Pasang Sherpa lives in a displaced persons’ camp under a plastic tent in Chabahil, Nepal. (Photo by M. Sophia Newman)
When Next City began its Health Horizons: Innovations and Informal Economies column last March, I set out to cover a year of global health innovations affecting informal workers in cities in low- and middle-income countries. “I’ll trace a path around the planet,” I wrote about my plans for the year, “talking to healthcare corporations, labor activists, and the average woman selling oranges in places like Khayelitsha, Cape Town, South Africa; Kibera, Nairobi, Kenya; the slums of Karachi, Kolkata and Kathmandu … .”
I did reach Cape Town, Nairobi and Kathmandu, and also reported on places I’d lived before, such as Accra, Ghana, and Dhaka, Bangladesh. In the last year, I’ve talked to waste-pickers and public health officials, a 2015 Nobel Prize winner (Angus Deaton), and an 89-year-old earthquake survivor in Nepal.
Here, my takeaways from reporting the yearlong series.
The dividing line between “developed” and “developing” worlds is not as sharp as one might think.
Although there are some ways in which life in lower-income countries differs from life in the United States, my native country, the dividing line is never as absolute as it might seem. Many American problems are growing global concerns. And the battle that defines U.S. healthcare — the issue of insurance — is now a struggle waged across developing nations too.
Nor is the dividing line between urban and rural lifestyles in low-income countries.
In the U.S., the divide between rural and urban populations can seem total. People who live in the city may never live in a small town in their lives, and vice versa. Often, the two groups think, act and vote differently.
But in many low- and middle-income countries, farmers sell their wares in open-air urban markets, street vendors fan out from urban centers to remarket goods along roads and in rural villages, and even those who move into the city permanently often retain social ties and customs from rural hometowns. And while some populations move between city and country, others are expanding outward into once-rural areas. These connections make developing world cities porous, more similar in disease risk and social behavior to rural areas.
Urban design matters.
If anything, the transient contact that rural people tend to have with the city lends urban planning more importance. Public health and safety has long been advanced by redesigning urban environments. In London, redesigning urban spaces was among the very first public health efforts. Urban planning to enhance health transformed American cities in the last century or so too. Today, urban planning transformations are helping Kibera, a huge slum outside of Nairobi, and Khayelitsha, a suburb of Cape Town, South Africa, reduce the threat of violence. Elsewhere, researchers are exploring urban waste management, beneficial human-microbe interactions and other aspects of healthy urban design.
Still others are celebrating successes in urban planning. In Kathmandu, smart building construction withstood earthquakes, saving thousands of lives. Urban design is a powerful part of creating health for whole populations.
Technology is important.
Technological projects are another big part of global health innovations, and everything from NASA satellite data to robocalls to “dumb” phones can improve global health. New devices and apps seem to appear by the day. While it can be overambitious (or just plain false advertising) to expect that low- and middle-income nations will “leapfrog” from minimal development to cutting-edge tech in everyday life, the use of increasingly sophisticated technology is clearly rising around the globe.
Technology doesn’t just have to be invented, but used well.
Among the most profound insights this year was Geek Heresy, a book that remarked on the limits of technological innovation to lead to real change and highlighted “the importance of heart, mind, and will.” Often, the real advancement came from integrating knowledge into life-saving changes or helping medical personnel use technology well.
The simplest designs often work best.
Will the “origami condom” be the next big thing in HIV prevention? Maybe. (The article on it ranks among my favorites.) But a design doesn’t have to be eyebrow-raising or touched by scientific genius to have a good impact. Among the compelling-but-not-startling innovations in global health are this shower, this bike path and this TV show.
Respect and human connection are likely the strongest healing tools we have.
Above all, the necessary moves for a healthy population weren’t just about technology or design. There’s no substitute for the human element in creating global health successes. In fact, the best innovations in global health are less about introducing the latest tech than about promoting enduring human dignity — whether that meant protecting miners’ rights, bolstering public respect for trash-pickers, rebuilding cultures imperiled by war or preventing (more) physical danger to garment factory workers.
There are plenty of reasons to celebrate.
Despite odds that seem to work against it, global health innovations often succeed. In post-earthquake Nepal, an anticipated epidemic never happened. In sub-Saharan Africa, polio has essentially vanished — but left behind some crucial means to fight Ebola. Between 2002 and 2014, a global distribution system passed out 548 million bed nets, which, combined with other efforts, helped avert 115 million malaria infections. After a year of reporting on dozens of nations and seeing Khayelitsha, Kibera and Kathmandu firsthand, here is what I have gathered: Despite everything, global health is full of good news.