Global Health Financing in an Age of Fiscal Austerity
With an election year up on us here in the United States, there have been repeat attacks on how we invest US dollars overseas, particularly through foreign aid programs and from some very vocal critics of foreign aid funding amongst the GOP primary candidates. (I’m looking at you, Ron Paul.). Both those outside and within the development bubble have begun to acknowledge the importance of becoming more results-driven and evidence focused in global health programming, as evident in the year-old USAID Evaluation policy, the focus on results-based financing projects, and the renewed interest in investing in operations research amongst some donors.
Tracking outcomes through rigorous monitoring and evaluation systems is one piece of that puzzle. The other is knowing where funding is being spent, in order to determine where we’re seeing the greatest impact for our dollar. Not a small order, given the complexity of how health programs around the world are financed through bilateral, multilateral and other agreements, with funds often shifting from on implementing agency to another through sub-contracting agreements.
The Institute for Health Metrics and Evaluation has recently published their third annual report on global health financing, one of the most comprehensive looks at where DAH is coming from, where funds are going, how funds are being used, and what kind of changes have we seen in the donor landscape over time. Authors Chris Murray and Michael Hanlon spoke on January 19th at the Global Health Council about their findings in the most recent iteration of the report, and some of the key trends that emerged.
From 1990 to 2011, DAH has increased from $6 billion to nearly $28 billion respectively, with the greatest increases in the past decade. This figure from the report shows how DAH has increased over the past two decades, breaking down each year by donor.
“Continued growth from 2010 to 2011 was a welcome surprise,” said Dr. Murray. While funding from some institutions like the Global Fund, United Nations, and US-based foundations, increases from other sources (NGOs, GAVI, bilaterals, and World Bank loans) increased and made up for the gap. Dr. Hanlon highlighted three key findings he took away from the analysis and writing the report: funding for HIV has flattened in recent years, malaria funding is increasing, and TB funding is increasing. Together, changes in funding for these three disease areas are driving the overall changes in trends.
Two key themes emerged through the presentation and comments from attendees at the event:
- how does donor funding impact country government spending on health (substitutability or subadditionality, depending on who was talking about it), and
- how does the emphasis on showing short, quick gains impact spending on health systems or health sector strengthening activities necessary to create sustainable programs?
I’ll explore the discussions around both in two subsequent posts in this series.
The report provides a wealth of information, including data on funding by technical area, country, and donor. The data set is also publicly available if you’re a researcher looking to run your own analyses. Numerous static and interactive graphics are also available on the IHME website; I found the treemap of development assistance by technical area over time quite fun.
This post is the first of four on findings from the IHME Global Health Financing 2011 Report & how they fit in the broader context of the global health landscape.
Inner Domesticity
Somehow it’s almost Christmas & 2011 seems to have flown by. In the flurry of activity, my time to share here has been limited due to competing priorities at work & with volunteering with OHMH and Culinaerie.
As I continue to grow & share those experiences, many of you who read this site & keep up with me either in person or through social media have asked why I don’t post recipes with the endless stream of food photos that end up on my twitter & facebook pages. Well, if you ask you will receive…eventually…
Inner Domesticity is a new tumblr I launched in order to share photos, recipes, cooking-related ideas, and other things I find generally inspiring. Less wonky & certainly less internationally focused than here, but perhaps more uplifting.
Bon appetit mes amis!
Fact: Put #Kardashian in a tweet and watch it spread.
Yesterday I posted a series of tweets with facts about the crisis in the Horn of Africa as part of the USAID FWD Global Day of Action, trying to do my part to spread my word to some of the 13.3 million people the agency was trying to reach with facts about the crisis.
I have a reasonable following on Twitter (around 1,200) for a personal account, and followers were kind enough to retweet some of the facts.
Actual facts about the Horn of Africa: 5 or fewer RTS.
This tweet:
More than 40 RTs and numerous comments.
Lesson: connect the wonky development numbers to pop culture and other contextual cues that people can relate to, and anecdotal evidence indicates that they’ll be more likely to laugh a little & pay some attention. We live in a sea of stats and data which can be hard to navigate or personalize. Connecting something that has been splashed all over the media (the Kardashian wedding) to what’s happening in a place that seems so distant (Somalia/Kenya/Ethiopia) seemed to get the point across.
That said, I have no way of knowing if the people who responded were already engaged in the issue, actually looked at the website, or took any other action. But I do think we need to start looking at ways to connect the information we have about global health and crises we’re trying to increase awareness of to examples that make sense to the general public.
