Film Review: The Soloist, and Issue: Homelessness in America

Yesterday I saw "The Soloist" in a theater, and it inspired me to go domestic on the blog. "The Soloist" has a potent combination of themes; those of you who know me will not be surprised that I loved a movie that addresses homelessness and poverty in America, mental illness, race, the dynamics of helping/not helping people, group identity, the power of music, and the process of writing. It's in theaters right now, and I really recommend that you check it out if you have a chance. You can watch the trailer here.

For this blog entry, I'll review the film and also talk a bit about homelessness in the U.S. of A.

"The Soloist" is based on the true story of an encounter between Steve Lopez, a columnist for the L.A. Times, and Nathaniel Anthony Ayers, a gifted Julliard-trained musician who Lopez finds living on the streets of L.A. Lopez begins to write about Ayers' life, and the two of them become friends. He learns about the mental illness (schizophrenia) that derailed Ayers' plans to be a successful musician. He listens to Ayers play a two-stringed violin, and then a donated cello, in the street. He tries to help Ayers; he learns that helping is more complicated than we would like to think.

On a filmic level, I was impressed with "The Soloist." I thought Jamie Foxx and Robert Downey Jr. (and the other cast members as well) were completely brilliant in their roles. The soundtrack (comprised mostly of classical music and variations, featuring a lot of Beethoven music) was gorgeous. I was also pleased because the cello happens to be my favorite instrument to listen to, besides the piano. But what really made me fall in love with this movie was what it's about.

When I was in high school I started volunteering weekly in the playroom at my local homeless shelter. I think it was this experience that really broke apart, for me, some of the myths about the face of homelessness. Throughout high school, college, and my post-college years, I continued to volunteer (and, for a time, work as a paid employee) with the homeless population. (I haven't managed to do much work in this area since I had a baby two years ago.) So you can imagine why this issue is so important to me. When I think of homelessness, I think of specific people--like a woman I knew, who had been married to an abusive husband and had no family to turn to. One day, after a particularly bad beating, she took her two daughters (ages 2 and 6 months) and all the cash she could find, got in the car, and drove until she ran out of money. She ended up in our city (three states away) and at our soup kitchen. She ate all her meals with us, and took public assistance for a few months until she could find a job and affordable+adequate childcare (not easy things to find). After a while she saved up enough money to put a deposit on an apartment... and then I lost touch with her. But when I think of homelessness, I think of people like her.

I've often said that poverty in America is a different thing than global poverty, and it is. (You're not very likely to die of starvation in America, or of diarrhea or measles or malaria--in other parts of the world, you're lucky if you don't. In some countries, the majority of people make less than a dollar a day, and live in conditions that would qualify them as homeless in America.) Poverty in America is is a bit different, and that's part of the reason I typically focus this blog on global issues. But don't assume I'm not equally concerned with domestic issues--I am. America has extreme economic inequality; there is a LOT of money up in here, and we still have children sleeping on the streets. And since most of my blog readers live in the U.S., that means some of the issues raised in this post are happening in your own backyard--and I don't know about you, but it makes me feel complicit.

It's difficult to find reliable statistics about homelessness, because homelessness is, by its very nature, a transient and difficult thing to measure. There are homeless people who live in shelters, or on the streets, or in cars, or who sleep on friends' couches. Some people may experience a lack of permanence that has them sleeping in hotels when they have some cash, or on the streets when they don't. An estimated 3.5 million Americans experience homelessness every year. For most of them, homelessness is a temporary condition, although an estimated 10 percent of them deal with chronic (or long-term) homelessness.

I know many people have a particular image that comes to mind when they think of people dealing with homelessness. When I think of homelessness, I think first of children--which is appropriate, since nearly 40 percent of America's homeless people are children (and nearly half of those children are under the age of five).

So who is homeless in America? Here are some things to consider, gleaned from the National Coalition for the Homeless:

* Approximately 40 percent of homeless men are veterans of the armed forces.

* Roughly 16 percent of homeless individuals suffer from "some form of severe and persistent mental illness."

* Studies have found that nearly half of all homeless women and children are fleeing domestic violence.

* Families with children comprise nearly one-quarter of homeless individuals.

* Up to 25 percent of homeless people work full-time.

* The federal definition of "affordable housing" is housing that costs 30 percent of a person's income. This is calculated to guarantee that there is adequate money left to pay for insurance, health care costs, food, heating, and the many other expenses that people face (especially people who have to deal with the high costs of prescriptions and doctors' visits for treating chronic health conditions, including mental illnesses). But in most states, a minimum-wage worker would have to work 89 hours a week in order to earn enough to pay only 30 percent of their income to housing.

The problems faced by homeless individuals should be self-explanatory, but I'll mention a few anyway. Homeless people are extremely vulnerable to physical assault, rape and sexual assault, and theft. Homeless families generally don't have good access to health care, mental health care, and dental care, and mortality rates are three times as high as within the general population. Between the risk of physical danger, subpar health care, and being subject to dangerously cold weather, the average life expectancy for homeless individuals is age 51. Children in homelessness are much less likely to get a good education (which is part of the reason that homelessness is so self-perpetuating). One-third of homeless people do not get enough to eat. This section could go on for pages, but I think you get the idea.

