The Visual Du Jour – Best System in the World

Via The Guardian, a global comparison of health care spending as % of the GSP:

No big surprise here. The US is in a class of its own, with 18% of the GSP going to health care spending. Having a practically all private, oligopolistic system not subject to anti-trust laws will do that. And that is also a system operating on a rationing basis, with a significant number of people completely rationed out of the system.

One can see the same trend in the per capita spending on health care:

And, of course, if a system is more privatized, a greater share of spending will be privatized as well, as part of household budgets:

Stigma and Exclusion 101

Do check out this series of stunning photos on a disease of the Middle Ages that persist today even though it is treatable, leprosy in Brazil:

A disease like leprosy, which leaves people with deformities is more likely to generate stigma, exclusion and marginalization especially when it is thought that it is contagious and can be caught through casual contact. At the same time, it is a disease of exclusion and marginality itself.

One cannot help but be reminded of Foucault’s idea that hospitals were not necessarily places of care but as places of deviance management where deviants (whether sick or insane) could be safely guarded out of the way of decent society, under the moral authority of the Church, then, later of the medical profession. It is not surprising that the more deviant categories trigger fears in the general population, the more their institutionalization will be demanded from some corners. The same thing happened at the beginnings of the AIDS epidemic and then, more recently:

A stigma, then, is a two-way phenomenon, cause and effect: based on preexisting stigmatization (whether it is marginalization due to poverty in the case of leprosy or religion in the case of homosexuality), moral entrepreneurs will demand further stigmatization and exclusion from society, with no plan for reintegration at some later point. In all cases, this boils down to a purification of the “normal” population from its deviants but hidden behind rationalizations about health or rehabilitation or some imaginary danger to society.

The Medicalization of Social Suffering

The medicalization of deviance is more Todd Krohn’s turf. However, this was widely reported and should probably raise any sociologist’s antennas and I fully agree with this:

“A new survey from the European College of Psychopharmacology, a meta-analysis of a gathered mass of earlier research, reports that a staggering 164.8 million Europeans – 38.2% of the population – suffer from a mental disorder in any year. As well as depression, this includes neural disorders such as dementia and Parkinson’s; childhood problems from ADHD to “conduct disorder”; and the leading anxiety disorders – everything from panic attacks to obsessive-compulsive disorder to shyness. Depression and anxiety, they tell us, are disproportionately women’s ailments. Men, it seems, become alcoholics (another illness category) rather than depressives, particularly in eastern Europe.

Such reports are worrying. They may draw attention to a rising toll of human suffering, but they pinpoint the imperialising tendency of the mental health sector. Our ills and unhappiness are squeezed into a package labelled “disorder” and an ever-proliferating assortment of supposedly objective diagnostic categories. A cure is somehow promised, though it rarely seems to come, certainly not for everyone or for ever.

In talking to the press or drafting press releases, researchers often extrapolate from their material in order to create good copy. The notion that women are somehow more prone to mental illness often emerges – as it did in the Daily Telegraph’s headline on this survey.

According to Hans-Ulrich Wittchen, one of the report’s authors, the reason women suffer nearly twice as much depression and anxiety disorders as men lies in the changing social pattern in which women take on work on top of marriage and children. So stay home, ladies, and you’ll be as happy as apple pie; though in the 50s when we stayed home to bake it, the doctors gave us Miltown and Valium to help us take pain-free care of hubby and the young ones

On the subject of women’s greater susceptibility, it’s just as well to remember that women go to doctors far more than men, for all kinds of ills: indeed the way the stats add up, women’s greater incidence of mental ills just about equals their greater number of visits to the doctors. If men went to doctors as often as they go to the pub, it’s a fair guess that their unhappiness would be represented as depression or anxiety as well.”

What this highlights is how much medical disorders are socially constructed. For instance, see this post by Todd Krohn on the new edition of the DSM. Oftentimes, new medical designations reflect the social anxieties of our time and provide new ways of disciplining deviant without the guilt; after all, treating a disorder is a humane thing to do.

These classifications also reflect power relations between various institutions such as the criminal justice system, the psychiatric establishment and the pharmaceutical industry. At the other end of the spectrum, to whom these designations get applied is also a matter of social power and socially more or less acceptable and stigmatized populations.

But to put a medical label and to create a new mental health disorder does a few things: it reduces the space of normality. It also depoliticizes and desocializes social suffering. After all, considering the level of increasing social insecurity, how can one not feel anxious, or depressed (losing one’s job or home will do that people) and hearing morons on TV repeating over and over that the lousy unemployment benefit you get is too much and that you are just a lazy bum is not exactly cheering. And it would not be surprising either to find that those who suffer the most from such social suffering are the most socially vulnerable categories, such as women.

Once a condition is defined as medical disorder, then, the solution is a medical treatment, individualized and chemical. Social policy has been pushed out of the picture. The issue involved, anxiety or depression, no longer is perceived as a rational response to social conditions and social suffering, but rather a pathology unrelated to public policy.

And there is nothing new in defining women as permanent carriers of womanly pathologies. The medical establishment has long been a major bastion of patriarchal control.