Your thoughts? Any success stories on spreading the word for #FWD’s big day? I’d love to hear them.
FWD the Facts: November 9th as a Global Day of Action
Fact #1: Nearly 13 million people have been affected by the famine, drought, and war happening across the Horn of Africa.
Fact #2: That number (13 million) is more than four times the number affected by the earthquake in Haiti (3 million) and seven times the number affected by the tsunami in Indonesia (2 million).
Fact #3: Every six minutes, a child in Somalia dies from dehydration or malnutrition.
And my hypothesis: Despite all of this, it’s more likely that you donated to one of the other aforementioned crises and saw more media coverage than you’ve seen around the famine devastating the Horn of Africa. And many of you may be able to name all of the Kardashian sisters quicker than the countries affected by the crisis.*
The Kim’s divorce, the Michael Jackson verdict, and changes in Blake Lively’s relationship status all seem to be getting more press than this crisis. This raises questions about the values of the American media, which are ultimately driven by why sells to the American public. Are we burnt out on hearing about drought and famine in other countries? Do we not care? I vote no on both. We may be burnt out on tired and sad imagery, but we need to know the facts about what is happening in our global society. And we do care: even when life is challenging here, the lowest common denominator for a standard of living is lower for a Somalian refugee than for those struggling to make ends meet here in America, where at least we can turn on a tap for a drink of potable water.
USAID, an agency starting to try to push the envelope on sharing and social media, launched their USAID Forward the Facts (FWD) campaign at the Social Good Summit nearly two months ago. Since then, they have loaded the site with resources and action items people can take, from a $10 text donation to sample letters to the editor and Facebook status updates that “Forward the Facts” about the crisis in the Horn.
Today is their global day of action. The goal: to get 13 million people to forward the facts, hopefully sparking collective advocacy and activism around the crisis. Social networks are powerful things, as this video on the power of information sharing around vaccination illustrates:
Will you join us and share a fact as a status update, send a text donation, or even write your own blog post to increase awareness? Let me know what you decide to do – I’ll happily retweet and share.
*The main countries include Somalia, Kenya, and Ethiopia. Parts of South Sudan, Sudan, Djbouti, and Uganda have also been affected.
Whoopi Goldberg on why Americans should care about global health
“Why keep BS-ing ourselves? Why not get in and take care of business?”
Plus, others – like Rep. Markey and USAID’s Amy Batson - share their thoughts on the same question.
Updates: Moving forward & food love.
Posts here have become more staggered as my position at JSI picks up steam and we move into the fall Breaking Ground campaign – now underway – for One Home Many Hopes. There are also a number of brilliant voices writing in the international development and global health fields; when I’ve been writing lately, it’s been for the USAID Impact Blog or MCHIP, rather than my personal site. And while I could cross post here, I feel better pushing out the original links on my social media feeds.
Which all brings me to an odd point in the blog world. What I get asked most about by friends & Twitter followers alike is why I don’t post more recipes and information connected to the food photos that go up from all of my culinary adventures. Ask and you shall receive, my friends, though it may have taken me more than a year to get around to it..
Next week, once I’ve made the tweaks I want (and probably spent a few more hours on the phone with my brother, since I find customizing things to be easier on Tumblr if you can write/read HTML or CSS), I’ll post the URL for the new site & you’re welcome to keep an eye on it for food news, restaurant raves & rants, and recipes (with appropriate food porn to match). This site will remain active with continued intermittent posts, and I’ll try to get better at posting links to my other content.
Until next week…bon appetit!
Community Health Workers Save Lives
Community Health Workers (CHWs) have been getting more buzz lately than ever before, and for good reason. They’re able to provide services to people in rural and remote areas, improve equitable service delivery, and implement simple interventions (like vaccinations) that can have a huge impact on morbidity and mortality.
I’ve written about CHWs and the CHW Central resource on the MCHIP website, and today GOOD posted a fantastic infographic that really makes the case clear.
For your entertainment.
It’s amazing what manages to go viral (#HermanCainPizzaJams anyone?) and what videos seem limited to the niche market of aid wonks. I stumbled on this video from the Clinton Global Initiative featuring it’s Celebrity Advocacy Division & it’s celeb-advocates including Matt Damon, Ben Stiller, Kristen Wigg, and even a cameo by President Bill Clinton himself.
From reading Fast Company’s profile of Matt Damon’s work around advocacy for Water.org, my guess is that he would have more to contribute than just a softball team name. That said, though, this was an entertaining way to end my day.
