Archive for the ‘international development’Category

Is there a global health bubble? (Or: should you get an MPH?)

There’s a LinkedIn group for Global Public Health that occasionally has good discussion. One example, albeit a sobering one, is the current discussion of employment opportunities after MPH. I’ve been meaning to write about jobs for a while because now that I’m on the other side of the picture — an employed professional with a job at a reputable organization, rather than a grad student — I find myself doing an increasing number of informational interviews, and saying much the same thing each time.

[First, some caveats on the generalizability of the advice below: first, folks with an MPH from another country often have less debt burden than Americans, so may find it easier to do long unpaid or underpaid internships. Second, folks from low- to middle-income countries are and should be more employable, especially in their own countries. Why? Because they have incredibly valuable linguistic and cultural talents (see Alanna Shaikh's recent post on this), so much so that an organization choosing between an outsider and a local with the same technical skills, communication skills, etc, should almost always choose the local. If they don't, that's generally a sign of a dysfunctional or discriminatory organizations.]

The problem is that there is something of an MPH bubble, especially in global health. The size of MPH classes has increased and – more importantly – the number of schools granting degrees has risen rapidly. Degrees focusing on global health also seem to be growing faster than the rest of the field.  (I’d welcome data on class size and jobs in the industry if anyone knows where to find it.) This is happening in part because public health attracts a lot of idealists who are interested in the field because they want to make a difference, rather than rationally choosing between the best paying jobs, and global health has gotten a lot of good press over the last decade. Call this the Mountains Beyond Mountains Effect if you like.

If you know this, and still go into the field, and don’t have an MD or PhD that qualifies you for a different sort of job altogether, then you need to distinguish yourself from the crowd to be employable. I’m assuming your goal is to get a good job in global health, where “good job” is defined as a full-time professional position with a good (not necessarily big-name) organization, working on fulfilling projects and being paid well enough to live comfortably while paying off the loans that most American MPH grads will have. For some, though not all, a good job might also mean one that’s either based abroad or involves frequent international travel. If that’s the goal, then there are several ways to distinguish yourself:

  1. get some sort of hard, transferable skills. This can be research or M&E skills, especially quantitative data crunching ability, or it can be management/coordination experience with serious responsibility. Or other things. The key point is that your skillset should match jobs that are out there, and be something that not everyone has. A lot of MPH programs feature concentrations — or the lack thereof — that are more appealing to students than they are to employers. A biostatistics concentration will likely serve you better than a global health concentration, for instance, and with some exceptions.
  2. get solid international experience, preferably a year or more. Professional experience in public health — even with a lesser-known organization — is much more valuable than experience teaching, or studying abroad. Travel doesn’t count much, and it’s better to have experience in the region you’re interested in working in. There’s a huge catch-22 here, as you need international experience to get it, so that many global health folks start off doing work they’re critical of later in their careers.
  3. relatedly, speak an in-demand language, though this will only help you to work in the region where it’s spoken.
  4. have professional work experience. Even if it’s not in global health, having worked an office job for a year or two makes you more desirable to employers. No one wants to be your first employer, so folks who go straight to an MPH may find themselves less employable than peers who worked for a bit first.
  5. go to a top school, which signals that you’re smarter or better qualified than others (this often isn’t true, the key part is the signalling, and the networks you acquire). Also, graduates of top schools often get good jobs in part because those schools select people with good work experience, skills, and connections to begin with, so that a superior candidate at a school that’s perceived to be a second or third-tier school can do just fine.
  6. avoid debt (which often conflicts with ‘go to a top school’) to give yourself the flexibility to work for less or for nothing at first, until you can do the above.

Any one or two items from this list probably won’t cut it: you need to acquire several.  For example, I’ve known peers with a solid technical degree from a top school and some international experience who still struggled to get jobs at first because they had never had a regular office job before grad school. Also, the relative importance of each will vary according to the subfield of global health you’re interested in. For instance, learning languages might be more important for an implementation person (program coordinator or manager) or a qualitative researcher than it is for a data cruncher.

I used to be pre-med, until I realized I was more interested in policy and did not want to be a clinician, and the path to doing so in the US is long and expensive. Like many former pre-med students who decided not to go to medical school, it took me a while to figure out what I wanted to do, and how to do that without an MD. A couple years post-undergrad I found myself working a job that was interesting enough but not what I ultimately wanted to do, and unable to get a first job in global health without the requisite skills or longer international experience, and I didn’t have the resources to just up and move abroad on my own. So, I went to go to grad school with a technical focus (epidemiology) at a top school, and then used the practicum requirement to build more international experience (Ethiopia). The combination of school and work experience gave me solid quantitative skills because I chose to focus on that each step of the way. But, it also meant taking on quite a bit of debt, and the international practicum would have required even more had I not had generous funding from the econ/policy degree I did. This has worked out well for me, though that same path won’t necessarily work for everyone — especially if you have different interests from mine! — and I think it’s instructive enough to share.