Book Review – Fugitive Denim

Rachel Snyder’s Fugitive Denim: A Moving Story of People and Pants in the Borderless World of Global Trade is an interesting book but boy would the author have benefited from a sit-down with a good editor who would have told her that it needed a tighter structure and line of thinking. I initially picked up the book because I thought it was going to be about a specific global commodity chain (jeans) and it is partly that and it should have been that. But then, the author starts running in all sorts of direction that completely dilute that initial premise. So, at various points in the book, I was still wondering where the author was going.

So, starting from an environmentally and labor-conscious brand of jeans associated with Bono and his wife, Snyder retraces the global steps of what it takes to produce denim as a reflection of the the rules of global trade and mechanisms of global governance as they trickle down to local factories in various parts of the world. For instance, Snyder starts with the way the end of the quota system by the US:

“Part of the problem, at least as it pertains to global trade, is something known to the industry as the quota system. On January 1, 2005, a few months after Scott and Rogan’s meeting with Ali and Bono, a decades-old system called the Multi-Fibre Agreement (MFA) expired, in accordance with rules established by the World Trade Organization under something they called their Agreement on Textiles and Clothing (ATC). Members of the WTO were signatories of the agreement to end the MFA. In place for the better part of the post–World War II era under various aliases and auspices (the WTO took over the administration of the quotas when it was created in 1994), this system evolved as borders became more porous, consumers more aware, and organizations more global. Basically, the MFA set limits on the amount of textiles and apparel any one country could export to the United States. For example, of the roughly 365 million sweaters imported to the United States every year, the Philippines got to manufacture and export 4.2 million of them.2 The quota given to each country varied, and for the bigger manufacturers like China and India, a void was left when they reached their quotas—a void other, smaller countries like the Philippines gladly stepped in to fill.

From 1974 to 1994, the MFA dictated the global terms of the textile and apparel industry. It began as a way to protect manufacturing in industrialized countries in the face of competition from textile industries first in Japan, South Korea, and Taiwan after World War II, then in China, India, and other developing nations. The quotas ensured that no single developing country ever captured a monopoly of the developed world’s market by limiting what could be exported to countries like the United States. What this meant, in real terms, was that countries like Cambodia, recuperating from decades of war and genocide, had a clear entrée into a market that otherwise might have been prohibitively competitive. The same applied to Mauritius, Nepal, Laos, Lesotho, Peru, Honduras, Guatemala, Mexico, Indonesia, Tunisia, and dozens of other countries. Left on its own, the textile production market may have concentrated in just a handful of countries, rather than the sixty or so that compose it today. Ending the quotas was an attempt to rebalance our first attempts at, well, rebalancing. We would eradicate the trade laws we’d written and revised to partly protect the impoverished countries and thereby give the impoverished countries a chance to make it on their own, with not much more than their own pluck. What the World Trade Organization is doing by eliminating the MFA and eradicating the convoluted quota system is, in essence, pretty simple.” (23-24)

Snyder then examines the anticipated consequences of the removal of the quota for small countries that risk to be squeezed out by China. So, the first stop in Snyder’s examination is Azerbaijan, which is a major producer of cotton and where cotton growing and picking is still done in the old-fashioned way, mostly by women. Actually, throughout the whole global production chain, one finds women in the trenches and men in the offices. In the case of Azerbaijan, cotton experts (those who evaluate the quality and rating of the cotton) are men.

Compared to US growers, of course, Azeri farmers are at the usual disadvantage: US growers are heavily subsidized, while they get to experience the joys of “free trade”. And, of course, most of these subsidies go to large agribusiness firms, not family farms. The US is not the only culprit. The EU and Japan are also heavy subsidizers. The Azeri think they should move up the commodity chain and produce the finished jeans and other cotton products rather than limit themselves to growing cotton. The World Bank disagrees:

“The World Bank wanted Azerbaijan to sell only raw cotton and would subsidize this, but Vasif feels if the World Bank really wanted to help the country, it would give subsidies to start small factories to weave fabric or make finished garments.4 Ready-made thread sells for nearly double cotton’s price on the world market. Vasif and other Azeris who put forth this argument may never have heard of the quota system, but they all knew about the subsidies paid to U.S. cotton farmers by the American government. It’s a system that has helped keep farms in America afloat since the 1930s and which infuriates farmers around the globe, from Burkina Faso to Uzbekistan to Brazil. “Basically, the World Bank doesn’t want you to improve,” Vasif says. “The more finished a product is, the more money it demands from the global market. The World Bank gives credit if we do what they want, but we lose our freedom.” (63)

And so, Azeri growers remain poor because the rich countries’ subsidies depress the price of cotton on the world market. Never mind that the WTO has declared these subsidies to be illegal. That double standard has been a source of contention in world trade for a while.

