To Volunteer or Advocate?

How can a concerned, caring individual bring about change? Is it better to volunteer and help one-to-one or to advocate for change in a way that benefits whole groups of people?

Is it enough, for example, to volunteer at a food pantry that meets the needs of one person at a time, or to advocate for changing the food stamp program which serves millions, or better yet, funding job training, or education to equip people to become self-supporting?

Immediate relief vs. systemic change.

It’s a question that requires honest self-critique. I’ve observed for a number of years how individuals and organizations work to bring about change and I don’t see an easy resolution to the question. And it’s not a false dichotomy, though I wish it were. Individuals who volunteer to build a school in a remote village in Africa don’t necessarily move from individual engagement to support foreign assistance that addresses regional economic development. It’s a leap too far.

In my early years of working in this arena I thought it was possible to do exactly this, move people along a continuum from individual involvement on the ground to engaging in policy change. At the very least, I thought, it should be possible to get those who have seen with their own eyes how damaging poverty is to write a letter to request more funds for health care for the poor, or for economically strapped schools, or for foreign assistance for development initiatives. Not so.

It’s a jump some can’t make, or don’t want to, for a long list of reasons. It’s a move from the concrete to the complex, from one to many, from the personal to the impersonal. Some want to see immediate change as a result of a direct, hands-on relationship while others see policy change as the most effective means to create long-term change for whole groups of people.

I heard a polite but pointedly uncomfortable debate about this recently. One person who is ardently committed to advocacy claimed that some volunteers enjoy being in a superior position to those they help. They set up a donor-recipient relationship that is threatened when the "receiving" person becomes self-sufficient. Another, from an economically depressed community, said he wanted people from outside his community to stay away. They try to impose behaviors and solutions upon his community without understanding the obstacles they face nor the culture in which they live. Can’t even speak their language, he said. Better to stay away.

And so it went. Strongly felt opinions shot through the air like lightning bolts, landing with force and exploding preconceptions around the room. And they fell unresolved.

In fact, it’s not a new debate. It’s been around for years. The positions are predictable and more than a little tiresome after decades-long repetition. Worse, this is only an elementary starting point. When the debate takes form as competition for solutions pitting one against another, it becomes destructive. HIV/AIDS vs. malaria. Water development vs. education. Agriculture vs. economic empowerment. Thinking in polarities. Thinking small.

But there is value in the discussion, I think, because we’re at a hinge point in history and this dialogue is likely to shape both public policy and the fabric of our social community into the future. It’s more important now that people of goodwill find accommodation to many methods of change and to comprehensive solutions than to assert the correctness of a single way or a single problem.

The political dialogue we’ve had for the past several years hasn’t modeled a constructive approach to problem-solving. Rather, it’s demonstrated that a polarized, divided community isn’t healthy. If we learn anything from this, it’s that polarizing rhetoric and critical characterizations don’t yield constructive results. I don’t think creating divisions between people of good will about how they can best help bring about change is healthy either.

It should be possible for those with a common desire to make life better to agree that there are many pathways to the good.

In a commentary on the need for a strategic consensus on foreign assistance, Carol Peasley, President of the Center for Development and Population Activities, identifies how differences in priorities have fragmented approaches to health. The result is several "stovepipes" which result in a "mish-mash of vertical programs" that have actually had a negative effect on health systems in a variety of ways.

Peasley calls for bringing the stovepipes together and creating a truly global health approach to health. And she says it’s not enough for development organizations to provide direct services, they must also develop local capacity, yet another issue in this long line of change-making concerns.

What will be needed going forward is a give and take conversation among many actors and a spirit of concern that gives support for holistic, comprehensive problem-solving.

A Netbook Conundrum

I ordered an HP netbook online. It was heavily discounted and I like this model for its keyboard. I received an email confirmation followed by a UPS tracking number. The netbook was picked up in Shanghai. It’s in Anchorage as I write this.

Am I the only person who wonders how a company can make money on these dirt cheap machines with the overhead costs incurred?  Various manufacturers are selling netbooks for as little as $250. Even with economies of scale, it’s difficult for me to understand how a manufacturer can make the journey from Shanghai to the southern U.S. profitable.

Merrill Lynch Bonuses Top U.S. Contribution to Fight AIDS

On Rachel Maddow’s MSNBC  show Wednesday evening, economist Dr. Jeffrey Sachs made the point that the bonuses claimed by Merrill Lynch executives total more than the U.S. contributes to the Global Fund to Fight AIDS, Malaria and Tuberculosis .