The upside of this bubble is that organizations often hire well-educated, experienced people for even entry level position. The downside is that people from less privileged educational or financial backgrounds often get blocked out of the sector, given that you might have to volunteer for an extended period of time to get the requisite experience, or take on a lot of debt to get a good graduate degree.

In conclusion, getting an MPH — and trying to break into global health — is a personal decision that might work out differently depending on your personal goals, the lifestyle you’re looking for, and your financial background. But if you do get one, be aware that the job market is not the easiest to navigate, and many MPH grads end up unemployed or underemployed for a stretch. Focus on acquiring the skills and experience that will make organizations want to hire you.

Feb

27

2014

Data: big, small, and meta

When I read this New York Times piece back in August, I was in the midst of preparation and training for data collection at rural health facilities in Zambia. The Times piece profiles a group called Global Pulse that is doing good work on the ‘big data’ side of global health:

The efforts by Global Pulse and a growing collection of scientists at universities, companies and nonprofit groups have been given the label “Big Data for development.” It is a field of great opportunity and challenge. The goal, the scientists involved agree, is to bring real-time monitoring and prediction to development and aid programs. Projects and policies, they say, can move faster, adapt to changing circumstances and be more effective, helping to lift more communities out of poverty and even save lives.

Since I was gearing up for ‘field work’ (more on that here; I’ll get to it soon), I was struck at the time by the very different challenges one faces at the other end of the spectrum. Call it small data? And I connected the Global Pulse profile with this, by Wayan Vota, from just a few days before:

The Sneakernet Reality of Big Data in Africa

When I hear people talking about “big data” in the developing world, I always picture the school administrator I met in Tanzania and the reality of sneakernet data transmissions processes.

The school level administrator has more data than he knows what to do with. Years and years of student grades recorded in notebooks – the hand-written on paper kind of notebooks. Each teacher records her student attendance and grades in one notebook, which the principal then records in his notebook. At the local district level, each principal’s notebook is recorded into a master dataset for that area, which is then aggregated at the regional, state, and national level in even more hand-written journals… Finally, it reaches the Minister of Education as a printed-out computer-generated report, complied by ministerial staff from those journals that finally make it to the ministry, and are not destroyed by water, rot, insects, or just plain misplacement or loss. Note that no where along the way is this data digitized and even at the ministerial level, the data isn’t necessarily deeply analyzed or shared widely….

And to be realistic, until countries invest in this basic, unsexy, and often ignored level of infrastructure, we’ll never have “big data” nor Open Data in Tanzania or anywhere else. (Read the rest here.)

Right on. And sure enough two weeks later I found myself elbow-deep in data that looked like this — “Sneakernet” in action:

In many countries a quite a lot of data — of varying quality — exists, but it’s often formatted like the above. Optimistically, it may get used for local decisions, and eventually for high-level policy decisions when it’s months or years out of date. There’s a lot of hard, good work being done to improve these systems (more often by residents of low-income countries, sometimes by foreigners), but still far too little. This data is certainly primary, in the sense that was collected on individuals, or by facilities, or about communities, but there are huge problems with quality, and with the sneakernet by which it gets back to policymakers, researchers, and (sometimes) citizens.

For the sake of quick reference, I keep a folder on my computer that has — for each of the countries I work in — most of the major recent ultimate sources of nationally-representative health data. All too often the only high-quality ultimate source is the most recent Demographic and Health Survey, surely one of the greatest public goods provided by the US government’s aid agency. (I think I’m paraphrasing Angus Deaton here, but can’t recall the source.) When I spent a summer doing epidemiology research with the New York City Department of Health and Mental Hygiene, I was struck by just how many rich data sources there were to draw on, at least compared to low-income countries. Very often there just isn’t much primary data on which to build.

On the other end of the spectrum is what you might call the metadata of global health. When I think about the work the folks I know in global health — classmates, professors, acquaintances, and occasionally thought not often me — do day to day, much of it is generating metadata. This is research or analysis derived from the primary data, and thus relying on its quality. It’s usually smart, almost always well-intentioned, and often well-packaged, but this towering edifice of effort is erected over a foundation of primary data; the metadata sometimes gives the appearance of being primary, when you dig down the sources often point back to those one or three ultimate data sources.

