"The opening deal"

I liked this quote from economist Karthik Muralidharan, which is pulled from a conversation at Ideas for India with Kaushik Basu of the World Bank:

My own take on what is happening in economics as a profession, talking to people in other disciplines, is that our fundamental weakness at some level is that because the touchstone of policy evaluation is the idea of a Pareto improvement (is someone better off and no one worse off) - effectively, economists do not question the justice of the initial positions. You kind of take the initial position as granted and say that conditional on this, how do I improve things on the margin.

Given vast inequalities in the opening deal of cards, so to speak, there is obviously a deep political need to create the space for more pro-poor policy. I think because the professional economists have abdicated that space to saying that it is a philosophical debate and we have really nothing to say, the rights-based movement that has created the political space for pro-poor policy has also then occupied the space of how to design it because they are the people who have created the political movement.

My own view on this is that because economists have kind of been seen as apologists for the status quo in many settings, we have lost the credibility to say that we are as pro-poor as you are, but conditional on these objectives there are much better ways to design it.

Lots on poverty policy, inequality, etc at the link.

Have recent global health gains gone to the poor?

Have recent global gains gone to the poor in developing countries? Or the relatively rich? An answer:

We find that with the exception of HIV prevalence, where progress has, on average, been markedly pro-rich, progress on the MDG health outcome (health status) indicators has, on average, been neither pro-rich nor pro-poor. Average rates of progress are similar among the poorest 40 percent and among the richest 60 percent.

That's Adam Wagstaff, Caryn Bredenkamp, and Leander Buisman in a new article titled "Progress on Global Health Goals: are the Poor Being Left Behind?" (full text here). The answer seems to be "mostly no, sometimes yes", but the exceptions to the trend are as important as the trend itself.

I originally flagged this article to read because Wagstaff is one of the authors, and I drew on a lot of his work for my masters thesis (which looked at trends in global health inequities in Ethiopia). One example is this handy World Bank report (PDF) which is a how-to for creating concentration indexes and other measures of inequality, complete with Stata. A concentration index is essentially a health inequality version of the Gini index: instead of showing the concentration of wealth by wealth, or income by income, you measure the concentration of some measure of health by a measure of wealth or income, often the DHS wealth index since it's widely available.

If your chosen measure of health -- let's say, infant mortality -- doesn't vary by wealth, then you'd graph a straight line at a 45 degree angle -- sometimes called the line of equality. But in most societies the poor get relatively more of a bad health outcome (like mortality) and rather less of good things like access to vaccination. In both cases the graphed line would be a curve that differs from the line of equality, which is called a concentration curve. The further away from the line of equality the concentration curve is, the more unequal the distribution of the health outcome is. And the concentration index is simply twice the area between the two lines (again, the Gini index is the equivalent number when comparing income vs. income). The relationship between the two is illustrated in this example graph from my thesis:

You can also just compare, say, mortality rates for the top and bottom quintiles of the wealth distribution, or comparing the top 1% vs. bottom 99%, or virtually any other division, but all of those measures essential ignore a large amount of information in middle of the distribution, or require arbitrary cutoffs. The beauty of concentration curves and indexes is that they use all available information. An even better approach is to use multiple measures of inequality and see if the changes you see are sensitive to your choice of measures; it's a more a convincing case if they're not.

The new Wagstaff, Bredenkamp, and Buisman paper uses such concentration indexes, and other measures of inequity, to "examine differential progress on health Millennium Development Goals (MDGs) between the poor and the better off within countries." They use a whopping 235 DHS and MICs surveys between 1990-2011, and find the following:

On average, the concentration index (the measure of relative inequality that we use) neither rose nor fell. A rosier picture emerges for MDG intervention indicators: whether we compare rates of change for the poorest 40 percent and richest 60 percent or consider changes in the concentration index, we find that progress has, on average, been pro-poor.

However, behind these broad-brush findings lie variations around the mean. Not all countries have progressed in an equally pro-poor way. In almost half of countries, (relative) inequality in child malnutrition and child mortality fell, but it also increased in almost half of countries, often quite markedly.We find some geographic concentration of pro-rich progress; in almost all countries in Asia, progress on underweight has been pro-rich, and in much of Africa, inequalities in under-five mortality have been growing. Even on the MDG intervention indicators, we find that a sizable fraction of countries have progressed in a pro-rich fashion.