Not only is growing and picking cotton hard work, but it is also one of the most toxic crops as well:

“THOUGH COTTON MAKES UP ONLY ABOUT 3 PERCENT of our global agricultural land, it consumes nearly a quarter of the world’s insecticides and 10 percent of the world’s pesticides—more than any other crop—with cost estimates for the pesticides alone totaling $2.6 billion. The average pair of jeans carries three quarters of a pound of chemicals.1 Pesticides, of course, allow for the global cotton empire by killing the pests that would otherwise kill the cotton; but in short order, these pests build up a resistance and farmers need ever-increasing amounts of chemicals to combat the insects. Most of the conventional cotton in the United States is genetically modified, or Bt, cotton—with insecticides contained inside the seeds. (73)

Emphasis mine.

And the need for pesticides is a major source of debt for farmers in the Global South (in parts of India, indebted farmers kill themselves by swallowing the very pesticides that got them in a financial hole to begin with). Add to that the environmental devastation caused by the growth of cotton (the disappearance of the Aral sea as a result of cotton fields in Uzbekistan) or simply the death of farm workers from exposure to pesticides (in the US as well), and the picture that emerges is that of a production chain that is badly in need of sustainable practices:

“Aldicarb, phorate, methamidophos, and endosulfan were pesticides developed during World War I as toxic nerve agents; all are allowed under the EPA’s ruling.8 Another particularly nasty organophosphate called chlorpyriphos was also a World War I nerve gas and is used in more than a hundred registered products in the United States alone.9 While the EPA has banned it from home use because of “its negative impact on children’s health,” it remains commonly used in agriculture.10 Methyl parathion is also common, though it is listed as “extremely hazardous” and nineteen countries have banned it, while another forty-three make importing it illegal.11 The United States is not one of them. Nor is China, which has become the world’s biggest user of pesticides.


This does not preclude the United States from exporting products that it considers too harmful for use in American homes. The EPA has even ruled that banned pesticides are not prohibited from being imported into the United States so that they may be repackaged for export. Between 1997 and 2000 forty-five tons of pesticides that were either “severely restricted” or “forbidden” altogether were exported every hour, totaling roughly 3.2 billion pounds. More than half these products—many of which are classified as extremely hazardous by the World Heath Organization—were shipped to the developing world.” (74)

There is now a movement to get more organic cotton grown (Turkey is the leader in that) but organic cotton only represents 1% of the global production although that percentage is growing slowly because organic cotton is more labor intensive and of lower quality. And as Snyder shows, a lifetime of picking cotton is devastating on the health and life expectancy of the pickers.

Next stop down the commodity chain is Italy where jeans (fabric and models) are designed for the major store brands of Europe and the US. It is quite a contrast compared to the rough life of the Azeri farmers. Snyder describes a hectic life of design shows across the major cities of Europe and their various fashion weeks. It is pretty much the only part of the production process that takes place in the Global North. The designed models are then sent to independent contractors in the Global South, for production. And that is even a battle that Italy is losing to China as well.

Fabric design is itself quite a process:

“There are almost endless combinations of things that can be done to treat jeans, using a surprising array of materials: glass, sandpaper, diamond dust, pumice stones, enzymes, chemical or mechanical abrasion, and many others. Stonewashing, which requires the harvest of pumice from around the world, has come under fire from environmental groups, particularly when stones are first dipped in bleach and then used to treat jeans. Plastic balls and enzymes are used more and more in “stonewashing,” though the effect is still often disappointing. This washing and finishing is almost unquestionably the least environmentally friendly part of the entire manufacturing process. Clothes are sprayed with chemicals to create a variety of effects, or overdyed (with one color layered over another or an excess of color applied to the fabric), or coated in resin and baked in enormous ovens. Polymer resin is commonly used to coat creases and folds in clothing, thereby making them permanent, and to set color; it also sometimes contains formaldehyde. Workers in the laundry industry must don an array of contraptions—special respirators, boots, coveralls, gloves, protective eyewear—to shield them from the myriad chemicals in use in nearly every operation. Buckets and buckets of chemicals with names wholly unrecognizable to me sat lined up in a warehouse where purple spray—potassium permanganate—was hosed onto jeans as they dangled on metal hangers from the ceiling.” (121)

Something that has been dramatically illustrated by photographs such as these (see the rest here):

it is well known that many countries of the Global South do not have strict environmental regulations or, if they do, they may suspend them in export zones to attract contracts from Western companies. That is especially the case for Indonesia and Thailand. As we know, when it comes to such contracting, there is a race to the bottom going on and contractors in the Global South have to compete with each other and cut costs in whichever way they can, mostly on environmental and labor costs. After all, we want our jeans cheap. That cost is borne by someone else’s environment, health and wages.

Next stop in Cambodia where jean factories are pulling a generation of daughters out of the countryside to the main cities where the money they make is still better than what their families earn on farms, although Cambodia is one of the countries most likely to be on the losing side of the end of the quotas.

This is where the book gets a bit off-track. While Snyder takes a lot of time describing the lives of two factory workers (which is really interesting), she starts focusing more on corporate responsibility and standards than on the commodity chain per se. This has to do with the fact that Cambodia is a special case for the ILO through the Better Factories Cambodia program:

“Better Factories Cambodia is a unique programme of the International Labour Organization. It benefits workers, employers and their organizations. It benefits consumers in Western countries and helps reduce poverty in one of the poorest nations of the world.