How can this happen? Honestly, I ask myself that question every day. I mean, I can understand why it happens: A confluence of events that force people onto the streets. Poverty + expensive rental housing + increasing unemployment + the mortgage crisis + mental illness + inadequate health care/mental health care for many low-income Americans + domestic violence + inadequate veterans assistance + a low minimum wage + inadequate substance abuse programs + widespread misconceptions and intolerance toward homeless people that result in huge challenges for organizations that are trying to create more opportunities for housing and employment. Etc.

But the question I ask myself is not answered by any of these "explanations;" it is: How do we let this happen? President Obama recently said that it is "not acceptable for children and families to be without a roof over their heads in a country as wealthy as ours." I agree; I think it's unconscionable.

OK, so... what do we do? Often when I'm writing these posts I want to drop everything and move to Uganda. I want to do something. This post will be easy for you to act on in a very personal way, because homelessness exists in communities across the United States. Chances are, there is a homeless shelter or food pantry near you that is in need of volunteers or donations.

Click here to access a directory of service organizations across the country. You can search by state. The directory is not comprehensive, though, so you might also want to check in your phone book. The "blue pages" near the front should have a listing of local community service organizations. Or just get to work on Google. If your nearest organization has a website, it probably includes lists of what the organization is most in need of.

Also, the Take Part website for "The Soloist" has a directory of volunteer opportunities, as well as information and tips on how to get involve in your own community. While you're there, check out this video that debunks some of the popular myths about homelessness.

Once you've found an organization, call your nearest shelter/pantry and ask to talk to the volunteer coordinator. If possible, call with an idea of what you're hoping to do already in mind. This will depend on how much time you're willing to commit, but here are a few ideas:

*If you want to commit a couple of hours a week: Your organization may need people to serve meals, or to sort through donations, or to wash dishes, or to play with kids in the playroom, or to teach a computer class, or to teach a dance class for kids... Setting aside two or three hours a week will enable you to really get to know the people you're working with.

*If you want to do a big one-time only project: Donate some cash! Or organize a food or clothing drive in your neighborhood, or plan a party and ask everyone who attends to make a donation or bring a sack of food for the food bank. Be creative; big projects take planning, but they are a great way to pull together resources and simultaneously raise awareness about the issues connected with homelessness. (Some of your friends might not even realize that homelessness exists in your community.)

*If you want to do a little bit here and there: Perhaps you can take in periodic donations of food or clothing, or maybe the organization needs people to pick up food/donations from local businesses. Or maybe the organization has a big event coming up and they need help preparing or staffing. Some organizations will be able to accommodate you on this kind of an occasional basis.

*If you'd prefer to get involved in an activist kind of way, local organizations may or may not be your best bet. Sign up for the newsletter at the National Coalition for the Homeless website, or check out this list of advocacy groups.

All right, get to it! If you are able to watch "The Soloist" or get involved in a community project, I would love to hear about your experiences...

Issue and Action: Malaria

Tomorrow (April 25) is World Malaria Day, so of course: Let's talk about it.


(This photo is from the Bill & Melinda Gates Foundation photo gallery.)

This is how it happens: Malaria is caused by a microscopic parasite that is carried by infected mosquitoes. When an infected mosquito bites a person, the parasite goes straight to the person's liver and begins to reproduce, then the infection is passed throughout the body through the blood stream. If the parasite arrives in the brain, cerebral malaria (which may lead to a coma and permanent neurological damage, and may be fatal) occurs.

Every 30 seconds, a child dies from malaria. Worldwide, malaria exists in 109 countries (which, combined, are home to half of the world's population) and kills a million people every year. In Africa specifically, malaria kills more children than any other disease. Overall, 90 percent of the people who die of malaria live in Africa. As is the case with so many public health issues, children are disproportionately affected by malaria.

Of course, even if a person doesn't die of malaria, there can be long-term effects just from contracting the disease. Globally, there are an estimated 350 to 500 million cases of malaria every year. Children who survive a case of cerebral malaria may suffer from long-term learning impairments or brain dysfunction. Also, malaria can cause anemia in children, which makes them more vulnerable to diarrhea, dehydration, and respiratory illnesses--which can, as we've seen in previous posts, be fatal in areas without ready access to health care, clean water, and adequate nutrition. Also, pregnant women (another high-risk population) who contract malaria have higher infant mortality rates, and their babies may be born with dangerously low birthweights.

You can imagine the toll that this disease takes on communities and nations; Africa loses an estimated $12 billion every year because of malarial infections.

One of the best-known (and simplest, and cheapest) ways to prevent malaria is to promote mosquito control initiatives. Distribution of insecticide-treated mosquito nets have been shown to have a remarkable effect on decreasing malaria. Technological innovation has made these nets more effective; old nets sometimes had to be re-sprayed with insecticide every six months, but the new nets are extremely effective. This, in combination with simple public health efforts such as removing standing water from the vicinity of homes (since mosquitoes breed near standing water), is crucial toward preventing malaria.