They also compared variations that were common across countries vs. common across indicators -- in other words, to see whether the differences across countries and indicators were because, say, some health interventions are just easier to reach the poorest with, and found that more of the variation came from differences between countries, rather than differences between indicators.

One discussion point they stress is that it's been easier to promote equality in interventions, rather than equality in outcomes, and that part of the story is related to the quality of care that poorer citizens receive. From the discussion:

One hypothesis is that the quality of health care is worse for lower socioeconomic groups; though the poorest 40 percent may have experienced a larger percentage increase in, for example, antenatal visits, they have not observed the same improvement in the survival prospects of their babies. If true, this finding would point to the need for a monitoring framework that captures not only the quantity of care (as is currently the case) but also its quality.

Weekend reading: race in America

Ta-Nehisi Coates is one of my favorite writers -- I highly recommend his memoir, The Beautiful Struggle, about growing up in Baltimore. His writing has a riveting flow even on the most innocuous subjects, so when he writes about something serious it really kills. He has a long and excellent cover story in The Atlantic this month on Barack Obama: "Fear of a Black President". It's the best thing I've read this month:

What black people are experiencing right now is a kind of privilege previously withheld—seeing our most sacred cultural practices and tropes validated in the world’s highest office. Throughout the whole of American history, this kind of cultural power was wielded solely by whites, and with such ubiquity that it was not even commented upon. The expansion of this cultural power beyond the private province of whites has been a tremendous advance for black America. Conversely, for those who’ve long treasured white exclusivity, the existence of a President Barack Obama is discombobulating, even terrifying. For as surely as the iconic picture of the young black boy reaching out to touch the president’s curly hair sends one message to black America, it sends another to those who have enjoyed the power of whiteness.

Read it.

Two excellent fora

First, a forum on Afghanistan in The New Republic. One depressing view comes from Amitai Etzioni:

I long argued that before we promote the full slew of human rights, we should attend to the most basic of them all: to protect life. Not because other rights are unimportant but because they are contingent on keeping people alive. We are failing this test in Afghanistan as we are about to leave after the elections, and leave a country in which killing will be rampant. We should try to work with the ISI, which has some leverage over the Taliban, to see if, in exchange for our support, they would try to avoid a civil war in Afghanistan and ensure that it will not serve again as a haven for terrorists. If not, we better have the drones ready.

I am not surprised that we shall not leave behind a stable democratic country; I never believed we could engage in nation building in this part of the world. And I am not surprised that we shall leave behind a country even more corrupt and subject to drug lords that we found. I am distressed about the size of the cemeteries Afghanistan will need.

Second, on inequality in the US and what can be done, in the Boston Review. Topics covered include taxes on the rich, education, labor markets, and much more.

Yes

Elizabeth Warren:

There is nobody in this country who got rich on his own. Nobody. You built a factory out there? Good for you. But I want to be clear: you moved your goods to market on the roads the rest of us paid for; you hired workers the rest of us paid to educate; you were safe in your factory because of police forces and fire forces that the rest of us paid for. You didn’t have to worry that marauding bands would come and seize everything at your factory, and hire someone to protect against this, because of the work the rest of us did. Now look, you built a factory and it turned into something terrific, or a great idea? God bless. Keep a big hunk of it. But part of the underlying social contract is you take a hunk of that and pay forward for the next kid who comes along.

Spot on, from the social contract to the big hunk and paying it forward. (h/t Jesse)

Future poverty

I'm not usually a fan of institutional blogs. When a big NGO creates a blog it's often for solely promotional purposes, and much of what I find interesting is criticism. Also, blogs are often written by younger, lower-level staff who don't necessarily have the same freedom to innovate and must have their posts approved by higher-ups. One of the few blogs associated with an NGO that does make it into my Google Reader is From Poverty to Power by Duncan Green at Oxfam. This post at the end of July caught my eye: "By 2015 Nigeria will have more poor people than India or China."