It does this by monitoring and reporting on working conditions in Cambodian garment factories according to national and international standards, by helping factories to improve working conditions and productivity, and by working with the Government and international buyers to ensure a rigorous and transparent cycle of improvement.

The project grew out of a trade agreement between the United States and Cambodia. Under the agreement the US promised Cambodia better access to US markets in exchange for improved working conditions in the garment sector. The ILO project was established in 2001 to help the sector make and maintain these improvements.”

And the program seems to work and Cambodia uses its good labor practice as its comparative advantage, because otherwise, there is no way it can compete with the giant next door, China and its monumental export zones. And from the way Snyder describes it, it seems that there are improvements but there are still enormous labor issues:

“Of course, it would be naïve to suggest that problems, generally termed noncompliance, were not still rampant in the industry as a whole. Numerous examples of child labor, forced labor, abhorrent conditions, and abysmal pay abound. In the spring of 2006, the National Labor Committee put out a report on widespread industry abuses in Jordan in factories that contract with Wal-Mart, Kmart, Kohl’s, Gloria Vanderbilt, Target, and Victoria’s Secret, among others. The report cites instances of forced labor, indentured servitude, physical and mental abuse, rape, mandatory pregnancy testing (mothers-to-be are often fired so the factory won’t have to pay maternity costs), withholding payment, and unsanitary conditions. Of 60,000 factory workers in Jordan’s export processing zone, more than half are immigrants (often illegal) and thus particularly vulnerable. Jordan also receives preferential access to the U.S. consumer market as part of the U.S.-Israel free-trade deal. The report told of workers locked in a single room at night and forced to work until 2:00 or 3:00 A.M.; factories had withheld meals and in one case punished a handful of workers by locking them for several hours in a deep freezer.” (257)

But part of the improvement is because monitoring and indexing working conditions in factories has become a big business in itself. The certification processes are proliferating but there is no uniform standard so, different indexes might mean different things or countries might pick and choose which index or certification process to be part of.

In the end, as Snyder reiterates several times throughout the book, it comes down to the prices that consumers are willing to accept in exchange for jeans that are produced in a sustainable and fair fashion.

As I mentioned above, the book would have benefited from some tighter editing and greater consistency of topic. I really liked the development on the different kinds of workers involved in the global commodity chain but I don’t give a damn about Bono and his wife. Sometimes, the focus on individuals was much too strong (who cares that one of the Italian designers was pregnant and the whole story around that) compared to the big picture. Too many times, as I was reading the book, I asked myself “where is she going with this?”. Other than that, the book is an easy read.

Again, the accounts of the lives and working conditions of Azeri cotton picker and Khmer factory workers were quite interesting and moving. These are the people on whose shoulders we’re standing when it comes to our quality of life. They do deserve the exposure.

A World of Pain

Because fighting the war on drugs (in this case, heroin) is more important than providing pain relief to patients in large parts of the world with morphine:

“For much of the Western world, physical pain ends with a simple pill. Yet more than half the world’s countries have little to no access to morphine, the gold standard for treating medical pain.

Freedom from Pain shines a light on this under-reported story. “For a victim of police torture, they will usually sign a confession and the torture stops,” says Diederik Lohman of Human Rights Watch in the film. “For someone who has cancer pain, that torturous experience continues for weeks, and sometimes months on end.”

Unlike so many global health problems, pain treatment is not about money or a lack of drugs, since morphine costs pennies per dose and is easily made. The treatment of pain is complicated by many factors, including drug laws, bureaucratic rigidity and commercial disincentives.


Overall, Freedom from Pain reveals that bureaucratic hurdles, and the chilling effect of the global war on drugs, are the main impediments to a pain free world. Patients will continue to suffer until global bodies actively work with countries to exclude medical morphine from the war on drugs, and change the blunt drug laws that curtail access to legitimate medical opiates worldwide. Uri Fedotov, the executive director of the United Nations Office of Drugs and Crime, admits in the film that the war on drugs is cutting people off from pain medication, but offers little in the way of concrete proposals for changing the status quo.

Lohman points out that inertia may be the greatest obstacle to improving access to morphine, and that pressure brought by doctors and human rights activists is critical to getting pain medication to the people who need it. That is what happened in Uganda, the final stop in the film. Dr Jack Jagwe, who served in that war-torn country’s health ministry in the 1990s, worked closely with foreign doctors and the international community to put into writing that every citizen there should have the right to palliative care – a first in Africa.”

Book Review – The Immortal Life of Henrietta Lacks

Rebecca’s Skloot‘s The Immortal Life of Henrietta Lacks is not a sociology book but there is certainly a lot of sociology between the lines. The book is a (well-deserved) best-seller, so, most people know what it’s about. There are several narrative threads: (1) the one that inspired the title, that is, the life of Henrietta Lacks, the woman who gave us the HeLa cells that are so widely use in medical research; (2) a bit of history of medical research, especially cell research, along with issues of consent and commercialization of cell lines; (3) Skloot’s journey as she tries to piece together Henrietta Lacks’s life and that of her family.