That’s not to say that generating this metadata is bad: for instance, modeling impacts of policy decisions given the best available data is still the best way to sift through competing health policy priorities if you want to have the greatest impact. Or a more cynical take: the technocratic nature of global health decision-making requires that we either have this data or, in its absence, impute it. But regardless of the value of certain targeted bits of the metadata, there’s the question of the overall balance of investment in primary vs. secondary-to-meta data, and my view — somewhat ironically derived entirely from anecdotes — is that we should be investing a lot more in the former.

One way to frame this trade-off is to ask, when considering a research project or academic institute or whatnot, whether the money spent on that project might result in more value for money if it was spent instead training data collectors and statistics offices, or supporting primary data collection (e.g., funding household surveys) in low-income countries. I think in many cases the answer will be clear, perhaps to everyone except those directly generating the metadata.

That does not mean that none of this metadata is worthwhile. On the contrary, some of it is absolutely essential. But a lot isn’t, and there are opportunity costs to any investment, a choice between investing in data collection and statistics systems in low-income countries, vs. research projects where most of the money will ultimately stay in high-income countries, and the causal pathway to impact is much less direct.  

Looping back to the original link, one way to think of the ‘big data’ efforts like Global Pulse is that they’re not metadata at all, but an attempt to find new sources of primary data. Because there are so few good sources of data that get funded, or that filter through the sneakernet, the hope is that mobile phone usage and search terms and whatnot can be mined to give us entirely new primary data, on which to build new pyramids of metadata, and with which to make policy decisions, skipping the sneakernet altogether. That would be pretty cool if it works out.

Jan

28

2014

A more useful aid debate

Ken Opalo highlights recent entries on the great aid debate from Bill Gates, Jeff Sachs, Bill Easterly, and Chris Blattman.

Much has been said on this debate, and sometimes it feels like it’s hard to add anything new. But since having a monosyllabic first name seem sufficient qualification to weigh in, I will. First, this part of Ken’s post resonates with me:

I think most reasonable people would agree that Sachs kind of oversold his big push idea in The End of Poverty. Or may be this was just a result of his attempt to shock the donor world into reaching the 0.7 percent mark in contributions. In any event it is unfortunate that the debate on the relative efficacy of aid left the pages of journal articles in its current form. It would have been more helpful if the debate spilled into the public in a policy-relevant form, with questions like: under what conditions does aid make a difference? What can we do to increase the efficacy of aid? What kinds of aid should we continue and what kinds should we abolish all together? (emphasis added)

Lee Crawfurd wrote something along these lines too: “Does Policy Work?”  Lee wrote that on Jan 10, 2013, and I jokingly said it was the best aid blog post of the year (so far). Now that 2013 has wrapped up, I’ll extend that evaluation to ‘best aid blog post of 2013′. It’s worth sharing again:

The question “does policy work” is jarring, because we immediately realise that it makes little sense. Governments have about 20-30 different Ministries, which immediately implies at least 20-30 different areas of policy. Does which one work? We have health and education policy, infrastructure policy (roads, water, energy), trade policy, monetary policy, public financial management, employment policy, disaster response, financial sector policy, climate and environment policy, to name just a few. It makes very little sense to ask if they all collectively “work” or are “effective”. Foreign aid is similar. Aid supports all of these different areas of policy….

A common concern is about the impact of aid on growth… Some aid is specifically targeted at growth – such as financing infrastructure or private sector development. But much of it is not. One of the few papers which looks at the macroeconomic impact of aid and actually bothers to disaggregate even a little the different types of aid, finds that the aid that could be considered to have growth as a target, does increase growth. It’s the aid that was never intended to impact growth at all, such as humanitarian assistance, which doesn’t have any impact on growth.

I like to think that most smart folks working on these issues — and that includes both Sachs and Easterly — would agree with the following summaries of our collective state of knowledge:

  •  A lot of aid projects don’t work, and some of them do harm.
  • Some aid, especially certain types of health projects, works extremely well.

The disagreement is on the balance of good and bad, so I wish — as Ken wrote — the debate spilled into the public sphere along those lines (which is good? which is bad? how can we get a better mix?) rather than the blanket statements both sides are driven to by the very publicness of the debate. It reminds me a bit of debates in theology: if you put a fundamentalist and Einstein in the same room, they’ll both be talking about “God” but meaning very different things with the same words. (This is not a direct analogy, so don’t ask who is who…)

When Sachs and Easterly talk about whether aid “works”, it would be nice if we could get everyone to first agree on a definition of “aid” and “works”. But much of this seems to be driven by personal animosity between Easterly and Sachs, or more broadly, by personal animosity of a lot of aid experts vs. Sachs. Why’s that? I think part of the answer is that it’s hard to tell when Sachs is trying to be a scientist, and when he’s trying to be an advocate. He benefits from being perceived as the former, but in reality is much more the latter. Nina Munk’s The Idealist – an excellent profile of Sachs I’ve been meaning to review — explores this tension at some length. The more scientifically-minded get riled up by this confusion — rightfully, I think. At the same time, public health folks tend to love Sachs precisely because he’s been a powerful advocate for some types of health aid that demonstrably work — also rightfully, I think. There’s a tension there, and it’s hard to completely dismiss one side as wrong, because the world is complicated and there are many overlapping debates and conversations; academic and lay, public and private, science and advocacy.