This post highlights two ideas that I've come across again and again in the last year, which make me most optimistic and hesitant about the near future:

1. A much, much smaller percentage of the world lives in extreme poverty today than 30-40 years ago.
2. Most of that decline has been driven by reductions in India and especially in China. Thus, as those nations continue to see reductions and many countries in Africa lag behind, the largest countries in Africa with the youngest populations (ie, Nigeria) will soon outpace India and China in terms of absolute numbers living in the worst poverty. While some African countries -- I'm thinking of Nigeria and South Africa in particular -- have considerable resources to devote to poverty alleviation, when they choose to, those resources pale in comparison to those available to say, the Chinese state.

The commenters on the original post also highlight some important methodological limitations in the Brookings study that Green cited. Read it all here.

Something powerful, ctd

Yesterday I posted about HU Queer Press, an online magazine published by an anonymous group of LGBTQ students at my alma mater, Harding Unviversity. Since then the issue has gotten a lot of press, including Jezebel, The New Yorker blog, KARK, and others. I got a call earlier today from a gay Harding student who is upset by HUQP's approach to the issue and says that some of what they say is factually incorrect. I said that if he wanted to write a response, I'd publish it for him and keep him anonymous as well. I'll reserve my reactions for the comment space, and would love to hear other views as well. Here's what he said:

I am a gay student currently attending Harding University who wants to voice my own experiences and give voice to the experiences of other gay students at HU.  While the accounts presented in “The State of The Gay” e-zine are compelling, sad, frustrating, and even downright infuriating, they are not representative of the current environment on campus.

Harding University does not have a rule against “being gay.”  I am open about my sexuality all over campus—to students, faculty, staff, and members of the administration.  The fact that I am a gay man is common knowledge, not just at Harding University, but also at my church (a Church of Christ). Never once have I been threatened with expulsion or forced reparative therapy.  If anyone was threatened with disciplinary action unless they received counseling, it was not for simply identifying themselves as gay.   When a rule is broken, action is taken, but there is no rule against “being gay.”  This hasn’t always been the case, and Harding isn’t a perfect place. Is there bigotry there?  Yes, and we must deal with that.  We should not blast them, however, for things that simply aren’t true.

Additionally, there is a growing impression that Integrity Ministries at Harding is a place where people are forced to go and be “fixed.”  This is simply not true.  Everyone who is a part of Integrity Ministries is there of their own free will and choice.  The names of the persons attending meetings and/or utilizing resources are not even known by anyone in the administration, faculty, or staff. Students approach the ministry, the ministry does not approach (or impose upon) students, and their identity is kept highly confidential.

If the ethic driving the current debate is freedom of choice, then we must extend that freedom to those whose faith and personal relationship with God have led them to CHOOSE to address their sexuality in the way they see fit. The reason my friends and I remain anonymous in this debate is not because we fear oppression from Harding University—but the exact opposite.  Those who are driving this debate are not allowing us our own freedom, and not creating a “safe place” for us to be honest about who we are and who we want to be.  These people who demand a safe place for themselves are guilty of denying the same thing to us.  At Harding University, we have found many, many, many people who are loving, accepting, nurturing, and inclusive.  Simply put:  HUQueerPress does not represent the majority of gay students at Harding University, and everyone at the University (administration included) is not the grotesque stereotype that HUQueerPress is trying to make them out to be.

--Joe Gay

Something powerful

I've tried to keep this blog professionally relevant, focusing on global health and development. But I want to share something a little different, and this is the best way I know how--hope you'll forgive the tangent. I went to college at Harding University, a conservative, private Christian University in my hometown of Searcy, Arkansas. Harding is strict -- you can get kicked out for dancing,* having sex, being gay, or drinking alcohol. The 5,000+ undergraduates are required to live on campus at first, with guys' dorms and girls' dorms and a nightly curfew where your RA's check to see if you're in your room. Daily chapel is required and everyone must take a Bible class each semester. It's like Footloose but with more Jesus and a lot less Kevin Bacon.

Except that earlier today, a bunch of gay and lesbian students at Harding spoke out:

We are here to share with you our struggle. We are here to be a voice for the voiceless who are quietly dying inside the walls of our campus. We want you to know us. We are your friends, co-workers, students, family members, fellow worshipers, professors, athletes, and scholars.[...] We are queer. We are gay, lesbian, bisexual and transgender. While the rest of you fall in love with the opposite sex, we share our lives and beds with those of our own gender.