Other crucial initiatives involve improving access to drugs that treat malaria (which at present may be hard to come by, or too expensive). Other organizations are working to develop other prevention strategies (such as a malaria vaccine). The international community is working toward a goal of near-zero deaths from malaria by the year 2015. Obviously this will require concerted effort--and commentators seem divided on whether it is possible at this point--but many organizations are working toward this goal.

Recent data suggest that things are already changing, in some target countries, even faster than anyone expected. For instance, in Zambia, malaria deaths have been cut by two-thirds! And countries like like Rwanda and Ethopia are registering significant declines in their child mortality rates, attributable to the widespread distribution of bed nets.

I love these figures; I love to tell them to people who try to tell me that making donations to public health NGOs doesn't make a difference. Because if you choose your organizations wisely, your small donations really can contribute to difference-making.

If you're interested in learning more or donating to one of these organizations, here are some good ones to check out:
Bill & Melinda Gates Foundation
The Global Fund to Fight AIDS, Tuberculosis and Malaria
Nothing But Nets
Malaria No More

Also, if you have ten seconds to spare, you can sign this proclamation indicating your support for President Obama's promise to make ending malaria a national priority in the USA.

And if you have ten dollars to spare, you can donate an insecticide-treated mosquito net to an African country (and receive a woven African bracelet as a gift).

Issue: Water

"The human right to water is essential for living a life of human dignity. It is the pre-requisite for all other human rights."
(Kofi Annan)

Yesterday (March 22) was World Water Day, and this coming week (March 22-28) is World Water Week. It's perfect timing for this blog to address the world water crisis. Water is often discussed in conjunction with sanitation, but for today's post I am just going to focus on water.

Across the world, nearly 900 million people lack access to clean water. This lack of access to water poses a huge public health problem; every day, 4,200 children die of water-related diseases. (An estimated 125 million children under the age of five live in households that do not have regular access to clean water.) Most of these children dying of water-related diseases are die from diarrhea--an illness that kills an estimated two million children every year. Incredibly, the number of diarrhea-related deaths around the world is currently on the rise.

This is a big, big deal and it directly affects roughly 1/7 of the world's population.

There are really two linked issues when we're talking about the world water crisis: water scarcity, and water quality.

The water scarcity issue is particularly prevalent in Africa, where vast tracts of the land is dry and receives little rain. In some rural regions, women walk ten miles a day to fetch water for their families--carrying 40- or 50-pound water containers--and during the dry season, women may walk nearly twice that distance. (You'll notice I said women, not people--water-gathering is typically considered a female activity, linked to domestic reproductive tasks, and across the world women generally bear the brunt of water-collecting labor.) In fact, the World Health Organization has estimated that African women and children spend, collectively, 40 billion hours a year gathering water.

You can imagine that this takes its toll on women and families in various ways. Health problems can develop from carrying heavy loads long distances (even, in some cases, curved spines and pelvic deformities that cause problems during childbirth). Pregnant women who carry these heavy loads suffer increased health risks. Women and girls traveling alone can be vulnerable to violence and rape. And in some families, girls are required to gather the water--a task that can take so much time that it makes it impossible for the girls to attend school. This time-consuming activity also prevents women from working in other income-generating activities or vital domestic tasks (or caring for their own health).

In the West, we're always being exhorted to drink eight glasses of water a day. Certainly this would be good, healthy advice for anyone, but it isn't an option for much of the world. In fact, one flush of a Western toilet uses as much water as the average person in the developing world uses for a whole day's washing, drinking, cleaning and cooking.



So once a woman has spent half her day collecting and carrying water, the difficulty still hasn't ended. Because chances are, the water she found is not clean or safe for her family to drink. Issues of water quality affect people in urban and rural areas alike.

My own personal introduction to the water quality issue came when my husband and I were living in Mozambique. We were conducting a research project that took us out to a rural village with our research assistants to do some interviews. We noticed a hole in the ground toward the center of the village, and we went to take a look. This was the water supply for the entire village: A crumbling hole dug in the ground--not even a well--with dirt and dead insects floating on top. I remember feeling sick: Even though I'd read about water quality issues, I looked down at that dirty water and imagined scooping up a cup of it for a child to drink, and I felt the world's inequity sink down into my bones.

When a person drinks unclean water (any water from a non-purified source, which can include groundwater, contaminated rainfall, floodwater, or river water, to name a few), that person is vulnerable to various waterborne diseases. Diarrhea, cholera, and typhoid are the most common diseases that are transmitted through unclean water supply. There are dozens of other waterborne diseases--giardiasis, guinea worm, etc. (These are all diseases that occur from drinking unclean water; I am not even going to go into diseases that are connected to standing water, like malaria, dengue fever, or schistosomiasis and related parasitic infections--maybe in a future post.)


This interesting document is a reminder that water scarcity and quality are not necessarily issues of physical scarcity, but that the Africa water crisis is "structurally induced scarcity." In some cases, the world water crisis has been accentuated by politics, economic interests, and even unscrupulous marketing practices. I can't resist mentioning an issue that I find particularly telling:

Back in the 1970s and 1980s, people began to learn that Nestle and other baby formula companies had been aggressively marketing infant formula in less-developed countries. The suggestion implicit in the marketing campaigns was that babies would grow fatter and healthier with formula than they would with breastmilk. Many women (who grew up in communities where breastfeeding was previously the normal--and even only--way of feeding a baby) began to give their babies formula instead, in response to the marketing campaigns. And this is what happened: Families began to spend money they didn't have on infant formula they didn't need. They began to mix the formula with the only water sources they had, which were often unclean. And, since the formula labels were often in a foreign language like English (or because the mothers had not been to school or learned to read), the mothers often used very small amounts of the formula, to make the container last longer.