Sach’s comment came on the same day The New York Times reported an investigation by New York Attorney General Andrew Cuomo turned up the fact that 700 Merrill executives received $3.6 billion in bonuses even as the company lost $27 billion in 2008.

The U.S. pledged $2.9 billion to the Global Fund for 2009 and is $1 billion behind in its pledge.

Panning for Gold in Zimbabwe

The Guardian features a video apparently smuggled from Zimbabwe about desperate people, ironically, panning for gold to survive. Zimbabwe’s economy could hardly be in worse condition and people are bartering gold powder for a tin of millet meal, bread or salt. It’s hard to imagine a more dysfunctional and implausible situation.

Once the food basket of East Africa, Zimbabwe’s agricultural  production has been destroyed. Blessed with precious metals but unable to extract them, their market value is squandered as they are traded away for the bare necessities.

Astronomical inflation has rendered its currency valueless. Some interviewed in the video say those who can’t pan for gold, such as the elderly and young children, face starvation. Beyond the irony, this is the tragedy. People are starving.

I haven’t been back to Zimbabwe since the board of directors of United Methodist Communications (called the General Commission on Communications) met there a couple of years ago. The group I traveled with stopped at a rural village while our video crew taped a pre-arranged interview with a young mother with HIV/AIDS. As we waited, several young men came to us and offered uncut diamonds. In this region it was not uncommon for locals to dig for diamonds and sell or smuggle them. Still another irony.

Because it’s illegal to traffic in the diamonds, we, of course, declined. But the illicit diamonds were one more indication of the strange reality of Zimbabwe.

It’s too soon to know if the on-again-off-again talks about power-sharing will actually result in a coalition government. Humanitarian organizations are working to slow the hunger and a runaway epidemic of cholera. As bad as the global economy is,  Zimbabwe is one of the places where the suffering and struggle to survive are as stark and grim as it gets.

WHO has called for a stepped up response to the cholera epidemic and Americares has doubled its aid commitment and is responding with water purification efforts. Oxfam is calling on the nascent unity government to prioritize humanitarian needs and act immediately.  ZOE Ministry continues to provide aid to Zimbabwean children.

Did Wells Fargo Just Commit a PR Blunder?

It’s your fault, and mine, that Wells Fargo can’t say "thank you" to its tellers by taking them to Las Vegas for twelve days of revelry and relaxation because we’re so persnickety about how the bank’s corporate leaders spend money. That’s the gist of a full-page letter published in the New York Times this morning.

No, it’s not what the letter intended to say, but in today’s climate of anger, frustration and fear, it’s easy to imagine that’s how it will be read. As I read the letter I thought it is a very risky, cheeky message, one that could as easily backfire as not. I view it from a communications angle and wonder what, exactly, it hopes to accomplish.

I don’t know Mr. Stumpf, the CEO who signed the letter, and I’m not a customer of Wells Fargo (at least so far as anyone of us can know in the topsy turvy world of corporate buyouts.) I don’t even hold a grudge against any bank or financial institution. But this is a study in corporate communications that’s worth a look. Here’s why.

In the worst case scenario it could become yet one more example of the public relations fiascoes of an era of reckless greed and tone-deaf behavior by senior executives in banking and finance. It might start something like this: Wells Fargo President John G. Stumpf signed off on an audacious letter that lays blame on the media for the misperceptions that, in turn,  led Wells Fargo to cancel what he calls an employee recognition affair but what some critics called a Las Vegas junket at two of the city’s top hotels over 12 days. Mr. Stumpf’s letter says such recognition events are at the heart of the company’s culture.

Wells Fargo Letter The letter runs on the same day the front page of the New York Times features an article about people in Ft. Meyers, Florida losing their homes. It tells of an entire exurban neighborhood abandoned to weeds. It says crime is increasing and empty houses are being taken over by sellers of another kind of weed and turned into drug houses. It is accompanied by photos of people standing in line for free food.

All of this is the result of lax housing development regulations and freewheeling mortgage lending according to some interviewed in the article. Against this backdrop, Mr. Stumpf’s letter blames the media and by implication an oversensitive public for preventing him from honoring his mortgage broker teams that brought in 230 billion dollars of business. We readers should just hold our horses for a moment and consider how we are punishing Wells Fargo employees who are being denied the recognition they deserve, the letter says.

Because we’re so worked up about CEOs who’ve received taxpayer bailout money paying $1,300 for waste paper baskets, spending half a million on spa treatments and going on Caribbean golf outings while people are being evicted from their homes and waiting in line for a free loaf of bread, all Mr. Stumpf can do for his employees is put a feckless letter in the newspaper to say "thank you," and by the way, he wasn’t going to spend taxpayer money anyway.

