themselves, or with volunteer help.
By 2005, the program had covered more than 34,000 homes in 650 neighborhoods and 200 suburban communities. It expanded into other Mexican states starting in late 2003 and installed cement floors in about 300,000 of the 3 million homes indentified in the country’ s 2000 census as having dirt floors.
Researchers collected information about children’s incidences of diarrhea, results of fecal samples, blood tests for anemia, and height and weight data to reveal stunting of growth, and also assessed the youngsters’ communication and language abilities. They compared the statistics for youths under the age of 6 both in the Coahuilan city of Torreón, where Piso Firme was enacted, and in the cities of Gómez Palacios and Lerdo in the same urban area but located on Coahuila’s border with state of Durango, where Piso Firme was still not fully under way in 2005.
Additional data came from a cross-sectional household survey conducted with the Mexican National Institute of Public Health in spring 2005, the 2000 Mexican census, vital statistics mortality files and national household surveys taken from 1994 to 2000.
Homeowners in Torreón reported a nearly 20 percent reduction in the presence of parasites, and when compared to their neighbors, their children under the age of 6 showed the following improvements:
- Almost 13 percent fewer episodes of diarrhea
- A 20 percent reduction in incidences of anemia
- Higher scores of 30 percent on language and communication skills for toddlers ages 12 to 30 months
- Scores 9 percent higher on vocabulary tests for youths ages 36 to 71 months
The researchers caution that the dirt-to-cement strategy probably would not have the same results in rural areas without access to safe water supplies.
The research team included Gertler, who is the director of UC Berkeley’s Institute for Business and Economics Research and recently served as the chief economist of the World Bank’s Human Development Network; Rocío Titiunik, a UC Berkeley graduate student in agricultural and resource economics; Sebastián Martinez, a World Bank economist who earned his Ph.D. in economics at UC Berkeley; Sebastian Galiani, an associate professor of economics at Washington University in St. Louis; and Matias Cattaneo, an associate professor of economics at the University of Michigan who also earned his Ph.D. at UC Berkeley.
MEXICO CITY (AP) — Mexicans would live an average of two months longer if they breathed cleaner air, Harvard researchers conclude in a study published Monday. The study found that some 7,600 people’s lives were cut short each year by diseases related to air pollution between 2001-2005, representing about 1.6 percent of annual deaths in Mexico.
The highest proportion of those deaths — 38 percent — were in Mexico City, a mountain-ringed valley long known for its dense layer of smog.
Mexico’s average life expectancy — 72.3 years for men and 77.8 for women — would be longer by 2.4 months if urban air quality were improved, according to the study published in Proceedings of the National Academy of Sciences.
The researchers — Gretchen Stevens, Rodrigo Dias and Majid Ezzati of the Harvard Initiative for Global Health — used death records and air quality monitoring data to estimate the number of people who died from lung cancer, cardiopulmonary diseases, respiratory infections and other illnesses as a result of breathing heavily polluted air. Then they estimated what Mexico’s average life expectancy rate would be if those people had not died early.
The researchers also studied the effect on mortality rates from the use of solid fuels, like coal and wood burning, and from unsafe water sanitation in Mexican homes.
ScienceDaily (Sep. 24, 2008) — In an effort to curb the rising rates of HIV and sexually transmitted infections (STIs) along the Mexico-US border, a binational team of researchers led by the University of California, San Diego School of Medicine have shown that brief but personalized behavioral counseling significantly reduced rates and improved condom use among female sex workers in Tijuana and Ciudad Juarez, Mexico.
The researchers observed a 40 percent decline in the combined rate of new STIs (including HIV, syphilis, gonorrhea and Chlamydia) in the group of female sex workers who received the 30-minute one-on-one counseling intervention, compared to an encounter that was based on educational information only. The study, headed by Thomas L. Patterson, Ph.D., professor of psychiatry at UC San Diego School of Medicine, in collaboration with researchers from across Mexico, at UC Davis and Northeastern University, will be published on line September 17 in advance of the November edition of the American Journal of Public Health.