You can imagine what happened. In addition to losing the natural benefits of breastfeeding (like passing antibodies on to the babies, facilitating the release of bonding hormones, and having a natural method of fertility suppression and birth spacing), the families lost money and inadvertently exposed their babies to the dangers of unclean water and malnutrition. And babies got fatal diarrhea. And babies began to die. You can read more about this in Gabrielle Palmer's marvelous book, The Politics of Breastfeeding, which I highly recommend.

When I worked with UNICEF in the Philippines, I learned that UNICEF still will not accept monetary or in-kind donations from Nestle, because Nestle has continued to promote the use of baby formula in the Philippines, undermining the health of babies and accentuating the already-enormous issue of water impurity and children's health.

We already have technology for many solutions to the world water crisis. In some cases, solutions are free: Encouraging a cultural return to exclusive breastfeeding, helping urban communities negotiate with their local governments to extend clean water systems to the entire community. Other solutions are well-established and cost-effective: Creating rainwater collection systems, or digging pumps and wells in rural areas to create access to groundwater sources. There is very little mystery behind the world water crisis. It's an issue of distribution, and with increased resources this is something the world community should be able to make fast progress on. Despite this, the world water crisis is actually becoming worse over the past few years. As the world's climate changes, communities are being subjected to more drought and the drying-up of water tables. It's urgent.

There are many, many organizations that are working on clean water and sanitation issues around the world. I'd like to introduce you to one project that I particularly like: Tap Project.



There are a number of ways you can get involved with the Tap Project.

1) Are you planning to go out to eat anytime soon? Click here for an interactive map, which will show you restaurants in your community that participate in Tap Project. At these restaurants, you can donate $1 (or more, of course) to Tap Project.

2) Learn more about becoming a Tap Project volunteer in your community or workplace by clicking here.

3) Make a donation (or learn more about using eBay's Giving Works program) by clicking here.

4) Or (this is even quicker and easier), text the word "TAP" or "AGUA" to UNICEF (864233) to make a $5 donation!

5) Check out this cool article in the New York Times to see some of the great ad campaigns that have been created to help Tap Project.

Do something for World Water Week...

Issue: Maternal and Newborn Health

The United Nations Children's Fund (UNICEF) recently released their annual report, The State of the World's Children, for 2009. Every year this report offers an in-depth look at one particular issue affecting children around the world. This year the report is entitled "Maternal and Newborn Health," and it assesses the health and well-being of pregnant women and new mothers and their babies around the world.

Doesn't the picture on the front sort of make your heart grow a few sizes?

I'm going to try to offer an overview of some of the issues presented in SOWC 2009, but obviously my efforts will be limited; the report is 158 pages long, packed with information. I really encourage you, if you're interested in this subject, to click here to read the report. You can view it as a pdf file or request a paper copy. The blocks of italics in this post are direct quotes from SOWC.

"In the developing world as a whole, a woman has a 1 in 76 lifetime risk of maternal death, compared with a probability of just 1 in 8,000 for women in industrialized countries. By way of comparison, the lifetime risk of maternal mortality ranges from just 1 in 47,600 for a mother in Ireland, to 1 in every 7 in Niger, the country with the highest lifetime risk of maternal death."

When we're talking about maternal deaths (the term used to describe deaths that occur during labor or as a result of labor), there are two types of causes. "Direct causes" are obstetric complications (like post-partum hemorrhage, infections, eclampsia, or obstructed labor), or complications from abortions. These causes may be labeled as actually causing the mother's death. But there are numerous other "indirect causes," as well, which contribute to the emergence of these direct causes. Common indirect causes of maternal death include:

*Anemia
*Poor nutrition
*Lack of birth spacing (e.g., having too many babies one after another, without giving the body time to recuperate)
*Malaria
*Iodine deficiency
*HIV/AIDS
*Undeveloped anatomy (e.g., young girls whose bodies are not developed enough to bear children)
*Inadequate hygiene (which can cause maternal-neonatal tetanus)
*Poverty

In other words, if a woman is sick and weak and undernourished, her chances of having a normal, uncomplicated labor are greatly diminished. This list is partial; there are many other factors--both biological and socio-cultural--that make labor more dangerous than it needs to be.

Obviously, the health of the laboring woman/new mother is inextricably linked with the health of her baby. These factors that contribute to unusually dangerous labors and serious health problems also contribute to health problems and deaths for newborn babies.

"The latest estimates from the World Health Organization, which date from 2004, indicate that around 3.7 million children died within the first 28 days of life in that year. Within the neonatal period, however, there is wide variation in mortality risk. The greatest risk is during the first day after birth, when it is estimated that between 25 and 45 percent of neonatal deaths occur. Around three quarters of newborn deaths, or 2.8 million in 2004, occur within the first week – the early neonatal period."