So, back to Ken’s questions that would be answered by a more useful aid debate:

  • Under what conditions does aid make a difference?
  • What can we do to increase the efficacy of aid?
  • What kinds of aid should we continue and what kinds should we abolish all together?

Wouldn’t it be amazing if the public debate were focused on these questions? Actually, something like that was done: Boston Review had a forum a while back on “Making Aid Work” with responses by Abhijit Banerjee, Angus Deaton, Howard White, Ruth Levine, and others. I think that series of questions is much more informative than another un-moderated round of Sachs vs Easterly.

Jan

22

2014

Spreading the word

If you haven’t already read Atul Gawande’s latest New Yorker piece on why some ideas spread fast and other spread slow, get to it:

 In the era of the iPhone, Facebook, and Twitter, we’ve become enamored of ideas that spread as effortlessly as ether. We want frictionless, “turnkey” solutions to the major difficulties of the world—hunger, disease, poverty. We prefer instructional videos to teachers, drones to troops, incentives to institutions. People and institutions can feel messy and anachronistic. They introduce, as the engineers put it, uncontrolled variability.

But technology and incentive programs are not enough. “Diffusion is essentially a social process through which people talking to people spread an innovation,” wrote Everett Rogers, the great scholar of how new ideas are communicated and spread. Mass media can introduce a new idea to people. But, Rogers showed, people follow the lead of other people they know and trust when they decide whether to take it up. Every change requires effort, and the decision to make that effort is a social process.

Much of the material is Gawande’s essay won’t be new if you’re already interested in or working on maternal and child health, but Gawande presents it incredibly well. His comparison of spreading social innovation with the work of salesman also reminded me of another parallel: the parallels between diffusing secular, health-enhancing ideas and missionaries’ evangelistic techniques.

If that last sentence scares you off, hold on a moment for some background. I grew up in a small religious town in Arkansas and my first trips to developing countries were as a missionary. Over time my interests shifted from the preaching and teaching side of things to the medical side, and eventually to health and development policy as an entirely secular pursuit. When I first got to grad school for public health this resulted in some awkward moments, as many conversations would start with “so what first interested you in global health?” If I led with “well, I grew up wanting to be a missionary” I would often get one of two reactions: immediate skepticism of my motivations from my secular liberal classmates, or enthusiastic endorsement of my work (as they misunderstood it) from religious classmates. All that to say: while I think there are very good general reasons to keep public health and missionary efforts as separate as possible, both in theory and praxis, there are several things we secular liberals can still learn from the more devout.

One example is the neverending debates amongst evangelists between those who seek technological shortcuts and those who stick with old-fashioned person-to-person contact. This is a frequent topic at missions conferences (if you didn’t know such conferences existed, it might be an interesting google). You can view the rise of Christian radio broadcasts, followed by Christian TV and televangelists, as the great technological shortcuts: they give a single preacher the ability to reach millions, and if the message is just as good as when delivered in person, why shouldn’t it be just as effective? Some people are persuaded by televangelists, of course, but the effectiveness of the individual doesn’t scale easily to mass media. Likewise, in recent years there’s been much enthusiasm for social media and its potential to save more souls — but the results rarely pan out.  So despite all of the advances in mass and social media, most evangelists still harp on the importance of individual contact, of building relationships. One of the most effective (in terms of growth rate) groups in the world are Mormons, who, no coincidence, devote years of effort to one-on-one contact.

Gawande’s essay tells the story of how BRAC precipitated oral rehydration solution in Bangladesh, and I couldn’t help thinking of their campaign  as a sort of especially successful roving gospel meeting. And here’s Gawande’s closing, where he talks with a nurse who was convinced by a younger, less-experienced trainer to adopt some best practices for safe childbirth:

 “Why did you listen to her?” I [Gawande] asked. “She had only a fraction of your experience.”

In the beginning, she didn’t, the nurse admitted. “The first day she came, I felt the workload on my head was increasing.” From the second time, however, the nurse began feeling better about the visits. She even began looking forward to them.