All is not well for us at Harding. Our voices are muted, our stories go unheard, and we are forced into hiding. We are threatened with re-orientation therapy, social isolation, and expulsion. We are told stories and lies that we are disgusting sinners who are damned to hell, that we are broken individuals and child abusers....We have felt the pain of the deep, dark closet, and we are here to announce that we will not stand for it any longer.

That's the opening statement from HU Queer Press, a group of anonymous LGBTQ students, who are publishing a webzine about being gay at Harding. You can find the first issue, "State of the Gay at Harding University" at their website:

It's powerful stuff, ranging from the sweet to the visceral. The stories mix courage with self-hatred, love of friends and allies at Harding with hatred for its oppressive atmosphere and teachings. You really should read the whole thing, but here are a few of my favorite parts:

First is this sweet piece from "Dovey" writing about "How I Realized I Like Girls (And Why I'm Surprised I Didn't Realize Sooner.)":

When I was13, I, like most every girl my age, had a best friend (we'll call her Elle.) We spent almost all of our free time together, wrote several-page-long notes to each other that we passed when we met in the school halls, wrote stories about what our lives would be like when we grew up. We loved all the same movies, all the same books, and some of the same music....

I began to realize, though, that every time Elle had a boyfriend (and she had a LOT of them) I got immensely jealous. Even if he was someone who had always been a good mutual friend, I would begin to resent him. It wasn't just that Elle was spending less time with me, or that I felt left out. I wanted to hold her hand like they did. I wanted her to look at me the way she looked at them. I wanted to kiss her goodbye when we all left at the end of the school day.

Then "C" writes about coming out:

Most of the people I first told just kind of smiled and said "I figured." And of course they still loved me. Soon I had this great group of people encouraging me. I got enough confidence to finally tell my parents. They too already had some idea that this might be coming, but there was no smile on their face when they said so. "We were afraid of this." "I'm very disappointed."

"Z" chronicles his history:

[Age 13] Jeff kissed me... One day Jeff took me in the woods and said that he liked me, like he liked Kathleen. He leaned in and kissed me. I felt more alive in that moment than I had ever felt before. The next day in school, Jeff told the entire locker room that I tried to kiss him and that I was a Fag. I knew what it meant now. I sat alone in the lunchroom for the rest of middle school. I never had one friend from school. I turned to church....

[Age 17] Brad pulled me in the back of the room. He kissed me. I kissed him back. He unbuttoned my shirt and I pulled his off. He took off my belt and got down on his knees. He took me in his mouth and I came. I punched him in the face. I called him a Faggot and kicked him in his ribs. What had I done? God please save me. Take this away from me and I'll be a slave to you. I'll never do this again. I want you to take me under your wings and rescue me? Rescue me from whom? ME.

"K" criticizes the "Toxic Teachings" at Harding by highlighting the following course notes for a currently offered class. These were written by a Harding professor:

Certain signs of pre-homosexuality: 1) repeatedly stated desire to be other sex or act like other sex, 2) strong preference for cross dressing or pretending to dress like other gender, 3) strong and persistent desire for opposite roles.

Single Mothers: Cub Scouts and male Sunday school class is not enough to help a boy reach a clear gender identity: the boy must have one salient (good and strong) man who takes a special interest in him - one male chooses him. Men: find those fatherless boys and invite them to go fishing. Play catch with him - especially the quiet boy in the background... the one in the background - he is the one we have to go after.

Seriously? Who's recruiting who?

"K" also shares notes from a journal entry after a therapy session at Harding:

I need to make this decision. Will I go through with this or not. If so I need to truly count the cost and realize that this will cost me. If yes, that I for sure want to pursue my life as a Godly person with Him above all else:

I would have to see myself as heterosexual.

Every time I am attracted or want to look at another guy I would have to say "No. I am a heterosexual and I do not have these desires. They are not natural." I would completely have to capture my thoughts, deny them, and never intend to pursue or continue these thoughts.

There's a lot, lot more. Some amazing introspection, some self-loathing. A little coming out, a lot of the closet, some falling in love. They write a how-to for reading the Bible as gay-neutral, if not gay-friendly. They write about getting called fags.

And they write about the problems they have with "Integrity Ministries," the fairly new support group for students who "struggle with same-sex attraction." In some ways, Harding, or at least the people who are associated with it, have come a long way. The creation of Integrity Ministries a couple years ago suggest that the administration at Harding has realized it has a "gay problem" that isn't going away with denial and condemnation alone, the previous approach. I know that some of my friends saw the inception of Integrity Ministries as a step forward. But taking a tiny step forward from a wallowing pit of homophobia still leaves Harding far short of where it should be.