The ten countries with the highest death rate for children under the age of 5 are:
1. Sierra Leone
2. Afghanistan
3. Chad
4. Equatorial Guinea
5. Guinea-Bissau
6. Mali
7. Burkina Faso
8. Nigeria
9. Rwanda
10. Burundi

"Some 86 per cent of newborn deaths globally are the direct result of three main causes: severe infections – including sepsis/pneumonia, tetanus and diarrhoea – asphyxia and preterm births. Severe infections are estimated to account for 36 per cent of all newborn deaths. They can occur at any point during the first month of life but are the main cause of neonatal death after the first week."

There are so many ways to promote maternal and newborn health. One of the crucial keys is prenatal care and adequate nutrition. When women are well-nourished and healthy, most labors proceed well without complications. However, this is not as simple as it sounds; the current and ongoing World Food Crisis that is driving food prices up around the world is making it difficult for women to meet their basic nutritional needs, let alone consume the extra calories that pregnant women need. And lack of access to basic health care for infections and illnesses (such as malaria) makes women even more vulnerable to complications.

One crucial element to decreasing maternal and newborn mortality is to provide training and resources to traditional birthing assistants, or midwives. Training programs (like this one, in Afghanistan) can integrate traditional and modern knowledge about childbirth, and provide midwives with much-needed supplies (like soap, clean towels, razor blades, receiving blankets, etc.) and training on techniques they may not be familiar with (such as infant resuscitation). Increasing pregnant women's access (before, during, and after labor) to trained labor assistants can ultimately result in the following crucial elements:

*Better management of infectious diseases (Prevention of malaria has been shown to decrease premature births!)
*Ongoing promotion of breastfeeding
*Prenatal and antenatal visits and assistance
*Improved hygiene practices
*Treated mosquito nets to prevent malaria infections in mothers and newborns
*Kangaroo mother care (e.g., skin-to-skin contact and on-demand breastfeeding) for low-birthweight babies

And of course, it's important to improve access to emergency obstetric care for babies and women with life-threatening conditions. Then, some of the best ways to promote child survival are to ensure that the child is exclusively breastfed, provide access to basic health care and immunizations, and prevent the child from contracting diseases like malaria.

Let me just give one example of how adequate prenatal care and effective care-provider training can work together. In Africa and Asia, over 30 percent of maternal deaths result from postpartum hemorrhage. The risk of hemorrhage is greatly decreased when a woman is healthy and nourished, and a few basic techniques can prevent hemorrhage. For example, the World Health Organization recommends delaying the clamping and cutting of the umbilical cord until it stops pulsing; this alone significantly decreases the risk of hemorrhage.

In addition to all these logistical factors, there are many socio-cultural factors that need to be dealt with to improve women's and babies outcomes. Here are a few things that have been proven to have a positive effect on maternal and newborn health, according to SOWC:

*Increasing educational opportunities for girls
*Decreasing gender discrimination (and letting women make choices about their health care, rather than having those choices dictated by husbands or communities)
*Preventing child marriage and early child-bearing by undeveloped girls
*Abandoning female genital mutilation (which causes many extra complications for child-bearing, e.g., accelerating the risk of post-partum hemmorhage and obstetric obstruction)
*Involving men and adolescent boys in maternal and newborn health and care (and focusing on family units)
*Creating supportive environments for women and babies
*Stopping violence against women (One example here: A study of 400 villages in rural India revealed that 16% of all deaths among pregnant women were due to partner violence. Cross-culturally, rates of violence against pregnant women are high)

One thing that this particular report didn't mention, though, was the risks that can also come along with the overmedicalization of birth. For instance, in the United States, over 30 percent of women give birth via Cesarean section. Best estimates suggest that perhaps five to ten percent of births require Cesarean intervention (and, in fact, SOWC presents similar figures). Unnecessary C-sections result in a host of risks to mothers (permanent injury to the bladder or uterus, infection, blood loss, damaged bowel functioning, future pregnancy complications, death, etc.) and babies (premature birth, breathing/lung problems, cuts and injuries, side-effects of anesthesia, difficulty breastfeeding, etc.) The United States tends to have extreme cases: On one end of the extreme are women who can't afford access to basic prenatal health care; on the other end, the trend toward non-medically-indicated elective (and expensive) C-sections that pose considerably more risk than a normal vaginal delivery.

On the child mortality list that I mentioned earlier (where the highest child death rates are closest to the top of the list), the United States comes in at number 151 out of 189; this means that there are 37 countries with lower infant-mortality rates than the United States. The countries with the best statistics (meaning the most babies who survive infancy) tend to be countries that provide a "best of both worlds" approach, where women have adequate access to prenatal care, good nutrition, supportive cultures and systems, and care providers trained in supporting natural childbirth processes, as well as emergency care. In other words, the technology exists to save mothers and babies in obstetric emergencies (and people have access to it), but low-intervention births are still considered the ideal situation for women and babies.

In case you're interested, here's the list from 151 to 189, so you can see all the countries that have better child survival rates than the U.S. The best in the world? Sweden.