Inspiration from Steve Jobs
In honor of Steve Jobs’ passing, here are 13 quotes that have inspired people around the globe. No matter what you think of the Apple brand, he was a visionary and inspiring leader who will be sorely missed by the technology community & millennials around the globe.
“Stay hungry. Stay foolish.”
“Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do. If you haven’t found it yet, keep looking. Don’t settle. As with all matters of the heart, you’ll know when you find it. And, like any great relationship, it just gets better and better as the years roll on.” (my favorite & definitely words to live by)
“When I was 17, I read a quote that went something like: “If you live each day as it it was your last, someday you’ll most certainly be right.” It made an impression on me, and since then, for the past 33 years, I have looked in the mirror every morning and asked myself: “If today were the last day of my life, would I want to do what I am about to do today?” And whenever the answer has been “No” for too many days in a row, I know I need to change something.”
“We don’t get a chance to do that many things, and every one should be really excellent. Because this is our life.”
“Remembering that you are going to die is the best way I know to avoid the trap of thinking you have something to lose.”
“You can’t connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something – your gut, destiny, life, karma, whatever. This approach has never let me down, and it has made all the different in my life.”
“Design is not just what it looks like. Design is how it works.”
“I want to put a ding in the universe.”
“No one wants to die. Even people who want to go to heaven don’t want to die to get there. And yet death is the destination we all share. No one has ever escaped it. And that is as it should be, because Death is very likely the single best invention of Life. It is Life’s change agent. It clears out the old to make way for the new. Right now the new is you, but someday not too long form now, you will gradually become the old and be cleared away. Sorry to be so dramatic, but it’s quite true.”
“Being the richest man in the cemetery doesn’t matter to me. Going to bed at night saying we’ve done something wonderful, that’s what matters to me.”
“You can’t just ask customers what they want and then try to give that to them. By the time you get it built, they’ll want something new.”
“My model for business is The Beatles: They were four guys that kept each other’s negative tendencies in check; they balanced each other. And the total was great than the sum of the parts.”
“That’s been one of my mantras – focus and simplicity. Simple can be harder than complex: You have to work hard to get your thinking clean to make it simple. But it’s worth it in the end because once you get there, you can move mountains.”
“I’m convinced that about half of what separates the successful entrepreneurs from the non-successful ones is pure perseverance.”
“Your time is limited, so don’t waste it living someone else’s life. Don’t be trapped by dogma – which is living with the results of other people’s thinking. Don’t let the noise of other’s opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.”
Note: These quotes were compiled by Mashable from a variety of Tumblr accounts. I find the slideshow presentation of them to be clunky and slow on the slow bandwidth here in Rwanda, so I’ve pasted them as a list instead. You can view the original post here.
Private Investment in Public Good
Combining the resources and expertise of the public and private sectors is a powerful development tool. Technical experts in health, agriculture, and other arenas can work across companies and agencies to maximize the impact of project dollars spent, and find innovative solutions to global challenges.
Throughout the Social Good Summit, numerous companies and private organizations have highlighted their initiatives and financial commitments to provide services, technology, or advocacy to improve the lives of those overseas. The commitments made by these companies are both forward thinking and inspiring, illustrating the power private industry has to improve lives and satisfy shareholders. A few examples highlighted at the Summit follow.
Merck committed $500 million over 10 years through their Merck for Mothers initiative to support access to drugs to for postpartum hemorrhage and pre-eclampsia/eclampsia, and family planning services. Globally, an estimated 215 million women want access to family planning services but don’t have it, and approximately 350,000 women die in childbirth each year. By providing access to contraception, an estimated 32 percent of those deaths could be averted, if not more. In a panel discussion around maternal mortality and the new initiative, the program’s director highlighted the company’s commitment to continue their support of affordable family planning services until we meet Millennium Development Goal 5.
Ericsson has a series of Technology for Good initiatives around maternal and child health, refugees, and education. In a conversation with Ericsson CEO Hans Vestberg and Director of Sustainability Elaine Weidman, both highlighted these initiatives as some of the most inspiring and important projects within the company. Program recipients in the Millennium Villages across 10 countries in sub-Saharan Africa receive the same quality products as consumers in the US and Europe, and are finding new uses for hardware technology never anticipated when the product was being designed.