“Why?” I asked.

All the nurse could think to say was “She was nice.”

“She was nice?”

“She smiled a lot.”

“That was it?”

“It wasn’t like talking to someone who was trying to find mistakes,” she said. “It was like talking to a friend.”

Shortcuts are nice: in public health, unlike evangelism, it’s usually actions rather than beliefs that ultimately count, so I’m all for technological shortcuts when they’re available and effective. But they’re too few and far between, and much of the low-hanging fruit in global health has already been picked. To climb the next step require a lot more effort at improving the “messy and anachronistic”  processes of people and institutions.

Aug

07

2013

Advocates and scientists

A new book by The Idealist: Jeffrey Sachs and the Quest to End Poverty. The blurbs on Amazon are fascinating because they indicate that either the reviewers didn’t actually read the book (which wouldn’t be all that surprising) or that Munk’s book paints a nuanced enough picture that readers can come away with very different views on what it actually proves. Here are two examples:

Amartya Sen: “Nina Munk’s book is an excellent – and moving – tribute to the vision and commitment of Jeffrey Sachs, as well as an enlightening account of how much can be achieved by reasoned determination.”

Robert Calderisi: “A powerful exposé of hubris run amok, drawing on touching accounts of real-life heroes fighting poverty on the front line.”

The publisher’s description seems to encompass both of those points of view: “The Idealist is the profound and moving story of what happens when the abstract theories of a brilliant, driven man meet the reality of human life.” That sounds like a good read to me — I look forward to reading when it comes out in September.

Munk’s previous reporting strikes a similar tone. For example, here’s an excerpt of her 2007 Vanity Fair profile of Sachs:

Leaving the region of Dertu, sitting in the back of an ancient Land Rover, I’m reminded of a meeting I had with Simon Bland, head of Britain’s Department for International Development in Kenya. Referring to the Millennium Villages Project, and to Sachs in particular, Bland laid it out for me in plain terms: “I want to say, ‘What concept are you trying to prove?’ Because I know that if you spend enough money on each person in a village you will change their lives. If you put in enough resources—enough foreigners, technical assistance, and money—lives change. We know that. I’ve been doing it for years. I’ve lived and worked on and managed [development] projects.

“The problem is,” he added, “when you walk away, what happens?”

Someone — I think it was Chris Blattman, but I can’t find the specific post — wondered a while back whether too much attention has been given to the Millennium Villages Project. After all, the line of thinking goes, the MVP’s have really just gotten more press and aren’t that different from the many other projects with even less rigorous evaluation designs. That’s certainly true: when journalists and aid bloggers debate the MVPs, part of what they’re debating is Sachs himself because he’s such a polarizing personality. If you really care about aid policy, and the uses of evidence in that policy, then that can all feel like an unhelpful distraction. Most aid efforts don’t get book-length profiles, and the interest in Sachs’ personality and persona will probably drive the interest in Munk’s book.

But I also think the MVP debates have been healthy and interesting — and ultimately deserving of most of the heat generated — because they’re about a central tension within aid and development, as well as other fields where research intersects with activism. If you think we already generally know what to do, then it makes sense to push forward with it at all costs. The naysayers who doubt you are unhelpful skeptics who are on some level ethically culpable for blocking good work. If you think the evidence is not yet in, then it makes more sense to function more like a scientist, collecting the evidence needed to make good decisions in the longer term. The naysayers opposing the scientists are then utopian advocates who throw millions at unproven projects. I’ve seen a similar tension within the field of public health, between those who see themselves primarily as advocates and those who see themselves as scientists, and I’m sure it exists elsewhere as well.

That is, of course, a caricature — few people fall completely on one side of the advocates vs. scientists divide. But I think the caricature is a useful one for framing arguments. The fundamental disagreement is usually not about whether evidence should be used to inform efforts to end poverty or improve health or advance any other goal. Instead, the disagreement is often over what the current state of knowledge is. And on that note, if you harbor any doubts on where Sachs has positioned himself on that spectrum here’s the beginning of Munk’s 2007 profile:

In the respected opinion of Jeffrey David Sachs…. the problem of extreme poverty can be solved. In fact, the problem can be solved “easily.” “We have enough on the planet to make sure, easily, that people aren’t dying of their poverty. That’s the basic truth,” he tells me firmly, without a doubt.

…To Sachs, the end of poverty justifies the means. By hook or by crook, relentlessly, he has done more than anyone else to move the issue of global poverty into the mainstream—to force the developed world to consider his utopian thesis: with enough focus, enough determination, and, especially, enough money, extreme poverty can finally be eradicated.