United States 8 151
Cuba 7 156
Hungary 7 156
Poland 7 156
Thailand 7 156
Australia 6 160
Canada 6 160
Croatia 6 160
Estonia 6 160
New Zealand 6 160
United Kingdom 6 160
Belgium 5 166
Cyprus 5 166
Israel 5 166
Republic of Korea 5 166
Malta 5 166
Netherlands 5 166
Switzerland 5 166
Austria 4 173
Czech Republic 4 173
Denmark 4 173
Finland 4 173
France 4 173
Germany 4 173
Greece 4 173
Ireland 4 173
Italy 4 173
Japan 4 173
Monaco 4 173
Norway 4 173
Portugal 4 173
San Marino 4 173
Slovenia 4 173
Spain 4 173
Andorra 3 189
Iceland 3 189
Liechtenstein 3 189
Luxembourg 3 189
Singapore 3 189
Sweden 3 189

Issue and Action: Child Survival

Today I received a link to the 2009 letter from the Bill and Melinda Gates Foundation. I have been consistently impressed with the types of projects the Foundation takes on--and I love their motto, "All Lives Have Equal Value"--so I enjoyed reading Bill Gates's open letter describing the Foundation's successes and failures over the past year. You can read the full text of the letter here.

I was especially interested in the segment on preventing childhood deaths. This is a big deal to me. Some days I wake up and look at my one-year-old daughter and feel overcome with gratitude that she is still here with me; I often feel hyper-conscious of the nearly 11 million children who die before reaching the age of five every year. That's 29,000 children a day (21 children every second) who die, mainly of preventable causes. Every one of those children is as real and warm and tangible to their parents as my daughter is to me. This graph (from the letter) gives a breakdown of the causes of these childhood deaths:



As you can see in the graph, more than half of the child deaths are caused by diarrheal diseases and dehydration, pneumonia and malaria. All these illnesses are preventable and treatable. Sometimes Westerners are surprised to hear about the gravity of diarrhea, in particular, in less-developed regions of the world, but for children who are undernourished and continually exposed to risk factors (like unclean water supplies) these diseases can be death sentences.

Here's some good news: Child mortality rates is one area where great progress has been made over the past 50 years. Here's another graph from Bill Gates' letter:



Amazing, right? The rate of childhood deaths has been cut in half, thanks to fifty years of hard work by many individuals, communities, organizations and entities. What this statistic says to me is that we have the technology and experience to completely eliminate preventable childhood deaths. Diarrheal dehydration can be eliminated when communities have access to clean water supplies, when breastfeeding is encouraged, and when simple rehydration strategies are employed for children who have diarrhea. Pneumonia can be prevented through adequate nutrition and improved sanitation, and the treatment for pneumonia is well-established, which makes it a question of making that treatment easily accessible for all the world's families. And malaria can be prevented with the use of treated mosquito nets and antimalarial medications, as well as vector control. Treatment for malaria exists but needs to be made more widely available in order to save more people's lives.

One of my favorite initiatives to decrease child mortality rates is UNICEF's "I Believe in Zero" campaign. The idea is that with adequate resources and political will, we can improve distribution of existing technologies to ensure that ZERO children die of preventable diseases. Visit the website to sign a petition to President Obama, donate to the cause, and recruit your friends and associates (by putting a collection canister on your desk at work, or putting a banner or widget on your website or Facebook page, or getting the word out to your local media).

Please click here to sign a petition indicating your support for a Presidential Initiative to Accelerate Child Survival.

Then click here to access information about the Global Child Survival Act (introduced in the House and the Senate, H.R. 2266 and S. 1418). From the website you can send letters to your Senator and Representative.

And while you're at it, why not click here to access information about a host of other children's issues that you can become involved in? The U.S. Fund for UNICEF website makes it easy to lobby your officials and speak our on issues that are important to you because they are important to children.

I believe in zero. I hope you do, too.

Issue: Universal Declaration of Human Rights

In 1948, when the atrocities from the time of World War II became known and named, the United Nations General Assembly adopted the Universal Declaration of Human Rights. The Declaration contains a preamble and 30 articles that enumerate basic human rights that every human being is entitled to enjoy. Here's just a sampling of the rights that are set forth in the Universal Declaration of Human Rights:

* The right to life, liberty, and security of person.

* The right to a nationality.

* The right to be equal before the law and not experience discrimination in the protections afforded by the law.

* The right to freedom of thought, conscience, and religion.

* The right to freedom of peaceful assembly and association.

* The right to a standard of living adequate for the health and well-being of him/herself and of his/her family.

* The right to education.

You can read the full text of the Universal Declaration of Human Rights here, or watch a really cool video with an animation sequence for each article here. (The film is totally worth the 20 minutes it takes to watch it.)

The year 2008 is the 60th anniversary of the adoption of the Declaration, so there have been a number of movements to spread the word about the Declaration and encourage people to get involved (personally and politically) in ensuring that their own life incorporates these principles of human dignity and human rights. Here are two websites that I recommend for learning more about the Universal Declaration of Human Rights.