Dow-Corning committed $5 million to the Global Alliance for Clean Cookstoves, which aims to avert many of the 2 million deaths that occur annually due to exposure to cookstove smoke. Their goal: empower 100 million home to adopt clean and efficient stoves and fuels by 2020. The financial commitment from Dow Corning will be supported with both technical and human resource for the Alliance’s programs. “This commitment will allow us to explore how to use our technology, business, and innovation expertise to provide a valuable contribution to improve and even save lives of those exposed to smoke from traditional cookstoves, especially women and children who spend hours each week collecting fuel, often in dangerous circumstances,” said Bob Hansen, Dow Corning President and CEO.
USAID also engages in numerous public private partnerships, recognizing the need to leverage business expertise to maximize the gains in health and development outcomes. Current alliances included the Mobile Alliance for Maternal Action, Helping Babies Breathe, Handwashing with Soap, and the African Diaspora Marketplace. MCHIP is an implementing partner or otherwise involved in the first three of these initiatives, providing necessary technical and logistic support. Continued development of partnerships is supported by Administrator Raj Shah and the USAID Forward agenda, allowing the Agency to “unleash it’s full potential to achieve high-impact development.”
In his speech to the UN General Assembly, President Obama said: “To bring prosperity to our people, we must promote the growth that creates opportunity…Innovation and entrepreneurship has transformed the way we live and the things that we can do. Emerging economies from Asia to the Americas have lifted hundreds of millions from poverty.“ Private support for international development endeavors, like those highlighted at the Social Good Summit, will continue to play an important role achieving the MDGs and other development goals.
Cross posted from MCHIP.
President Obama at UNGA: Remarks on Public Health
“To combat the poverty that punishes our children, we must act on the belief that freedom from want is a basic human right. The United States has made it a focus of our engagement abroad to help people to feed themselves. And today, as drought and conflict have brought famine to the Horn of Africa, our conscience calls on us to act. Together, we must continue to provide assistance, and support organizations that can reach those in need. And together, we must insist on unrestricted humanitarian access so that we can save the lives of thousands of men, women and children. Our common humanity is at stake. Let us show that the life of a child in Somalia is as precious as any other. That is what our commitment to our fellow human beings demands.
To stop disease that spreads across borders, we must strengthen our systems of public health. We will continue the fight against HIV/AIDS, tuberculosis and malaria. We will focus on the health of mothers and children. And we must come together to prevent, detect, and fight every kind of biological danger – whether it is a pandemic like H1N1, a terrorist threat, or a treatable disease. This week, America signed an agreement with the World Health Organization to affirm our commitment to meet this challenge. Today, I urge all nations to join us in meeting the WHO’s goal of making sure all nations have core capacities to address public health emergencies in place by 2012. That is what our commitment to the health of our people demands.”
President Obama, UN General Assembly speech, September 21, 2011
Four themes from Day 1 at #socialgood
The Social Good Summit kicked off today with an exciting round of presentations a varied lineup of billionaires, entrepreneurs, nonprofit enthusiasts, and senior government officials. I’ve seldom been to a conference with a more content-dense four hours of presenters (which even managed to stay on time through around 3:30 pm!), and met some interesting and insightful individuals interested in development and gobal issues from a wide range of perspectives.
While it’s hard to distill so much conversation and information into short bullet points, there were a few themes that emerged throughout the day.
1. People care. There is a huge interest in finding ways to leverage technology and social networks for good, and individuals and organizations are finding interesting new ways to make progress. Idealist is launching a service to “connect dots and connect people,” piloting in NYC. One Laptop Per Child reached a milestone in Uruguay, where every child 5-15 years of age has a laptop, which has revolutionized both learning in the classroom and at home. And Charity : Water is taking their transparency to the next level by allowing donors to see exactly what project their dollars went to in honor of their fifth anniversary. No one dedicates their life and professional career to these ventures without caring.
2. Health is fundamental. Ted Turner said it right up front: “Health care is not controversial…Everybody’s for better health for children and everybody else.” Throughout the day, other presenters, including Raj Shah and Christy Turlington Burns, talked about why global health matters, everywhere from the Horn of Africa* to rural Bangladesh. And here too.
3. Embrace social media as a tool for good. Alec Ross closed out the day with a presentation on the role of networks in foreign policy, telling an interesting story about Hillary Clinton and a half hour online roundtable hosted by an Egyptian firm, where she took hard hitting questions from Egyptian youth critical of America and it’s role during their revolution. There was no mahogany-table photo op for Politico, but, as Ross said, “her answers earned her some serious street cred.” Social media provides those kind of opportunities to connect, crossing normal hierarchical boundaries and geographical lines. To quote Ross again:
“Established authorities are now having to contend with this disruption [of social media]. And they can fight it, litigate it, or find ways to work with it. By fighting it, they swim against the tide of history.”
