in development

The hazy ethics of foreign aid and intelligent television.

Two recent podcasts from American Public Media got me thinking about how the complex ethics of foreign aid is ripe fodder for the renaissance of intelligent television. I was then reminded of David Simon's finale letter to fans of The Wire in which he writes: 

"We tried to be entertaining, but in no way did we want to be mistaken for entertainment. We tried to provoke, to critique and debate and rant a bit. We wanted an argument. We think a few good arguments are needed still, that there is much more to be said and it is entirely likely that there are better ideas than the ones we offered. But nothing happens unless the shit is stirred. That, for us, was job one."

It seems to me that a few good arguments are still needed in the world of foreign aid and international development.  Dambisa Moyo and her impressive/endless marketing of "Dead Aid" has definitely helped re-energize the argument.  But the argument that has momentarily emerged is overwhelmingly characterized by extremes - best illustrated by the Sachs v Moyo/Easterly flare up in the Huffington Post from a few months back.  Too much of the current talk around foreign aid is either for or against - more aid or no more aid.  There is very little examination of the many shades of gray in the foreign aid debate.  Again, David Simon:

"We are a culture without the will to seriously examine our own problems. We eschew that which is complex, contradictory or confusing. As a culture, we seek simple solutions. We enjoy being provoked and titillated, but resist the rigorous, painstaking examination of issues that might, in the end, bring us to the point of recognizing our problems, which is the essential first step to solving any of them."

I think audiences in the developed world are ready for a more nuanced examination of aid and development (so long as it's presented under the guise of entertainment).  The boom in undergraduate and graduate enrollments in global health programs certainly points to a growing interest and audience.  I just hope we don't spoil this moment with more skin deep awareness campaigns and one-sided storytelling.  I'm sure many in this field are asking for the global health/extreme poverty equivalent of An Inconvenient Truth.  Films like this could certainly help intensify interest and increase involvement among those already interested and involved.  Just bear in mind that they're not likely to change public opinion overall. Nor are they likely to engage new minds and stimulate fresh thinking.  

Surprisingly, serialized television may be the most effective medium to explore the complex, nuanced world of aid and development.  It has the capacity to not only create issue awareness, but it can actually engage audiences to think beyond the polarizing headlines and over-simplified sound bites of most mainstream media.  And it can capture and sustain the interest of an audience far broader than just those already prone to pay attention.  The Wire did so in their authentic examination of the social, political, and economic life of a struggling American city.  As did Battlestar Galactica as they explored religious fanaticism, global politics, terrorism, and the very question of what it means to be human.  Shows like these demonstrate that entertainment media can actually help us think about the complex issues that shape our world.  And they may even encourage us to engage and demand a more effective response. 

I realize that using entertainment television to promote social issues and influence behavior is nothing new.  But as far as I know, all previous efforts have been either purely didactic or secondary to the show's central narrative (i.e., social issue as product placement).  I'm not interested in more aid propaganda or message placement.  I'm interested in a thoughtful and engaging exploration of the moral, economic, political, social, religious, and cultural tension embedded within the world of international aid and development.  The intersection of all these themes and the communities they represent could make for a very compelling storyline using what Stephen Johnson calls "multiple threading" - a collection of distinct narrative strands that are woven together in order to tell a more complex and comprehensive story (see Everything Bad is Good For You).  And there's no shortage of archetypes to draw interesting characters from.  You've got bleeding hearts, egomaniacs, eggheads, adrenaline junkies, politicians, bandits, missionaries, distant donors, neocolonialists, geeks, medics, investors and more.  Some are inept.  Some are corrupt.  Many are smart and ambitious.  Most are interested in doing good. And all save a few are first and foremost concerned with their next promotion or personal salvation.  They are conflicted characters will colorful back stories.  Take this vivid description from Tales From The Hood of one curmudgeonly aid worker for example:

"He was crusty, cranky, jaded, cynical, field-hardened, and prone to sweeping generalizations and ridiculously extreme pronouncements. A lifetime of aid work had taken it’s toll on his body and on his personal life. He’d been divorced a couple of times and had a couple of chronic conditions of the sort that you to tend pick up when your life is spent in or bouncing between impoverished places, always a little bit ill, sleep-deprived and far from family for weeks/months on end."

I'm doubtful that many working in aid and development advocacy would support this kind of program.  On the face of it, a program that looks at all sides of the issue (good, bad, and everything in between) certainly doesn't explicitly advance their objectives.  But smart marketers today know that to change attitudes and behavior audiences need to be involved in the process of meaning making.  Or as Thierry Lefebvre writes in Creative Capitalism "some initial haziness - or room for improvement - can stimulate discussion and bring out ideas; haziness can be an effective marketing strategy."  There is no doubt room for improvement in our collective effort to improve the health and well-being of people living in the world's poorest places.  And maybe an authentic examination of foreign aid and development on the fictionalized small screen would help stimulate new ideas and build a broader base of support.  But if nothing else, it would certainly make for good television.

photo credit: zinarcotics/flickr

Ths social spread of behavior.

To follow up last week's post on the social nature of behavior change, there were another pair of great articles just published on Christakis' and Fowler's social contagion analysis of the Farmingham Heart Study data (one from Wired here, the other from the NY Times Magazine is here).  Their research first hit the mainstream press a couple years ago when they reported on the social spread of obesity.  The pair has gone on to explore their hypothesis further and publish their first general audience book Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives. Their research demonstrates the power of social networks to influence individual behavior.  Further, it forces us to drastically recast our understanding of public health when we think of people as an interconnected network rather than a mass of autonomous individuals.

