Category: Public Health

Read African Writers: Saturday Is for Funerals, by Unity Dow and Max Essex

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img_8657img_8658In the late 1990s, more than 30 percent of young adults in Botswana were infected with HIV. In the early 2000s, every Saturday was reserved for funerals. Subsequently, medication became available and far fewer people died, but high HIV infection rates persisted. Saturday Is for Funerals tells the stories and the science of the HIV epidemic in Botswana. Unity Dow, at the time a High Court judge in Botswana, opens each chapter with a story from someone affected by the HIV crisis. Max Essex, a pioneer in HIV research both globally and specifically in Botswana, ends each chapter with the research related to the phenomenon from Dow’s story. Together, they paint a powerful picture of Botswana both before and after AIDS drugs were available.

Essex’s writing is strongest when focused on medical rather than social aspects, and most of his sections do that. (There some repetition in Essex’s sections as well, but it’s not a fatal flaw.) The final chapter demonstrates the power of political leadership in changing the course of the epidemic in Botswana.

This is both valuable in helping readers to understand the dynamics of a society with staggering rates of HIV and as a largely successful model of how to mesh anecdotes and scientific research to give a fuller picture of a phenomenon.

Here is what other critics had to say:

Publishers Weekly: “Although occasionally repetitive, this richly informative book dispels much of the mystery still surrounding HIV/AIDS, revealing how life goes on for those infected. Readers overwhelmed by (and even numbed to) the images of desolation that accompany coverage of the epidemic will find a realistic but optimistic assessment of a society successfully tackling the problem and a model for other afflicted nations.”

Jennifer Rosenbush, Africana: “While much of the content in this book has cross-cultural resonance, Saturday is for Funerals is truly a story of Botswana and its people. Perhaps most importantly, this book depicts a success in the fight against HIV/AIDS. It presents more than glimmer of hope in an area of the world that is often depicted as hopeless. This valuable addition to the literature is accessible to lay people would be of great value to students in a range of disciplines.”

Cash Transfers and Health: Evidence from Tanzania

David Evans1 Comment

My paper, “Cash Transfers and Health: Evidence from Tanzania” (with Holtemeyer & Kosec of IFPRI) has been published in the World Bank Economic Review. The paper is attached. Here is the abstract:

How do cash transfers conditioned on health clinic visits and school attendance impact health-related outcomes? Examining the 2010 randomized introduction of a program in Tanzania, this paper finds nuanced impacts. An initial surge in clinic visits after 1.5 years—due to more visits by those already complying with program health conditions and by non-compliers—disappeared after 2.5 years, largely due to compliers reducing above-minimal visits. The study finds significant increases in take-up of health insurance and the likelihood of seeking treatment when ill. Health improvements were concentrated among children ages 0–5 years rather than the elderly, and took time to materialize; the study finds no improvements after 1.5 years, but 0.76 fewer sick days per month after 2.5 years, suggesting the importance of looking beyond short-term impacts. Reductions in sick days were largest in villages with more baseline health workers per capita, consistent with improvements being sensitive to capacity constraints. These results are robust to adjustments for multiple hypothesis testing.

This is a deep analysis of the health investments and impacts stemming from cash transfers in Tanzania. Here are some other resources from the same experiment:

  1. An open access working paper version of the attached paper is available here (which is substantively the same as the published version), and a summary blog post is here.
  2. A broader analysis of program impacts (beyond health) is available here. A quick summary of those results is available here.
  3. All of the data from the Tanzania community-based conditional cash transfer evaluation are available here.

awesome public health book (review): The Ghost Map: The Story of London’s Most Terrifying Epidemic – and How It Changed Science, Cities, and the Modern World, by Steven Johnson (read by Alan Sklar)

David Evans2 Comments

epidemiology, public health, urban planning, amateur activism, all rolled into a tasty narrative

“You and I may not live to see the day…and my name may be forgotten when it comes; but the time will arrive when great outbreaks of cholera will be things of the past; and it is the knowledge of the way in which the disease is propagated which will cause them to disappear.”  (John Snow to Henry Whitehead, p181)

I had heard the story about how John Snow essentially invented epidemiology by tracing cholera deaths to the Broad Street Pump in London, after which he removed the pump handle and the epidemic ended.  Johnson shows us that so much more was at work.  While John Snow was trying to figure out the source of the epidemic, a local clergyman was doing his own research, and the health board leaders were doing research to support their own – faulty – claims about airborne causes.  Johnson demonstrates not only the process of discovery but the challenging politics around trying to convince key leaders to remove the pump handle.  Just as interesting are the implications for public health and city planning even up until the present.  Johnson creates a very human, passionate narrative around all of this non-fiction, filled with nuggets (as when John Snow administered Queen Elizabeth’s anesthesia for one of her childbirths).  I completely recommend this important book: It wasn’t a pure page-turner, but it was interesting and it felt important.  Another great public health related book, written for younger readers, is An American Plague: The True and Terrifying Story of the Yellow Fever Epidemic of 1793, by Jim Murphy.  Ghost Map captures much more of the interconnectedness of the different sectors of society, though.

I listened to the unabridged audiobook narrated by Alan Sklar.  Good narration.

Note on objectionable content: Occasional non-Sunday School language when referring to London’s problem of disposing of human excrement.

Here is an excerpt from the New York Times Sunday Book Review:

Continue reading “awesome public health book (review): The Ghost Map: The Story of London’s Most Terrifying Epidemic – and How It Changed Science, Cities, and the Modern World, by Steven Johnson (read by Alan Sklar)” →

best public health idea of all time

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Edwin Chadwick…[argued] that delivering fresh feces in an expedient manner to England’s waterways would produce larger fish.

I think the most important element here is that the feces be delivered expediently.  From Steven Johnson’s The Ghost Map: The Story of London’s Most Terrifying Epidemic – and How It Changed Science, Cities, and the Modern World, p116