This gives the book a very structure that makes it highly readable, as Skloot mixes and alternates all three threads. And the science chapters are very well-written and make the topic very accessible to the non-specialist readers.

The three narrative threads are related, of course. The way in which Henrietta’s cells were extracted and used was fairly typical of the way research was done in the 1950s, and this also explains why the family was so extremely guarded when it came to sharing information with (especially white) reporters and journalists, hence, Skloot’s travails and tribulations when trying to contact Lacks’s relatives.

From a sociological point of view, this book perfectly illustrates what institutional racism and discrimination and structural violence are. The way Lacks’s cells were extracted, without her knowledge or consent (or that of her husband) typically reflects how the medical and scientific profession treated indigent and especially Black patients. These patients, often treated for free at places like Johns Hopkins, were considered fair game for testing, tissue extraction, etc. since they were not “paying customers”. And it is not that Lacks’s ended up in the hands of racist doctors. But she certainly ended up in a whole system of institutional discrimination where black patients got a different kind of care in a still segregated health care system. After all, the institution of medical research does not exactly have a glorious records when it comes to race, as the Tuskegee experiments remind us.

This leads me to the structural violence part. A great deal of the book is dedicated not only to the results of Skloot’s research but to that painstaking process itself. The children of Henrietta Lacks’s turned it into an obstacle course. Once you are past an possible initial reaction – “these people are nutcases” – it becomes clear that they bear the wounds of structural violence, that is, violence by social institution. Henrietta Lacks’s husband and children were lied to, manipulated, never really told what had happened to their wife/mother. And, of course, as the HeLa were widely commercialized, they never got a dime. But when it became known who had produced the HeLa cells, all of a sudden, a bunch of white people got interested in them, again, without compensation or recognition. As described in the book, they all lived in poverty and could not afford the medical care and medications that their mother’s cells had made possible.

And, of course, at the time, scientific and medical research was a white men’s world not well-known for enlightened views when it came to race and gender. And institutionally, those were the days before ethical standards, institutional review boards and HIPAA. And the culture was one of silent submission to authority, so, patients (especially women and minorities) did not ask questions and were treated in a somewhat disdainful and patronizing way.

The other kind of structural violence that Henrietta’s children suffered from came from within their family. Skloot provides painful description of the kind of massive abuse one of her sons suffered at the hand of his stepmother (which certainly accounts for his life of anger, violence and marginality) as well as the sexual abuse that one of Henrietta’s daughter experienced at the hand of a male relative, right under her father’s nose (and he did nothing). Male first cousin sexual abuse on female first cousin was apparently not out of bounds in the extended family. The other daughter, who probably suffered from some form of mental disability, ended up in one of these horrible mental institutions, never receiving any visitors after her mother’s death. Apparently, she was experimented upon while there.

Lacking a proper education, the Lackses end up either profoundly religious (of the revival kind, in the case of Deborah), having multiple brushes with the law, or at the very least severe behavioral problems. But all of them ended up prone to conspiracy theories as to what had been done to their mother and how the cells were obtained. None of which is surprising. But the depth of such structural wounds is highly visible as Skloot gets to meet different members of the Lacks’s family.

As I said, this is a fascinating read. Skloot has a great website with a lot of information as extension of the book, and this video:

The Visual Du Jour – Better Life Index

Now this is a great interactive graph combining a set of indicators on quality of life:

Each flower represents a country. Each petal is an indicator and the size of the petal reflects how well or how poorly each country is doing on the indicator.



Work-Life balance:

Go ahead, go play with the data. It’s amazing.

(Sub)Urban Environments and Social Pathologies

One of the things that those of us who teach undergraduate sociology try to get across to our students is the idea that social structures shape behavior. It may seem obvious to us but in a highly individualistic and puritanical culture, our students are more used to looking at behavior in psychological or moral terms. So, simply stating the idea that structure shapes behavior goes against the grain.

One nice way of illustrating the “environments / contexts / structures shape behavior” idea is how (sub)urban ecology determines human interactions, actions and practices. After all, every French student that Baron Haussman designed Paris’s large and wide boulevard to prevent the riff-raff from erecting barricades and to make it easier for the cavalry to charge against popular demonstrations.

And via Karl Bakeman, here is another good illustration using the urban development example:

“Crappy urban development isn’t just ugly and noisy and dirty. It is turning out to be lethal.

One Toronto study looked at how the quality of a community’s streets can affect people’s health, factoring into drastically reduced life expectancy. It’s the focus of an article in The Globe and Mail that discusses how Toronto and other cities are segregated not just by race and income, but also by the quality of the built environment — and what that division means for residents’ health.