Fair or not, that’s how the letter can be spun. That’s why it was a risk, in my opinion.

Mr. Stumpf, the anger, fear and sadness that I hear every day about lost pensions, lost homes and jobs is not merely palpable, it’s pervasive. Even if you have a case, you won’t be heard in this environment if you argue that you’re misunderstood because of media coverage and public misperception about this event. That horse is out of the barn. Your communications people failed you miserably. Whatever you intended, the letter sounds like whining and scapegoating.

Surely, if you want to thank your employees in a meaningful way, you can do so. No doubt you already ensure that each is paid a living wage with full health care coverage,  opportunities for training to upgrade their skills and profit-sharing based on achieving economies and implementing green practices. Perhaps you could agree that you will take no more than five times the salary of the lowest paid employee of Wells Fargo, that you will pay your own club membership fees, household help and forego all the other perks that sweeten the pot for CEOs.

The public reaction is not about recognizing your everyday employees. It’s about the symbolism of a junket by bankers to Las Vegas in the midst of what some are calling a depression. It’s hardly worth defending an event such as this against public misperception and media half-truths no matter how praiseworthy your intent. That case won’t "stick" today.

Whatever you do, you should tell your communications people to conduct a communications audit, an implications wheel, focus groups, attitudinal surveys, or use any number of other research tools that start with what your customers and the wider public think of your bank and the finance industry before you make another defensive and reactionary public comment. Then work backward to develop your messages and services. And then test those messages and see if they work.

And please, don’t blame us for your questionable calls. You’re already in a deep hole, and you just paid good money for a message that digs it even deeper.

A Postscript : In her own inimitable style Maureen Dowd commented on this issue today.

Blogging Global Health

Christine Gorman who writes the Global Health Report blog proposed last week to a dozen health bloggers that they write on prevention vs. treatment and nine bloggers took up her challenge. The variety of posts and the wide range of subjects and expertise are interesting. Christine offerred these links which I repeat here:

Healthtwine: Prevention vs. Treatment
On why “we tend to value current health more than future health.”

Superbug: Prevention v. treatment (1st Global Health Blog Carnival!)
On the need for a vaccine against methicillin resistant staph aureus.

Perspectives: Prevention vs. Treatment
On why prevention vs. treatment is the wrong way to think about drug resistance to malaria.

Karen Grepin’s Blog: Prevention vs. Treament in HIV: Have we given prevention a chance to shine?
Proving prevention works is a lot harder than you might think. Maybe that is another reason why there are so few studies on the effectiveness of prevention.

The Pump Handle: For Whom Prevention Pays
On one of the bigger, overlooked stories of public health in the U.S.–the faltering anti-tobacco struggle, another victim of the economic crisis.

HIV Information for Myanmar: Two Quotes from Bogyoke
A few words on the greater good from the late Bogyoke (General) Aung San, who led the fight for Burmese independence after World War II.

Health Reform Watch: Health Care, “Common Sense” and a Global Health Blogging Experiment
A bit off-topic and somewhat rambling (the French revolution?), but a look at whether concerns over health reform in the U.S. will crowd out discussion of global health.

Global Health at Prevention vs. Treatment–an Eternal Debate?
On why good decisions in public health “are about balance, and looking for long-term systemic solutions instead of the quick fix.”

And from a public relations perspective:

Ruder Finn’s DotOrg (U.K.): The Lazarus Effect
Lucy asks “Are there are any differences between ’selling-in’ stories that have a prevention angle over those that emphasise treatment.”

Bill Gates Unleashes Mosquitoes

At the TED Conference Bill Gates opened a glass jar of mosquitoes and let them fly, saying there’s no reason only poor people should be infected.

Moments later he explained the mosquitoes really weren’t carrying the malaria parasite, but the point was made.

A couple of thoughts. First,  let’s hear it for Bill Gates for finding another way to bring attention to the fight against this disease. I didn’t see the feeds on Twitter or other instant media today because I was working. But I saw coverage on NBC national news this evening. Gates got significant coverage. Good job.

Second, the story was first told on Twitter from the conference by someone in attendance.  It’s a measure of the value of instant access and the buzz it created spread quickly.

CDC Social Media Sites

An email from the CDC (Centers for Disease Control) promoting their new social media sites just arrived.The note also advises that CDC and HHS, FDA (Health and Human Services, Food and Drug Administration) are cooperating to provide information.

I like the idea of the CDC taking the initiative to push out information, and doing so by concentrating on the salmonella outbreak in some peanut butter products.

I went to the site and it looks like it covers the bases for consumers as well as health communicators. In addition to pointing to several websites it includes RSS feeds, Twitter, MySpace and a link to enroll for email updates.