1) Every Human Has Rights. This campaign is sponsored by The Elders, an organization I've only recently learned about but that really gets my heart palpitating. (The video at the beginning of this blog post is from The Elders.) The Elders is a council of--well, of some of my greatest heroes, actually. Nelson Mandela, Graca Machel, Desmond Tutu, Kofi Annan, Muhammad Yunus, Aung San Suu Kyi, and others. The council has come together with the idea that if our world is a village, we need people with experience and commitment and compassion (a council of Elders) to share with us the value of their experience. So you can click here to get messages from The Elders, and here to get involved with the Every Human Has Rights campaign.

2) Protect the Human with Amnesty International. Seriously, take some time to check out this website. The Film, Music and More section is really great, with some fascinating films and book resources--too many for me to link all of them here, but go take a look. If you go to the Take a Stand section, you can quickly send letters and sign petitions on issues like Darfur, violence against women, political prisoners, and more.



"Where, after all, do universal human rights begin? In small places, close to home -- so close and so small that they cannot be seen on any map of the world. Yet they are the world of the individual person: the neighborhood he lives in; the school or college he attends; the factory, farm or office where he works."
--Eleanor Roosevelt

Issue and Action: The Global Food Crisis

Earlier this year, we were hearing from major news outlets about the world food crisis. Between the months of January and April of this year, rice prices increased globally by 141 percent. This was big news here in the United States; I remember hearing that in my home state of Utah, people were buying up all the rice and wheat in sight because of fears over the crisis. But the reports sometimes underplayed the extent to how keenly this price difference was felt in other parts of the world. Keep in mind that there are one billion people in the world who live in less than $1 a day. For many of these people, 75 percent of their income may go to providing food for their families. You can imagine that on a budget like that, any amount of food-price inflation can be catastrophic. We read about riots in West Africa, civil unrest in Haiti, panic and despair all over the world.

When the first reports of the crisis were released, governments from around the world pledged $12 billion in food aid to the hardest-hit countries. Now, five months later, right around $1 billion of that promised amount has been delivered. It's interesting to consider how quickly our government managed to act when the financial markets crashed last month--but how lethargically our government (and others) is moving to respond to the food crisis.

At this point, many countries are still suffering from inflated food prices. Partially as a result of the global community's delayed reaction to the food crisis, the situation is still serious. According to United Nations estimates, the number of malnourished people around the world has grown, over the course of the past year, from 850 million to 925 million people. This means that after decades of progress in reducing world hunger, we are seeing the progress rolled backward, and for the first time in years, there are more hungry people around the world than there were last year.

I just finished an online conference call with Oxfam America, a humanitarian organization that does respected work nationally and internationally. One country highlighted in the conference call was Bangladesh. In the past 9 months, rice prices have risen 90 percent, and as a result the national poverty level has risen from 40 percent to 48 percent. (Keep in mind people fit into this definition of poverty if they are making less than $1.25 per day.) In Haiti, where riots earlier this year ended up in five people dying, people are resorting to eating "mud cakes" out of salt, vegetable shortening, and mud. Hunger and malnutrition already contribute to the deaths of 3.5 million children per year globally, and the numbers are bound to increase with this crisis. As grains like wheat and rice become more expensive, families are often obliged to cut out fruit, vegetables, and protein sources from their diets, and the myriad effects of poor nutrition ensue.

There are many different reasons for this ongoing problem. I'll briefly mention a few. Fundamentally, there have been a number of droughts this year in less-developed countries. (As the world's climate changes and the weather becomes more unpredictable, this is expected to be an ongoing challenge.) As emerging economies develop more capital (e.g. China) and begin to eat more like Americans, the world's grains are increasingly used for beef production rather than human consumption (and it takes 700 calories worth of animals' feed to produce 100 calories of beef). The instability of oil prices doesn't help, either--as oil prices go up, agricultural expenses follow suit. Additionally, as the U.S. has increasingly subsidized biofuel production (something many other developed countries to, too), the price of grain has risen; in other words, rich countries' energy policies have contributed to the rising cost of food around the world.

Oxfam's approach to this crisis has three different levels of intervention. The short term interventions are simple: emergency food aid. Particularly now, as winter is approaching in countries like Afghanistan (where humanitarian conditions are, according to what I learned today, currently the worst they've been in 20 years), emergency food aid is crucial. Middle-term interventions include improving access to food and supporting farmers in less-developed countries in their production efforts and stepping up our support of local reserves around the world. Long-term intervention is also key, though, and it revolves around reforming some of the underlying policies. The conference call a number of examples of policy changes that would be beneficial:

* Rethink the way the U.S. distributes food aid. Currently, the U.S. donates a lot of food aid--which is great--but typically the food is purchased here in the States then shipped overseas. This doubles the cost and slows deliveries. In countries where resources are available (but still unaffordable), it is quicker and more cost-efficient to a) purchase the food there, or b) distribute cash instead, assuming there is enough food on the market that people can purchase it themselves.

* Reinvest in agriculture. In the past, 30 percent of the U.S.'s international aid went to agriculture programs; now it is down to only 5 percent. Agricultural support programs would increase poor farmers' ability to increase production. (Since agriculture is an industry that relies heavily on credit at the beginning of the planting season, increasing credit options for poor farmers would enable them to produce more.) As it is right now, the lack of agricultural support is turning poor countries into importers and taking away their ability to feed themselves.