"In essence, Christakis and Fowler’s work suggests a new way to think about public health. If they’re right, public-health initiatives that merely address the affected individuals are doomed to failure. To really grapple with bad behaviors that spread, you have to simultaneously focus on individuals who are so distant they don’t even realize they’re affecting one another."

Of course, since their data is from a Boston suburb, the health issues they've examined are decidedly of the developed world.  Obesity, smoking, happiness.  But their hypothesis could have dramatic effects on the developing world as well.  For starters, community is a much stronger condition of daily life in the developing world.  In general, social ties are stronger and networks are larger in these regions.  Africa may be disadvantaged in many ways, but when it comes to social capital few communities are suffering from Putnam's Bowling Alone syndrome. 

"Christakis and Fowler postulate that our ability to affect people three degrees away from us may have evolutionary roots — and so may the very shape of human social networks. Tribal groups that were tightly connected were likely more able to pass along positive behaviors than those that weren’t."

The breadth and depth of social connections in the developing world could significantly support strategies aimed at behavior change.  When dealing with poorly educated populations a more nuanced understanding of cultural values and social ties is critical.  And if their hypothesis - that good (or bad) behaviors pass from friend to friend like contagious viruses - proves out to be true, social marketing strategists will need to rethink both their campaign plans and M&E methods.  But working from a more accurate model of behavior could help campaigns addressing issues ranging from family planning to safe water to malaria prevention and more, become far more efficient and effective.  And as mentioned last week, it appears that some already are.  It may not be apparent on the face of it, but the use of cows to broadcast behavior change in West Pokot, Kenya does indeed have a lot in common with a Facebook application to encourage smoking-cessation in America.

"Nathan Cobb, a smoking-cessation expert and researcher at the Schroeder Institute for Tobacco Research and Policy Studies, is designing an application that Facebook users can install on their pages when they’re trying to quit smoking. The application will publicly display how long they’ve gone without cigarettes, whether they are using a nicotine patch and how much money they have saved by not smoking. The idea, Cobb says, is to take your invisible, internal battle to quit smoking and make it visible so that it can influence your friends (and friends of friends) who are still puffing away."

In other words, the cows of West Pokot and a smoking-cessation Facebook application both make an otherwise hidden behavior visible and thereby facilitate the social spread of behavior change.

Using cows to broadcast behavior change.

I came across a story last week about a very small but successful program to curb female genital mutilation (FGM) in West Pokot, Kenya.  The Kenyan government outlawed FGM nearly 10 years ago.  But its deep cultural roots have allowed the tradition to endure.  Given that the practice predates both Islam and Christianity it's easy to understand why, despite ample evidence of serious health risks, FGM isn't going to simply stop overnight.  Changing mass behavior is seldom swift and never based on reason alone.  And when the behavior in question is attached to a rich tribal, cultural, and even political tradition, lawmaking isn't likely to bring about lasting change. But when criminalization is coupled with community based interventions, sustained behavior change may actually stand a chance.

The community based intervention I came across is using cows to reward women who quit their work as female circumcisers.   Six years ago, a local women's organization devised the plan when they learned that their previous efforts had failed.  The program's director realized that simply talking to circumcisers about the dangers of FGM wasn't working.  They found that the circumcisers often went back to the custom due to idleness.  To solve for the problem they needed to do more than just ask the circumcisers to stop, they needed to get them to start something else. And preferably, that something else would replace the income the women earned as circumcisers. So they asked the women (sorry, "crowdsourced") what income-generating activity they would like to start.  Aside from FGM, raising cattle is about the only way to make a living in West Pokot.  The women wisely asked for cows.  Those ten women are now offering to give seven heifers to other women who pledge to quit their work as female circumcisers.

This may seem like a pretty simple, common sense campaign.  And it is.  But I think one of the strongest features of the campaign has largely been overlooked - the role the cows play in signifying behavior change.  In other words, the cows make it visible to the entire community who is no longer participating in a practice that is now often carried out in secret.  And making that behavior change visible is a critical element to facilitating mass adoption.

As Mark Earls describes in HERD, most efforts to change behavior misunderstand the very nature of human behavior in the first place.  They assume that human beings are rational, independent decision makers.  In reality, the decisions we make are often irrational and largely influenced by others.  Mark argues that to create behavior change we need to start thinking of people as herd animals.  That is, we do what we do largely because of what we see others doing around us.  The cows in West Pokot allow others to see what the women are, in this case, no longer doing.  The cows act as both incentive to participate and marketing vehicle.  The consumer analogue Earls would point to is the white ear buds for iPod.  Since mp3 players are typically stashed away in the listener's pocket, the white earbuds make it clear to passersby who is actually listening to an iPod.  The earbuds make the behavior visible.  And making the behavior visible facilitates peoples' natural tendency towards copying.  It's then no surprise that the advertising campaign that launched the iPod didn't focus on the revolutionary technology or beautiful design, it focused on that one simple way to signify iPod ownership and thereby accelerate mass adoption. In effect, the cows are the white earbuds of West Pokot's campaign to stop FGM - a way to make an otherwise hidden behavior visible.  And thereby, encourage copying and mass behavior change.

This is not to diminish the role the cows play as an income generating incentive.  The incentive is critical.  But so is the uniformity of that incentive.  Had the women not been asked to agree upon a single income generating activity and rather been given money to start a business of their own choosing, the opportunity to broadcast the behavior change would be lost.  The cows act as an icon for the campaign's effort to end FGM.  And in this remote corner of Kenya, the sight of women herding cattle may actually help usher in a new era of health and human rights for women.