Because users are more likely to search for information through Google than to go to a website, the communications strategy is more functional and, therefore, more likely to be a practical tool to people concerned about the recall.

It’s a good step forward and I hope beyond this recall it establishes a proactive strategy to distribute health information when other concerns arise, and beyond that, as a part of the on-going, non-emergency work of these agencies.

Prevention vs. Treatment

Christine Gorman at the Global Health Report blog asked several bloggers who write about global health to take on the subject of treatment vs. prevention. I write about health as a layperson from personal  experience and public policy. Other bloggers writing today on the subject offer professional expertise and a variety of viewpoints.

The news that the malaria parasite has developed resistance to the best new drug formulated to treat it is cause for significant concern. According to reports, malaria along the Cambodia Thailand border shows signs of resisting artemisinin, an extraction from a plant used in traditional medicine.

One of the greatest fears in the malaria community is the resurgence of the disease, something veterans have witnessed before in the not-so-distant past. Malaria was significantly reduced globally in the 1950s only to come back aggressively and with greater resistance when abatement efforts slowed. The failure to contain it through consistent, on-going effort led to an even more virulent and widespread global outbreak.

We are at a key moment in the fight against this disease. It could be the first warning of a drug resistant strain that has the potential to explode into an even greater threat to world health. How will political and  health leaders respond?

They face a key issue, one that has been discussed and debated for a number of years–prevention vs. treatment. The debate isn’t only about malaria, of course, it cuts across the spectrum of health concerns. It’s about an underlying philosophy of funds allocation. Should time, talent and resources be channeled to research, prevention or direct service?

I became involved in the debate more than thirty years ago around another set of issues. The issue I confronted (as a citizen member of a board of directors for a genetic research program) was to support a policy to put more funds into preventive research which, if enacted, would have the effect of redirecting funds away from direct treatment for children with genetic conditions.

It was an agonizing forced choice, one that I’ve since come to believe is short-sighted and even morally indefensible. It posits that funding research, treatment and prevention is not possible.

It’s based on the morally repugnant premise that health care can be reduced to an economic argument. Obviously, research for prevention must be funded. Prevention in the form of immunizations, innoculations, education for lifestyle changes and medications must be funded, and so, too, must treatment. It’s short-sighted to juxtapose these as if they are competitive, or worse, to act as if funding them is a zero sum game. It isn’t.

It’s also worth noting that the drug resistant parasite in Asia can migrate to other regions, and the mosquito carrying it is no respecter of nationality. Thus, threats in one part of the world threaten people across the world.

A few years ago, I wrote of the proposal by Gary Gunderson and Larry Pray to  focus on the leading causes of life. They make the point that focusing on deficits frames the discussion so that it leads to competition for finite resources when we could see the whole constellation of health in a holistic and positive view. Calling this a search for the “leading causes of life,” Gunderson and Pray write we must move forward on all fronts and not try to capture our piece of the pie for one area of work.

The debate about treatment vs. prevention is the wrong debate. The larger issue is about funding those efforts that lead to a healthy, productive future globally, or choosing other paths.

The United States chose the path of profligate spending on war that destroys human life and leaves us less secure in virtually every way–emotionally, financially and physically.

The same politicians who are resisting health care funding are the ones who drove us into the economic ditch that is collapsing on us now. They went along with an off-budget war that will cost 3 trillion dollars while cutting taxes to pay for it and now tell us we can’t devote our precious limited resources to constructive uses. Bob Herbert asks why anyone is listening to them today. Indeed, why?

To debate treatment vs. prevention is to become diverted from the crucial issue–how shall we move forward humanitarian, progressive policies and programs that contribute to global well-being?

Through global partnerships we can carry out research to prevent and treat malaria, and do much more to combat other diseases and health concerns as well. But this will require sustained support for a change in priorities, a change that has begun but will need continuing reinforcement and updating.

With regard to malaria, it’s urgent to continue preventive measures including bednets, training, environmental cleanup, water management and indoor spraying in addition to sustained spending on research and treatment.

Prevention vs. treatment? That’s the wrong debate.

BBC & Sky Refuse Gaza Appeal

The BBC and Sky television refuse to broadcast a two-minute appeal for humanitarian aid for the children of Gaza, contending that to do so would risk the impartiality of news coverage.

A coalition of thirteen humanitarian agencies is participating in the Disasters Emergency Committee to provide emergency assistance to the people of Gaza.

Dr. John Sentamu, Archbishop of York, had the most concise criticism saying, “This is not a row about impartiality but rather about humanity.”