Once, when I asked what kept him going at this frenzied pace, he snapped back, “If you haven’t noticed, people are dying. It’s an emergency.”

—-

via Gabriel Demombynes.

If you’re new to the Millennium Villages debate, here’s some background reading: a recent piece in Foreign Policy by Paul Starobin, and some good posts by Chris Blattman (one, two, three), this gem from Owen Barder, and Michael Clemens.

Aug

03

2013

CHAI jobs

While I write this blog in a personal capacity, I thought I’d point out a few open positions at the Clinton Health Access Initiative and especially on CHAI’s Applied Analytics Team, which I joined in early June:

And there are two open positions with the Applied Analytics Team:

  • Senior Research Associate (Masters or PhD) working on Demand-Driven Evaluation for Decisions (3DE), and
  • Health Economist. Ideally this position would be filled by someone with a PhD in economics, modeling skills, and HIV experience in public health, policy, or very applied research – the sort of person who can think outside of their academic specialty and wants to work on applied research questions that policy makers needed answers to yesterday.

There are many more positions posted on the careers section of the CHAI site, though unfortunately there’s no RSS feed of posted positions.

Jul

30

2013

Americanah

Americanah, the new novel by Chimamanda Ngozi Adichie is very good. I have a long list of Nigerian fiction on my to-read list, but Americanah got bumped to the top because it seemed like the perfect transition from Princeton to Nigeria: I heard Chimamanda speak in Princeton – where she, like Ifemelu, the main character, lived for a year on a fellowship – a month or so ago.

Americanah starts with Ifemelu taking NJ Transit from Princeton to Trenton to get her hair braided, because Princeton is the sort of place with an “ice cream shop that had fifty different flavors including red pepper” but no one to braid black hair. Following her TED Talk advice, Americanah crams in many narratives. It’s set in Lagos and London, Brooklyn and Baltimore, New Haven and Philly, and it’s about migration from Lagos to America, from Lagos to London, and from everywhere back to Nigeria. One character, in London:

His eyes would follow them, with a lost longing, and he would think: You can work, you are legal, you are visible, and you don’t even know how fortunate you are.

It’s about dating across race, wealth, and cultures; academics and intellectuals and the many people who are only one or the other, not both; the London black market of arranged sham marriages and faked ID documents; accents real and faked; sex work; the constant burdens and exploitation and desperation of the undocumented; Barack Obama; the hope and opportunity that can come with an approved visa application; and hair. Lots of hair.

There are Americans who deny that racism is still a problem. Wealthy folks who, learning Ifemelu is from Nigeria, try to connect by mentioning their latest trip to Tanzania, their opinion of Ethiopian beauty, the charity they support in Malawi. Ifemelu thinks:

There was a certain luxury to charity that she could not identify with and did not have…. Ifemelu wanted, suddenly and desperately, to be from the country of people who gave and not those who received, to be one of those who had and could therefore bask in the grace of having given, to be among those who could afford copious pithy and empathy.

Another character is at a London dinner party, thinking:

Alexa, and the other guests, and perhaps even Georgina, all understood the fleeing from war, form the kind of poverty that crushed human souls, but they would not understand the need to escape form the oppressive lethargy of choicelessness. They would not understand why people like him, who were raised well fed and watered but mired in dissatisfaction, conditioned from birth to look towards somewhere else, eternally convinced that real lives happened in that somewhere else, were now resolved to do dangerous things, illegal things, so as to leave, none of them starving, or raped, or from burned villages, but merely hungry for choice and certainty.

Ifemelu is, for a while, a blogger who writes “Raceteenth or Various Observations About American Blacks (Those Formerly Known as Negroes) by a Non-American Black” which gives Adichie a venue to make observations, often hilarious and/or impolite. One post starts:

Dear Non-American Black, when you make the choice to come to America, you become black. Stop arguing. Stop saying I’m Jamaican or I’m Ghanaian. America doesn’t care. So what if you weren’t “black” in your country? You’re in America now….

Americanah never dwells on a single theme until it becomes tiresome The major characters are sympathetic but flawed, and the observations are constantly insightful – I wanted to quote much more here. So, highly recommended.

Jul

03

2013

Several job opps

Some other good places to look for jobs: mHealth student Google group and the African Development Jobs blog.

Jun

04

2013

“What is wrong (and right) in economics?”