People living in less walkable, outlying parts of the city, with less access to green space and recreational opportunities, as well as healthy food, are at increased risk of obesity and diabetes:

The first Canadian study of its kind, published in 2007, the Diabetes Atlas investigated 140 Toronto neighborhoods over three years to examine the role of several factors — including community design, population density, access to healthy and unhealthy food — on the diabetes epidemic. Poverty and ethnicity were found to be key in the development of type 2 diabetes. The researchers also concluded that walking and transit times to recreation facilities in the city’s outlying neighborhoods were as long as 40 minutes and 20 minutes, respectively, each way. It takes only 30 minutes of walking or moderate exercise, combined with a healthy diet, to cut the risk of diabetes in half. But a walk through a bleak or potentially dangerous neighborhood is hardly inspiring, especially if the only nearby landmark is a highway …

We used to call them ugly, but now social geographers and medical practitioners label the disconnected sections of the city “obesogenic,” meaning environments that promote obesity.

“Obesogenic” is not a word I had ever heard before I read this article. But apparently it’s been around since about 1996. It makes sense that somebody would have coined it — the Centers for Disease Control reports that nine states in the United States now have more than 30 percent obesity rates.

How did we get there? Sheldon Jacobson of the University of Illinois has just released a study looking at the correlation between increasing automobile use and increasing obesity:

After analyzing data from national statistics measured between 1985 and 2007, Jacobson discovered vehicle use correlated “in the 99-percent range” with national annual obesity rates.

“If we drive more, we become heavier as a nation, and the cumulative lack of activity may eventually lead to, at the aggregate level, obesity,” he said …

The sedentary lifestyle that automobile use enables coupled with the prevalent role it plays in increasing the sprawl of our cities, towns and suburbs is the “societal price we pay for always being in a rush to get places,” Jacobson said.

“For the last 60-plus years, we’ve literally built our society around the automobile and getting from point A to point B as quickly as we can. Because we choose to drive rather than walk or cycle, the result is an inactive, sedentary lifestyle. Not coincidentally, obesity also became a public health issue during this period.”

Before the automobile became such a prevalent mode of transportation for the vast majority of Americans, “it took much more energy just to live,” Jacobson said.

The thing is, even if you don’t own an automobile, you live in a place that is built for them — because by now, every place is. As the Toronto study and others in the United States have revealed, it’s not just the autocentric suburban states in the so-called “Diabetes Belt” that have a problem. Residents of dense urban areas also suffer from high rates of obesity and diabetes, in part because of the lack of healthy food choices, in part because certain ethnic groups are more predisposed to diabetes, and in part because the streetscape is degraded and ignored. The problem is worst in parts of the city like New York’s Southwest Bronx — where neglected street infrastructure, pedestrian-unfriendly design, crime rates, and urban freeways make it unpleasant or unsafe to spend much time outside.”

Read the whole thing.

Book Review – Just Give Money to the Poor

If you are a public policy wonk interested in development, Just Give Money to the Poor: The Development Revolution from the Global South by Joseph Hanlon, Armando Barrientos and David Hulme, is for you.

This book argues for the value and effectiveness of cash transfer programs in order to alleviate poverty in the Global South as opposed to programs based on the faulty and yet still used modernization theory and as opposed to the complicated and short-sighted programs offered by the multitude of NGOs based more on donors priorities than actual need.

The book is strongly data-driven and reviews in details the different programs that have been piloted or implemented in various countries of the global South but they all lead to four conclusions:

“These programs are affordable, recipients use the money well and do not waste it, cash grants are an efficient way to directly reduce current poverty, and they have the potential to prevent future poverty by facilitating economic growth and promoting human development.” (2)

That being said, reviews of these programs (especially in Brazil, Mexico, South Africa, Indonesia, India and Zambia, among others) reveal two problematic areas: targeting (who gets the cash payments) and conditions (should there be any? What kind?)

It should be noted that cash transfer payments are not really new. Most high-income countries have such programs in place in a variety of ways: family grants, government-administered pensions, children and elderly benefits are the main ones. But it has always been assumed that only the rich countries could afford such programs and it goes against the conservative belief that the poor are poor because of their own failings and that therefore only the “deserving” poor should receive assistance. In poor countries, these can take the form of family grants, pensions, child benefits, employment guarantee.

Why do these programs work?

“A quiet revolution is taking place based on the realization that you cannot pull yourself by your bootstraps if you have no boots. And giving “boots” to people with little money does not make them lazy or reluctant to work; rather, the opposite happens. A small guaranteed income provides a foundation that enables people to transform their own lives. In development jargon, this is the “poverty trap” model – many people are trapped in poverty because they have so little money that they cannot buy things they know they need, such as medicines or schoolbooks or food or fertilizer. They are in a hole with no way to climb out; cash transfers provide a ladder.” (4)

But there are specific conditions that make these programs work effectively in reducing poverty. They must be:

Fair in that people largely agree as to who should receive the benefits. Universal benefits are usually perceived as fair but do not target the poorest and most vulnerable categories. Targeting may be more difficult to administer and may be divisive.

Assured, that is, people know that there is money coming in every month so they can plan accordingly and start living beyond day to day survival.

Practical in that there should be an civil service capacity to administer the programs and deliver benefits as simply as possible.

Not just pennies in that the benefits should be large enough to really trigger change in behavior such as letting children stay in school longer or using medical services more frequently.

Popular in that programs should be politically acceptable.