4. Believe in your own abilities. And, if you follow Ted Turner’s advice, “Early to bed, early to rise, work like hell, but advertise.” Young people, particularly those in college and their twenties, are going to have to be the ones to advocate for improved policies on climate change, overfishing, health, and all sorts of other things (according to Ted), and we’re only more powerful as individuals when we come together around a common cause. Monique, the famous singer who served as an ambassador for the UN, said it well when asked how young people can make a difference. Part of her answer focused on connecting to others, but in summary she said:
“Every young person [should] pursue their greatest passion, and inside of themselves say what aspect can be applied toward social good…I don’t want young people to have to wait till they become successful to make a difference.”
If today was any indication, there are a number of us young people who have connected to causes we care about and speak to with great passion, which keeps me excited for what’s to come in the next few days of the summit.
*If you’re looking to take action around the health and humanitarian crisis in the Horn of Africa, due to the ongoing drought and famine, check out my post about the new USAID FWD (Famine, War, and Drought Relief) campaign over on the MCHIP blog. FWD is a progressive and smart website launched today by the Agency to better connect Americans with what’s happening on the ground, both good and bad.
Dear Google Marketing Department
You are brilliant.
Haven’t seen the genius yet?
and
Thanks for the smiles and bringing a little tear. I needed that this week.
Twitter Chaos
Twitter. Facebook. Blogs.
What would 9/11 have been like if we had all of those different forms of social media, with the popularity, that we have now? Those mediums undoubtedly changed how much of America (and the world) experienced the news that Obama Bin Laden had been killed. We didn’t just have CNN and other news stations to watch; we had live feeds pouring into our phones and computers from friends, family, and strangers around the world.
Wondering just how popular twitter really is for breaking news? Check out this graph of tweets per minute surrounding the announcement.
Thanks to Jessica DiRocco, a young professional who works at USAID and blogs at http://jessicadirocco.blogspot.com for the link.
People who make OHMH work.
I love serving as the DC Director for OHMH, and was even more delighted to join the company of other volunteers when our resident blogger interviewed me. There are dozens of talented people who help make OHMH what it is, and I feel privileged to work with so many of them.
A few you can meet through the OHMH blog:
Jason Jacob – Boston
Cristina Banderas – NYC
Me – DC
DC Aid Hack #tweetup
After a long day checking to see who retweeted your latest blog post while trying to get a report done for the job that actually pays you, you deserve a drink. So, come on out and meet all the others who spend their day improving their work efficiency through twitter.
If you do not use twitter, join now or you will be ridiculed by all for not having a clever handle that is the adult version of an AIM username. Please bring friends and co-workers who might be interested in hanging out with people who work in international aid and development. Heck, bring your dog; it would be a great conversation piece.
Our commitment to you who are already tweeting away: we will not judge you based on your Klout rating. At least one attendee with a Klout rating higher than Bill Easterly will be in attendance, in case that’s an incentive to come. Not saying who…it could be Bieber.
We will be gathering downstairs at the Iron Horse starting at 6PM. There will be some fun balloons that are guaranteed to be filled with helium. If you feel like you might want food, do not worry because the Iron Horse will not provide any. So, be sure to bring a snack or even a meal to the bar.
Hope to see you all there!
RSVP here
Brought to you by technology and the amazing planning skills of Tom (@viewfromthecave), Lauren (@laurenist), Linda (@meowtree), myself (@abmakulec), and others.
A speech worth reading.
A friend passed this along via e-mail, and while it’s dated May 1999, the themes are equally relevant today.
And if you don’t have time to read the whole thing, at least internalize one of the most important lines:
“But nothing important, or meaningful, or beautiful, or interesting, or great ever came out of imitations. The thing that is really hard, and really amazing, is giving up on being perfect and beginning the work of becoming yourself.”
–
Anna Quindlen’s commencement speech at Mount Holyoke College (May 23,1999)
I look at all of you today and I cannot help but see myself twenty-five years ago, at my own Barnard commencement. I sometimes seem, in my mind, to have as much in common with that girl as I do with any stranger I might pass in the doorway of a Starbucks or in the aisle of an airplane. I cannot remember what she wore or how she felt that day. But I can tell you this about her without question: she was perfect.