Economist Dani Rodrik has a great essay up on his website on what’s good and bad about economics. Here’s a bit on the relationship between trade policy and growth:

I remember well the reception I got when I presented my paper (with Francisco Rodriguez) on the empirics of trade policy and growth. The literature had filled up with extravagant claims about the effect of trade liberalization on economic growth. What we showed in our paper is that the research to date could not support those claims. Neither the theoretical nor empirical literature indicated there is a robust, predictable, and quantitatively large effect of trade liberalization on growth. We were simply stating what any well-trained economist should have known. Nevertheless, the paper was highly controversial. One of my Harvard colleagues asked me in the Q&A session: “why are you doing this?” It was a stunning question. It was as if knowledge of a certain kind was dangerous.

There’s a lot of good material in there about what economics is and isn’t, and how to do it better.  I had forgotten that Rodrik studied at Princeton, so was pleasantly surprised by this:

However, contemporary economics in North America has one great weakness, and that is the excessive focus on methods at the expense of breadth in terms of social and historical perspective. PhD programs now train applied mathematicians and statisticians rather than real economists. To become a true economist, you need to do all sorts of reading – from history, sociology, and political science among other disciplines – that you are never required to do as a graduate student. The best economists today find a way of filling this gap in their education. I consider myself very lucky that I was a political science major and did a master’s in public affairs (as it is called at Princeton) before I turned to economics. I say lucky, because some of my best work – by my judgement, at least – was stimulated by questions or arguments I encountered outside of neoclassical economics.

May

07

2013

(Not) knowing it all along

David McKenzie is one of the guys behind the World Bank’s excellent and incredibly wonky Development Impact blog. He came to Princeton to present on a new paper with Gustavo Henrique de Andrade and Miriam Bruhn, “A Helping Hand or the Long Arm of the Law? Experimental evidence on what governments can do to formalize firms” (PDF). The subject matter — trying to get small, informal companies to register with the government — is outside my area of expertise. But I thought there were a couple methodologically interesting bits:

First, there’s an interesting ethical dimension, as one of their several interventions tested was increasing the likelihood that a firm would be visited by a government inspector (i.e., that the law would be enforced). From page 10:

In particular, if a firm owner were interviewed about their formality status, it may not be considered ethical to then use this information to potentially assign an inspector to visit them. Even if it were considered ethical (since the government has a right to ask firm owners about their formality status, and also a right to conduct inspections), we were still concerned that individuals who were interviewed in a baseline survey and then received an inspection may be unwilling to respond to a follow-up. Therefore a listing stage was done which did not involve talking to the firm owner.

In other words, all their baseline data was collected without actually talking to the firms they were studying — check out the paper for more on how they did that.

Second, they did something that could (and maybe should) be incorporated into many evaluations with relative ease. Because findings often seem obvious after we hear them, McKenzie et al. asked the government staff whose program they were evaluating to estimate what the impact would be before the results were in. Here’s that section (emphasis added):

A standard question with impact evaluations is whether they deliver new knowledge or merely formally confirm the beliefs that policymakers already have (Groh et al, 2012). In order to measure whether the results differ from what was anticipated, in January 2012 (before any results were known) we elicited the expectations of the Descomplicar [government policy] team as to what they thought the impacts of the different treatments would be. Their team expected that 4 percent of the control group would register for SIMPLES [the formalization program] between the baseline and follow-up surveys. We see from Table 7 that this is an overestimate…

They then expected the communication only group to double this rate, so that 8 percent would register, that the free cost treatment would lead to 15 percent registering, and that the inspector treatment would lead to 25 percent registering…. The zero or negative impacts of the communication and free cost treatments therefore are a surprise. The overall impact of the inspector treatment is much lower than expected, but is in line with the IV estimates, suggesting the Descomplicar team have a reasonable sense of what to expect when an inspection actually occurs, but may have overestimated the amount of new inspections that would take place. Their expectation of a lack of impact for the indirect inspector treatment was also accurate.

This establishes exactly what in the results was a surprise and what wasn’t. It might also make sense for researchers to ask both the policymakers they’re working with and some group of researchers who study the same subject to give such responses; it would certainly help make a case for the value of (some) studies.

Apr

04

2013

Rearranging the malarial deck chairs?

A friend sent this link to me, highlighting a critical comment about the future of the World Health Organization, in the context of the World Malaria Report 2012. Here’s an excerpt of the comment by William Jobin:

Their 2012 Annual Report is a very disturbing report from WHO, for at least two reasons:

1. Their program is gradually falling apart, and they offer no way to refocus, no strategy for dealing with the loss in funding, nor the brick wall of drug and biocide resistance which is just down the road. There is a label for people who keep doing the same thing, but expect different results. Do you remember what it is?