These programs are often designed to not just reduce immediate poverty but also to reduce intergenerational poverty by improving nutrition (and therefore health) as well as school attendance and decrease child labor. In addition, studies show that these programs also contribute to development by stimulating demand as the poor will spend the extra money they get locally. Having a little bit of financial security also fosters investment (in seeds and crops) and even some risk-taking (experimenting with high-yielding crops for instance). The money may also be used as start-up capital. In other words, the poor become more able to participate in the economy.

Again, this is not to say that these programs do not have their problems. Corruption is still a major issue in the global South. Developing effective targeting mechanisms can be tricky and conditionality is especially difficult. In addition, if more people are going to make greater use of health and educational services, then, these services have to be there. And, of course, there is no template that can be conveniently replicated from one country to the next. All the programs discussed in the book differ based on social context. For instance, pensions are especially effective in South Africa where there are a lot of multi-generational families and having seniors receive pensions allows adults to go away to find work knowing their children will be taken care of. On the other hand, Mexico and Brazil have programs that focus more on children and mothers.

I won’t go into the details of all the programs depicted in the book because that would be tedious. But that is actually one of the strengths of the book. The authors have done their homework, collected the data to determine the effectiveness of these different programs. So, as much as it is a public policy book, it is also a debunking book in that it destroys the myths that conservative ideology has regarding the poor and their behavior.

Compare and Contrast – Gender Progress and Misogyny

As many US states prepare to take away the rights of women, and as a British PM makes a sexist ass of himself, look at what is happening in supposedly less enlightened countries.

Item 1:

“Rwanda is today launching a cervical cancer vaccination programme for all its 12 to 15 year-old girls – the first comprehensive national scheme in Africa, where it is so badly needed. Some 275,000 women die from cervical cancer every year – most in developing countries. And the death toll is rising – to an expected 474,000 women a year by 2030, 95% of whom will be in the developing world.

Rwanda is unveiling an impressive and ambitious project and it needs to work and to encourage other developing countries to do the same. This is by no means a simple undertaking, although Rwanda may have some advantages over other sub-Saharan African states – it is very small and it has made great strides in preventive healthcare through setting up an excellent network of village-based community healthworkers (equipped with mobile phones). It is also – and this is why it is the darling of the aid donors – a very efficient, directed state where things happen when the government says they should.”

And item 2, more surprising, frankly:

“Pakistan has taken the landmark decision to allow transsexuals to have their own gender category on some official documents.

The country’s Supreme Court has ruled that those Pakistanis who do not consider themselves to be either male or female should be allowed to choose an alternative sex when they apply for their national identity cards.”

We, in Western countries, tend to see ourselves as bastions of civilization when it comes to gender issues. That is a myth that requires a lot of ideological work and cultural euphemization considering the level of sexism and misogyny coming, especially from the religious right. We tend to conveniently forget that developing countries tend to put more women in position of political power, often in the executive branches, but also in some legislatures while women are grossly underrepresented in that part of society in Western countries.

And as for the Pakistani decision to give transsexuals their own category, compare this progressive move to this.

Empowered = Individualized

A few days ago, Antonio Casilli wrote this:

“Who wants to appropriate the so-called « eHealth revolution » and put it to commercial use? Just have a read through this scary bit of pharmacom fireside chat freshly published on The Pharmaceutical Executive Magazine website then we’ll talk.

Thus spoke Sarah Krüg, from the Medical Education Group at Pfizer. Patients empowerment via online databases,  open information sharing and web-based self-help groups represents a business opportunity for pharmacoms (but then what doesn’t?). The danger that the biomedical monopoly over health care be replaced by an even more pervasive pharmaceutical merchandising is a clear and present one.”

“Empowered patients” and “patient-centered care” (also see “student-centered” as a favorite of education “reformers”) are buzzwords that actually mean the individualization of patients, left on their own, facing giant corporations from the insurance and pharmaceutical industry. Indeed, a constant companion to individualization is deregulation. Just let “empowered” patients google their health issues and find their own solution. Let them just get on message boards and online communities. Who needs doctors and health care guidelines, and facing the risks on their own, or with their social networks.

As I wrote elsewhere,

“The other feature is what Bauman (2000) calls “deregulation and privatization.” Any improvement to be made in living conditions is no longer seen as the job of the modern state but is more and more left to the efforts of individuals. The end of a progressive conception of society means that any idea of the “good society” has shifted to the idea of “human rights,” from the social realm to the individual. The result, for Bauman, is that, if individuals are freer to determine their own idea of happiness, it is also entirely up to them to achieve it and any failure will be attributed to their own shortcomings. In this sense, any notion of emancipation is no longer a social project to be achieved collectively but an individual task, with new experts (life coaches, therapists and counselors of all sorts, such as the omnipresent Doctor Phil) to guide individuals along the way. Furthermore, individual fulfillment will involve some form of consumption. Paraphrasing Peter Drucker, Bauman (2000:30) puts it this way, “no more salvation by society” (p. 30).