Let me be very clear what I mean by that. I mean that I got up every day and tried to be perfect in every possible way. If there was a test to be had, I had studied for it; if there was a paper to be written, it was done. I smiled at everyone in the dorm hallways, because it was important to be friendly, and I made fun of them behind their backs because it was important to be witty. And I worked as a residence counselor and sat on housing council. If anyone had ever stopped and asked me why I did those things–well, I’m not sure what I would have said. But I can tell you, today, that I did them to be perfect, in every possible way.
Being perfect was hard work, and the hell of it was, the rules of it changed. So that while I arrived at college in 1970 with a trunk full of perfect pleated kilts and perfect monogrammed sweaters, by Christmas vacation I had another perfect uniform: overalls, turtlenecks, Doc Martens, and the perfect New York City Barnard College affect–part hyperintellectual, part ennui. This was very hard work indeed. I had read neither Sartre nor Sappho, and the closest I ever came to being bored and above it all was falling asleep. Finally, it was harder to become perfect because I realized, at Barnard, that I was not the smartest girl in the world. Eventually being perfect day after day, year after year, became like always carrying a backpack filled with bricks on my back. And oh, how I secretly longed to lay my burden down.
So what I want to say to you today is this: if this sounds, in any way, familiar to you, if you have been trying to be perfect in one way or another, too, then make today, when for a moment there are no more grades to be gotten, classmates to be met, terrain to be scouted, positioning to be arranged–make today the day to put down the backpack. Trying to be perfect may be sort of inevitable for people like us, who are smart and ambitious and interested in the world and in its good opinion. But at one level it’s too hard, and at another, it’s too cheap and easy. Because it really requires you mainly to read the zeitgeist of wherever and whenever you happen to be, and to assume the masks necessary to be the best of whatever the zeitgeist dictates or requires. Those requirements shapeshift, sure, but when you’re clever you can read them and do the imitation required.
But nothing important, or meaningful, or beautiful, or interesting, or great ever came out of imitations. The thing that is really hard, and really amazing, is giving up on being perfect and beginning the work of becoming yourself.
This is more difficult, because there is no zeitgeist to read, no template to follow, no mask to wear. Set aside what your friends expect, what your parents demand, what your acquaintances require. Set aside the messages this culture sends, through its advertising, its entertainment, its disdain and its disapproval, about how you should behave.
Set aside the old traditional notion of female as nurturer and male as leader; set aside, too, the new traditional notions of female as superwoman and male as oppressor. Begin with that most terrifying of all things, a clean slate. Then look, every day, at the choices you are making, and when you ask yourself why you are making them, find this answer: for me, for me. Because they are who and what I am, and mean to be.
This is the hard work of your life in the world, to make it all up as you go along, to acknowledge the introvert, the clown, the artist, the reserved, the distraught, the goofball, the thinker. You will have to bend all your will not to march to the music that all of those great “theys” out there pipe on their flutes. They want you to go to professional school, to wear khakis, to pierce your navel, to bare your soul. These are the fashionable ways. The music is tinny, if you listen close enough. Look inside. That way lies dancing to the melodies spun out by your own heart. This is a symphony. All the rest are jingles.
This will always be your struggle whether you are twenty-one or fifty-one. I know this from experience. When I quit the New York Timesto be a full-time mother, the voices of the world said that I was nuts. When I quit it again to be a full-time novelist, they said I was nuts again. But I am not nuts. I am happy. I am successful on my own terms. Because if your success is not on your own terms, if it looks good to the world but does not feel good in your heart, it is not success at all. Remember the words of Lily Tomlin: If you win the rat race, you’re still a rat.
Look at your fingers. Hold them in front of your face. Each one is crowned by an abstract design that is completely different than those of anyone in this crowd, in this country, in this world. They are a metaphor for you. Each of you is as different as your fingerprints. Why in the world should you march to any lockstep?
The lockstep is easier, but here is why you cannot march to it. Because nothing great or even good ever came of it. When young writers write to me about following in the footsteps of those of us who string together nouns and verbs for a living, I tell them this: every story has already been told. Once you’ve read Anna Karenina, Bleak House, The Sound and the Fury, To Kill a Mockingbirdand A Wrinkle in Time,you understand that there is really no reason to ever write another novel. Except that each writer brings to the table, if she will let herself, something that no one else in the history of time has ever had. And that is herself, her own personality, her own voice. If she is doing Faulkner imitations, she can stay home. If she is giving readers what she thinks they want instead of what she is, she should stop typing.
But if her books reflect her character, who she really is, then she is giving them a new and wonderful gift. Giving it to herself, too.
And that is true of music and art and teaching and medicine. Someone sent me a T-shirt not long ago that read “Well-Behaved Women Don’t Make History.” They don’t make good lawyers, either, or doctors or businesswomen. Imitations are redundant. Yourself is what is wanted.
You already know this. I just need to remind you. Think back. Think back to first or second grade, when you could still hear the sound of your own voice in your head, when you were too young, too unformed, too fantastic to understand that you were supposed to take on the protective coloration of the expectations of those around you. Think of what the writer Catherine Drinker Bowen once wrote, more than half a century ago: “Many a man who has known himself at ten forgets himself utterly between ten and thirty.” Many a woman, too.
You are not alone in this. We parents have forgotten our way sometimes, too. I say this as the deeply committed, often flawed mother of three. When you were first born, each of you, our great glory was in thinking you absolutely distinct from every baby who had ever been born before. You were a miracle of singularity, and we knew it in every fiber of our being.
But we are only human, and being a parent is a very difficult job, more difficult than any other, because it requires the shaping of other people, which is an act of extraordinary hubris. Over the years we learned to want for you things that you did not want for yourself. We learned to want the lead in the play, the acceptance to our own college, the straight and narrow path that often leads absolutely nowhere. Sometimes we wanted those things because we were convinced it would make life better, or at least easier for you. Sometimes we had a hard time distinguishing between where you ended and we began.
So that another reason that you must give up on being perfect and take hold of being yourself is because sometime, in the distant future, you may want to be parents, too. If you can bring to your children the self that you truly are, as opposed to some amalgam of manners and mannerisms, expectations and fears that you have acquired as a carapace along the way, you will give them, too, a great gift. You will teach them by example not to be terrorized by the narrow and parsimonious expectations of the world, a world that often likes to color within the lines when a spray of paint, a scrawl of crayon, is what is truly wanted.
Remember yourself, from the days when you were younger and rougher and wilder, more scrawl than straight line. Remember all of yourself, the flaws and faults as well as the many strengths. Carl Jung once said, “If people can be educated to see the lowly side of their own natures, it may be hoped that they will also learn to understand and to love their fellow men better. A little less hypocrisy and a little more tolerance toward oneself can only have good results in respect for our neighbors, for we are all too prone to transfer to our fellows the injustice and violence we inflict upon our own natures.”
Most commencement speeches suggest you take up something or other: the challenge of the future, a vision of the twenty-first century. Instead I’d like you to give up. Give up the backpack. Give up the nonsensical and punishing quest for perfection that dogs too many of us through too much of our lives. It is a quest that causes us to doubt and denigrate ourselves, our true selves, our quirks and foibles and great leaps into the unknown, and that is bad enough.
But this is worse: that someday, sometime, you will be somewhere, maybe on a day like today–a berm overlooking a pond in Vermont, the lip of the Grand Canyon at sunset. Maybe something bad will have happened: you will have lost someone you loved, or failed at something you wanted to succeed at very much.
And sitting there, you will fall into the center of yourself. You will look for that core to sustain you. If you have been perfect all your life, and have managed to meet all the expectations of your family, your friends, your community, your society, chances are excellent that there will be a black hole where your core ought to be.
Don’t take that chance. Begin to say no to the Greek chorus that thinks it knows the parameters of a happy life when all it knows is the homogenization of human experience. Listen to that small voice from inside you, that tells you to go another way. George Eliot wrote, “It is never too late to be what you might have been.” It is never too early, either. And it will make all the difference in the world. Take it from someone who has left the backpack full of bricks far behind. Every day feels light as a feather.
A bit selfish.
In President Obama’s State of the Union address, he said:
Today, there are hundreds of thousands of students excelling in our schools who are not American citizens. Some are the children of undocumented workers, who had nothing to do with the actions of their parents. They grew up as Americans and pledge allegiance to our flag, and yet they live every day with the threat of deportation. Others come here from abroad to study in our colleges and universities. But as soon as they obtain advanced degrees, we send them back home to compete against us. It makes no sense.
Now, I strongly believe that we should take on, once and for all, the issue of illegal immigration. And I am prepared to work with Republicans and Democrats to protect our borders, enforce our laws and address the millions of undocumented workers who are now living in the shadows. (Applause.) I know that debate will be difficult. I know it will take time. But tonight, let’s agree to make that effort. And let’s stop expelling talented, responsible young people who could be staffing our research labs or starting a new business, who could be further enriching this nation.
When I heard this statement, I was surprised and a bit confused. I’m going to leave the issue of children of undocumented and illegal immigrants to someone with more expertise in the area, but I do find it odd to propose that we should keep foreign nationals here in America to work in our labs, research facilities, and other professional roles, when so many countries overseas continue to experience “brain drains” where a number of highly educated men and women chose to seek employment outside of their home nation.
I’m all for bright, intelligent young men and women from other countries coming to the US to attend one of our colleges or universities, particularly if they don’t have similar education opportunities in their home countries. The diverse life experiences and cultural traditions foreign students bring enrich the experiences of other students – some of the most interesting and insightful experiences I had in college were through interactions with international students. But, after graduation day has passed, I think we should be supportive of those who want to return home and use their education to improve their own country, building local capacity in a way that may be a bit different that the typical aid model. Otherwise, I think we’re being a bit selfish.
Perspective: looking forward
“For all our failings, despite our limitations and fallacies, we humans are capable of greatness.”
As the heated rhetoric of politics and policy took a short backseat to moments of silence and condolences for the innocent lives lost over the past few days, I stumbled on this video that put life in perspective. And made me think about how people in future generations would reflect on us, our actions, and our words, and where we might find ourselves in the future.
“Our remote descendants, safely arrayed on many worlds through the solar system and beyond, will be unified. By their common heritage, by their regard for their home planet, and by the knowledge that whatever other life may be, all humans, in all the universe, come from Earth. They will gaze up and strain to find the blue dot in their skies. They will marvel at how vulnerable the repository of all our potential once was. How perilous our infancy. How humble our beginnings. How many rivers we had to cross before we found our way.” [Carl Sagan]
Now, if only we can begin to seek common ground rather than arguments today.
In my dream, the angel shrugged & said, If we fail this time, it will be a failure of imagination & then she placed the world gently in the palm of my hand. ::storypeople::
Merry Christmas to all, wherever life has taken you this year.
On AED & aid appropriations
Last week, on Wednesday, USAID officially suspended the Academy for Educational Development (AED) from receiving future USG funds. AED released a statement the following day, and the news broke in different media outlets, including the Washington Post. With a portfolio of approximately $640 million in USAID contracts and projects in over 150 different countries, AED is a major player in development projects and has been held in high regard by many of my friends and colleagues who work in global health. The company has $109 million in contracts in Afghanistan alone, and has now been identified as the contractor that had issues with illicit use of funds/overpayment in a project in Pakistan this past summer; the investigation has focused on projects in Afghanistan and Pakistan, according to the Washington Post.
Development work is never going to be easy, straightforward, or without its leakages or corruption: no industry is perfect, least of all one working to alleviate global poverty and improve the lives of people overseas. No easy task. And some may argue that under-the-table payments and inflated financial incentives are simply a price paid for getting work done and saving lives: if a few extra dollars (or thousands) is what it takes to get a maternity ward built, will the number of lives saved be worth it? Ethics and decision making in aid, at a local level, are shades of gray, not black and white.
That said, to suspend a major contractor like AED after an investigation spanning nearly a year and a half, there must be systematic, high-level corruption, not simply mismanagement of funds on one specific project. USAID stated the suspension was due to “evidence of serious corporate misconduct, mismanagement, and a lack of internal controls, and raise serious concerns of corporate integrity.” It is my understanding that more specifics about the investigations findings will be released eventually, though I don’t have a great familiarity with the rules governing this kind of investigation or suspension.
While I feel sympathetic for the thousands of AED staff affected by this suspension who had no part in any sort of corruption, I commend USAID for taking action to prevent misuse of funds, and think this kind of accountability will only be more important in the coming two years. With Republicans – who have historically been less supportive of foreign aid – controlling the House for the coming Congress, and continued economic challenges domestically, I feel less than confident that the US will step up to meet the challenge of appropriating adequate funds to meet development goals overseas, and documentation of corruption and misuse of funds will certainly be used in next years appropriations hearings by those arguing aid dollars would be better spent here at home.
The ambitious (but still ambiguous) goals of the Global Health Initiative, the need to scale up to follow revised recommendations from the WHO for when an HIV-positive individual should initiate ART, and the continued challenge of to support developing countries aiming to meet the MDGs all require resources. Great Britain has stepped up and committed to meeting the target of 0.7% of GDP spent on overseas development assistance, but I sincerely doubt the US will be making a similar commitment anytime soon, especially under a Republican controlled House.
I would be interested in hearing thoughts and reflections from those working in this industry longer than I on what the long term fall out from the AED suspension will be.