2. Because the entire top management of WHO consists of physicians, they have no idea of the opportunities they are missing for additional funding and for additional methods to add to their chemically-oriented strategy…

Concluding with:

I am not sure WHO has much of a future, nor does the UN system itself, after their failure to prevent the wars in Libya and Syria. But as long as the UN and WHO continue to operate, they must refocus their approach to face the reality of a rapidly declining budget from UN sources. Instead, I see them just re-arranging the deck chairs on the Titanic.

My friend said, “I wish these comments (and issues with the WHO and UN) were more publicised! This is not the first time I am hearing of such issues with the WHO and its demise.” I’ve certainly heard similar sentiments about the WHO from classmates and professors, but it seems there’s much less open discussion than you might expect. I’d welcome discussion in the comments…

Mar

28

2013

Note to job seekers

The first question I’ve had in several recent job interviews/conversations was “do you speak French?” (I don’t.) Not that it’s impossible to find work if you don’t — but it certainly seems to be a major asset. If you want to work in global health, take note.

Mar

20

2013

On regressions and thinking

Thesis: thinking quantitatively changes the way we frame and answer questions in ways we often don’t notice.

James Robinson, of Acemoglu and Robinson fame (ie, Why Nations Fail@whynationsfailColonial Origins; Reversal of Fortune, and so forth), gave a talk at Princeton last week. It was a good talk, mostly about Why Nations Fail. My main thought during his presentation was that it’s simply very difficult to develop a parsimonious theory that covers something as complicated as the long-term economic and political development of the entire world! As Robinson said (quoting someone else), in social science you can say “more and more about less and less, or less and less about more and more.”

The talk was followed by some great discussion where several of the tougher questions came from sociologists and political economists. I think it’s safe to say that a lot of the skepticism of the Why Nations Fail thesis is centered around the beef that East Asian economics, and especially China, don’t fit neatly into it. A&R argue here on their blog — not to mention in their book, which I’ve alas only had time to skim — that China is not an exception to their theory, but I think that impression is still fairly widespread.

But my point isn’t about the extent to which China fits into the theory (that’s another debate altogether); it’s about what it means if or when China doesn’t fit into the theory. Is that a major failure or a minor one?  I think different answers to that question are ultimately rooted in a difference of methodological cultures in the social science world.

As social science becomes more quantitative, our default method for thinking about a subject can shift, and we might not even notice that it’s happening. For example, if your main form of evidence for a theory is a series of cross-country regressions, then you automatically start to think of countries as the unit of analysis, and, importantly, as being more or less equally weighted. There are natural and arguably inevitable reasons why this will be the case: states are the clearest politicoeconomic units, and even if they weren’t they’re simply the unit for which we have the most data. While you might (and almost certainly should!) weight your data points by population if you were looking at something like health or individual wealth or well-being, it makes less sense when you’re talking about country-level phenomena like economic growth rates. So you end up seeing a lot of arguments made with scatterplots of countries and fitted lines — and you start to think that way intuitively.

When we switch back to narrative forms of thinking, this is less true: I think we all agree that all things being equal a theory that explains everything except Mauritius is better than a theory that explains everything except China. But it’s a lot harder to think intuitively about these things when you have a bunch of variables in play at the same time, which is one reason why multiple regressions are so useful. And between the extremes of weighting all countries equally and weighting them by population are a lot of potentially more reasonable ways of balancing the two concerns, that unfortunately would involve a lot of arbitrary decisions regarding weighting…

This is a thought I’ve been stewing on for a while, and it’s reinforced whenever I hear the language of quantitative analysis working its way into qualitative discussions — for instance, Robinson said at one point that “all that is in the error term,” when he wasn’t actually talking about a regression. I do this sort of thing too, and don’t think there’s anything necessarily wrong with it — until there is.  When questioned on China, Robinson answered briefly and then transitioned to talking about the Philippines, rather than just concentrating on China. If the theory doesn’t explain China (at least to the satisfaction of many), a nation of 1.3 billion, then explaining a country of 90 million is less impressive. How impressive you find an argument depends in part on the importance you ascribe to the outliers, and that depends in part on whether you were trained in the narrative way of thinking, where huge countries are hugely important, or the regression way of thinking, where all countries are equally important units of analysis.

[The first half of my last semester of school is shaping up to be much busier than expected -- my course schedule is severely front-loaded -- so blogging has been intermittent. Thus I'll try and do more quick posts like this rather than waiting for the time to flesh out an idea more fully.]
Feb

25

2013

Growth and stagnation in global health funding

Amanda Glassman of CGD shares the graph below from the latest IHME “Financing Global Health” report, which tells the top-line story from the report in one neat picture:

This year’s report is subtitled, “The End of the Golden Age?” Maybe. I’d start with Amanda’s analysis here, then dive into the report overview [PDF].

Feb

18

2013