Individualization means that members of society can no longer count on social safety nets or the welfare state to negotiate the impact of risks on their lives (such as a job loss, loss of pensions and savings to the insecurities of the market). Liquid modernity leaves them “free” to figure out solutions on their own. Individuals are left to deal with societal and systemic conditions as part of their own individual life-projects. As Bauman (2000) writes, “risks and contradictions go on being socially produced; it is just the duty and the necessity to cope with them which are being individualized” (34).”

But that is a dreadfully scary prospect, so, let us not talk of that: let us talk of empowerment and individual choice. It sounds a lot better.

And, of course, in this process, as Casilli notes, there is no one left to contest corporate power and their capacity to shape information or astroturf online communities.

The Social Construction of Mental Illness

The Independent starts with this puzzling fact:

“Something is happening at the end of the wars in Iraq and Afghanistan that mental health experts are finding hard to explain: British and American soldiers appear to be having markedly different reactions to the stress of combat. In America, there has been a sharp increase in the number experiencing mental-health problems, including post-traumatic stress disorder (PTSD). Between 2006 and 2007 alone, there was a 50 per cent jump in cases of combat stress among soldiers and suicides more than doubled. Why the precipitous rise? And why hasn’t there been an accompanying rise in these symptoms among British troops?

The conclusion that British soldiers appear to have a different psychological reaction to the stresses of these modern conflicts was the finding of several recent high-profile studies. This year, in a Royal Society journal, Neil Greenberg of the Academic Centre for Defence Mental Health at King’s College London and colleagues reported that studies of American soldiers showed PTSD prevalence rates of in excess of 30 per cent while the rates among British troops was only four per cent. UK soldiers were more likely to abuse alcohol (13 per cent reported doing so) or experience more common mental disorders such as depression (20 per cent).

Such differences were found even when comparing soldiers who served in the most intense combat zones. In addition, while researchers found increased mental-health risk for American personnel sent on multiple deployments, no such connection was found in British soldiers.”

So, yes, it is not a bad idea to look for sociological explanations for this if indeed, combat conditions and numbers of deployment were controlled for. In other words, the idea is that social structure, power dynamics and culture create a context in which certain categories of thought emerge.

This is the social construction of reality. This is also something that Foucault studied in Madness and Civilization: how a society perceives certain behavior sand classifies them has less to do with the behaviors themselves (see how much the supposedly scientific and objective DSM has changed over the years), but with genealogies of power. In Western societies, the medical practitioner displaced the priest as the adjudicator of proper behavior and moral authority to decide as to what is mentally healthy and what is not. The many ways in which mental health is defined, diagnosed and treated has a lot to do with social control and normative enforcement.

So, again, what social conditions and dynamics would generate the differential rate of PTSD between American and British soldiers? The article goes over some of the history of dealing with soldiers coming home with mental problems and how the rise of the PTSD diagnosis had a lot to do with the US context of the Vietnam War and the social movement opposing it. The diagnosis then became more mainstream and embedded into the language of post-combat mental problems. This context is specifically American, and therefore less likely to affect British soldiers.

It is interesting but then comes the inevitable BS:

“Patrick Bracken, of Bradford University’s Dept of Health Studies, argues that the emergence of PTSD is a symptom of a troubled postmodern world. “In most Western societies there has been a move away from religious and other belief systems which offered individuals stable pathways through life, and meaningful frameworks with which to encounter suffering and death,” Bracken writes. “The meaningful connections of the social world are rendered fragile.”

Oh please. Not only is the American society drowning in religion and conservative dominant discourse on war and the role of the military but the US military is awash in fundamentalist and evangelical Christianity. If the statement above were true, then the British soldiers would the ones suffering from higher levels of PTSD, not the other way around.

So, maybe we should examine more seriously how fundamentalist religion might affect returning soldiers. Or the social conditions of their reinsertion (or lack thereof) in combination with the differences in health care systems between British and American soldiers.

Here is another suggestion: look at the demographics of the soldiers. We know the US military taps into the lower classes since the military is pretty much the only potential source of social mobility. Is it the same for the UK? And, of course, the process leading to the diagnosis themselves would need to be examined.

Unfortunately, the statement above explains nothing and provides no evidence of anything beyond this person’s ability to spit out a tired cliché. So, why is it even in the goddamn article?

Or have the awful, awful feminists made American soldiers wimpy? </sarcasm>

The Visual du Jour – Live Long and Prosper / Prosper and Live Long

Via Le Monde Diplomatique:

This is not surprising to see the contrast between the prosperous (at least until now) areas, in green where chronic illnesses prevail but are diseases tied to aging, as opposed to the semi-periphery and periphery where infectious / parasitic diseases are prevalent along with accidental deaths. Obviously, to be born and live in a prosperous society makes life more secure on different levels.

Lack of security also translates in downwards trends in life expectancy:

It isn’t just that poor countries have lower life expectancies but that they have declining life expectancies compared to 15 years ago or so.

Nor surprisingly either, what percentage of the GDP is spent on health care makes a large difference (although it is common knowledge that the US spends more for less than optimal results compared to other high-income countries):

Finally, the public / private shares of health care spending are also relevant: