Health as an indicator of good governance

As I wrote about 2 days ago, I have been thinking a lot about health and governance, and specifically, health as an indicator of good governance. What is governance and what is good governance? Much like porn, you know it when you see it (and I would suggest recent behavior on the part of our own Congress is not it.) It is hard to define good governance or even measure it, although we spend gazillions of dollars around the globe trying to assist other nations develop good governance practices (policies). And, frankly, through our efforts, we sometimes fail to assist because we interrupt the natural development with heavy handed resourcing and skew the efforts of the government. I saw that in Afghanistan first hand -- donors were competing to have their agendas met, paying off high ranking Afghan officials (topping off their salaries) in order to ensure they would have a seat at the table. In any case, governance and economics and social orders are all intertwined, and this is clearly articulated in a paper and book (although, admittedly I have not read the book yet), by Douglass C. North, John Joseph Wallis, and Barry Weingast, called "Violence and Social Orders." What I like about their argument is that economic systems and political systems develop together within a social context and violence is part of that construct -- only in a few countries have the political systems been able to push away violence enough so that the economic and political systems can flourish. Here is what they say:

We show how, beginning 10,000 years ago, limited access social orders developed that were able to control violence, provide order, and allow greater production through specialization and exchange. Limited access orders provide order by using the political system to limit economic entry to create rents, and then using the rents to stabilize the political system and limit violence. We call this type of political economy arrangement a natural state. It appears to be the natural way that human societies are organized, even in most of the contemporary world. In contrast, a handful of developed societies have developed open access social orders. In these societies, open access and entry into economic and political organizations sustains economic and political competition. Social order is sustained by competition rather than rent-creation. The key to understanding modern social development is understanding the transition from limited to open access social orders, which only a handful of countries have managed since WWII.

Access to the paper may be had here: http://www.nber.org/papers/w12795 I like this argument because it makes sense. More thoughts on this to follow.

Health as an indicator of good governance

It suddenly dawned on me this morning (jet lagged) that health is a direct reflection of good governance. An indicator that governments are functioning in a manner that is protective of the people they are governing. Online searching has revealed some interesting work by the Center for Global Development/Global Health Policy. I found an article from 2006 titled "Measuring Commitment to Health" (link:http://www.cgdev.org/doc/ghprn/Measuring_Commitment_to_Health,final.pdf), which describes the CGD's efforts to inform better measurment of government performance in the health sector. It's extremely well done both theoretically and delivery. The authors of this report discuss the Millenium Challenge Account, and how it measures government performance in the health sector, which is interesting:

At the forefront of the movement to link aid allocation to evidence of good governance is the Millennium Challenge Account (MCA), a bilateral U.S. development assistance program intended to promote poverty reduction and growth in countries with good governance and development policies.The MCA, managed by the independent agency the Millennium Challenge Corporation (MCC), uses a set of 16 indicators to measure various aspects of governance and commitment to sound policies in low- and lower-middle-income countries. Countries that perform well relative to their peers on indicators in three categories – labeled “ruling justly,” “economic freedom” and “investing in people” – are rewarded with access to the agency’s nearly $5 billion pool of aid money. For countries that do not pass this eligibility filter, the agency anticipates that the promise of aid in exchange for results will serve as an incentive to improve their performance, and recent research has supported this hypothesis

But what is "Good Governance"? Here is how the authors define it:

The most critical consideration in the serach for a proxy for good governance in the health sector is the definition of good government behavior. For the purposes of this analysis, the working Group poased four questions related to a government's commitment to the health of its citizents: i. Is the government placing appropriate priority on health, relative to its means? ii. Is the government focusing its resources on public goods and essential public health functions? iii. Is the government employing cost-effective health interventions so that limited health resources go furthest toward improved health outcomes? iv. Is the government protecting the poor and other vulnerable populations from catastrophic losses? In concept, then an ideal suite of indicators would relfect all of these elements of a government's health policies. Of these, however, questions (ii) and (iii) are easiest to measure objectively and are the focus of the Working Group's efforts.

Open access to health services of a reasonable standard...I think that's a succint (and not nuanced) summary of what the working group was thinking.

Syria's war has caused a re-emergence of polio. As a result, the W.H.O. is instituting a campaign to vaccinate 50 million children in the region. The diaspora of refugees undoubtedly will spread the disease. Here is a NYTimes article about the WHO initiative:http://www.nytimes.com/2013/11/07/world/middleeast/who-escalates-polio-fight-in-reinfected-mideast.html?_r=0.

http://www.foxnews.com/health/2013/11/01/who-confirms-four-more-cases-deadly-mers-virus/ Photo of corona virus from Fox News story on MERS

Here I am in the Middle East, and a coronavirus has developed that is being called the Middle East Respiratory Syndrome, or MERS. MERS has a nearly 50% mortality rate, and the CDC website claims that it has not yet reached the U.S. Really? That seems highly unlikely. Given the amount of travel between the U.S. and everywhere, and given the massive troop movements through the middle east, I am surprised at this news. Here is the CDC link:http://www.cdc.gov/coronavirus/mers/.

I'm Baaaa-aaacK! Although perhaps the most sporadic blogger in the world, I am persistent. My job in a prestigious defense analysis institutation limits my blogging in an unofficial way. I am on a temporary military assignment for the year, and therefore plan to take advantage of the time and do some blogging! I'm excited. I plan to figure out how to really dig in and do more dynamic presentations and tie in to a community. I have been away for so long I probably have no readers, but that's OK. I'm undeterred. Right now I'm sitting on a mattress in a foreign country in the middle east waiting for a ride to the airport. I DID get my flu shot, although I am not sure it is effective against all the strains that are blossoming and speeding their way around the globe. So, let's see what the internet says about the flu this season...

AMAZING collaboration between military, USAID, and not-for-profit

Wow! I recently heard a speech by Dr. William H. Foege, a world renowned epidemiologist who was key to the campaign that basically has eradicated smallpox (of course, with the exception of in Afghanistan and a few other war-torn areas), among other incredibly notable achievements. In his speech, Dr. Foege claimed that there would be an anti-malarial vaccine produced within the next 2-3 years, which is astonishing news from a very credible source.

This morning's news brings the announcement that the military, USAID and a not-for-profit called IDRI are collaborating to produce an anti-malarial vaccine. It's an incredible story, and if the effort is successful, the world will be changed. Here's the press release URL: http://m.prnewswire.com/news-releases/idri-usaid-strike-new-collaboration-for-malaria-vaccine-development-127868588.html.

I'm (slowly) writing a piece about the military's role in global health, and this kind of activity illustrates the real contributions that the U.S. government, writ large, can make. I hope it is successful!