* Rethink biofuels. Currently in the U.S., one-quarter of the corn produced is converted to ethanol. This would make sense if there was a global food surplus, but currently there is a shortage, so that corn could be better-used.

So this week I've got two action suggestions for you from Oxfam.

Action #1
Participate in the Fast for a World Harvest. Fast for a World Harvest is an ongoing event; in 1974, a group of 250,000 people fasted the Thursday before Thanksgiving and donated the money to Oxfam. Since then, people and groups have conducted fasts, organized hunger banquets, and sponsored community events to raise awareness about global hunger issues and raise money for the cause. Since this month is Thanksgiving, it's perfect timing for you to express your personal gratitude and simultaneously offer a token to those who are suffering from hunger.

There a number of ways you can participate in Oxfam's ongoing Fast for a World Harvest. One way is to make it personal: Set a goal to fast for a meal or a day, in solidarity with people suffering from hunger, then donate the money you would have spent on this meal (to Oxfam or another humanitarian organization of your choice). If you are involved with a community or campus group, think about sponsoring an event; the above link will provide you with organizational information and free materials. Also, communities and campuses around the country are sponsoring Fast for a World Harvest events (like Hunger Banquets): click here to search for events in your community.

This really is the ideal time to participate in the Fast. Next week is Thanksgiving, when we celebrate our abundance with food. What better time to remind ourselves of the fact that this abundance is not a global fact?

Action #2
Take a seat at Oxfam's World Table. Remember those choose-your-own adventure books we used to read as kids? In this interactive application, you can follow the life of one of six people living in a less-developed country, "make choices" and see some of the common dilemmas faced by people. I really recommend sitting down and trying this out when you have a few free minutes. It's good food for thought.

Also, check out the Africa Peace and Justice Network; they have a section of their website dedicated to international agricultural issues. On the green sidebar, you'll find information about two related legislative bills (one on farm aid and one on food aid) that you can research and write your legislators about.

Issue: Volence Against Women

This post is just a primer. I'm working on a lengthy post about Democratic Republic of the Congo, and it occurs to me I should probably offer some kind of brief primer on "gender-based violence" before I launch into the situation in the Congo. I don't really like the term "gender-based violence" because it sounds slightly sterile, but the term can be construed to include such diverse atrocities as spousal abuse, rape, sexual assault, female genital mutilation, sex-selective abortion and infanticide, honor killings, bride-burning, and the systematic use of rape as a weapon of war, among other practices. We'll get into more detail on some of these issues later.

In essence, though, women and girls are routinely targeted with violence simply because of their gender. There is no country or culture around the world that is immune to the selective abuses of girls and women. Here in the United States, in fact, one in three women report being raped or physically abused by a spouse, date or intimate partner at some time in their life.

Click here to watch a film and add your name to the United Nations Development Fund for Women (UNIFEM), indicating your commitment to fighting violence against women.

One other reason that I don't like the term "gender-based violence" is that it turns violence into a women's issue, when it clearly isn't. It's a human rights issue that affects men, women and children. The Family Violence Prevention Fund has a Men's Network Against Domestic Violence, that operates on the core fact that although most domestic violence and rape is committed by men, most men are not abusers. And in fact, men have power in stopping domestic violence that women don't have--not just in their own lives, but in their example and their words to other men. At this site, men can sign a pledge indicating their commitment to fighting rape and violence, and can access more suggestions on how to get involved in the movement.

Issue: Child Labor

I'm posting a video called "No Es Un Joc" ("Not a Game"); you can visit the website for more information. This video takes you into the lives of child laborers in several Latin American countries. I probably won't normally post videos that are this long, but I was really impressed with this one. It has a minimum of commentary, it lets children speak for themselves, and it really gives the viewer some critical perspective.

Child labor is a very real problem around the world. It's difficult to accurately say how many children are involved in child labor, because it's a tricky thing to define. Many children work in agriculture or with their families, and the line that marks an appropriate amount of work can be fuzzy. Reliable estimates state that 250 million children between the ages of 5 and 14 are economically active, and half of those children work full-time (meaning they don't go to school). Child labor is much more common in rural areas than in urban areas, and boys are more likely to be engaged in economic activity. (Still, girls are more likely to have heavy unpaid household chores in their home OR someone else's, and primary and secondary school enrollment rates are almost universally lower for girls than for boys.) Child labor is closely linked to other topics that we'll tackle in coming weeks and months: Child trafficking, child soldiers, street children, the gender gap in education, etc.

An important term to know when you're reading about child labor is "worst forms of child labor." Descriptions of what constitutes the worst forms of child labor were briefly categorized in the International Labor Organization's Convention 182). Basically, these worst forms include any kind of slavery or forced labor, commercial sexual exploitation (like prostitution and pornography), illegal activities (like drug trafficking), or any kind of work that subjects children to hazardous conditions or physical/psychological danger. This means that on the spectrum of child labor activities, working on a family farm is typically much less harmful than, say, being forced to fight as a soldier in Uganda or being forced into prostitution in Thailand. An estimated 179 million children are engaged in one of the worst forms of child labor on a full- or part-time basis. This comes out to be one child out of every eight children in the world.

To read more about child labor, click here or here.