I really admire the authors for doing this, in part because even writing anonymously, they still face big risks. If someone rats them out they could all get kicked out, and they could lose many friends. And just because they're gay doesn't mean they can easily leave Harding. Some students can only afford college with their parents' support, and some parents will only send their kids to Christian colleges. I guess others stay at Harding because they love the institution despite its flaws and want to go to a Christian school because of their deep faith, and they hope to change it from the inside out. If it were easy and they had no other ties, they'd transfer elsewhere and start a new life with people who love them regardless of their sexuality. But it isn't that easy.

I sympathize with them because I have mixed feelings about Harding as well. My dad teaches there and I grew up around the school. I went to Harding of my own free will because I wanted to be a missionary. I deconverted during my third year there. The process was a gradual one. The more I studied theology and the Bible and war and history and science (some through courses at Harding but also much on my own) the more my views shifted towards progressive theologies. I maintained an unhappy equilibrium as a liberal Christian with a belief in a vaguely Einsteinian God for somewhat less than a year. In hindsight the shift from fundamentalist belief to liberal belief was driven by an intellectual desire to believe something that was compatible with science and history and critical thought, but the choice to go from liberal theology to discarding my faith in faith altogether was more about choosing my allegiances. In the South, and especially at Harding, the association between that particular Christian tradition and reactionary filth was just too strong for me. At some point I couldn't stomach being associated with all that was anti-science, anti-feminist, and yes, anti-gay. If it wasn't clear before you read the HU Queer Press, one reason people get turned off by Christians like many at Harding is that their beliefs and actions cause a world of pain to those they label as sinful.

I have a lot of good memories, and I still love many people associated with Harding -- family, professors and mentors, and classmates. I doubt Harding will change much, or fast. They still don't let women speak in chapel or lead prayers, and you get kicked out for having straight sex too. My hope is more for the students who go to Harding and then move on, that they will emerge more compassionate and less homophobic than they might otherwise have been. Maybe we'll get a step closer to that if everyone at Harding reads this webzine (probably on their laptops at Midnight Oil since I'm sure they'll block www.huqueerpress.com on campus!).

One last thing: Early on, like many other straight male dorm student at Harding I called everyone a fag -- man, don't be such a fag! I used to be part of that putrid homophobic culture, and for that -- to anyone who reads this who I knew at Harding -- I'm sorry. It was as if by joking about it we could make "the gays" all just disappear." But they can't. They're there and they're not going away no matter how hard you pray, and now they're finding a way to speak out. Awesome. Read it and share it with your friends.

----------------------------------------------------------------------

One note: I was not involved in the production or hosting of HU Queer Press, and I don't know who they are. I just received an anonymous email a few days ago asking me to help with getting the word out since I have a blog.  In fact I think it's more powerful not knowing because they could be anyone I knew at Harding.

*Update 1: a commenter points out that they've never heard of anyone getting kicked out for dancing, and I think that's right. My apologies for the imprecision -- I should have said that dancing is against the rules.

Update 2: I'm tracking who all has written about the zine. If you notice a blog I haven't listed please mention it in the comments. So far: Hemant Mehta, Political Cartel, Ian Thomas, NWA Equality, Don Gaines, Talk About Equality, Arkansas Times' Arkansas Blog, Coleman Yoakum, Change.org petition, Nelson Shake, 

Mapping Race in Baltimore

The New York Times has a new interactive feature up, called Mapping America: Every City, Every Block. It uses "local data from the Census Bureau's American Community Survey, based on samples from 2005 to 2009." The data includes income and education levels by census tract, which is interesting but not that visually stimulating, and the more striking data on race by household in each census tract. Areas with higher population density are typically easier to work with -- try New York City for starters. My current home, Baltimore, makes a great test case. On these maps, each circle represents 50 households. (As you zoom further out, you start seeing counties instead of census tracks, and each dot represents many more households.)  A screenshot:

By race, blue = black, green = white, red = Asian, yellow = Hispanic.

For those unfamiliar with Baltimore, that's the Inner Harbor at the bottom. As you can see, the neighborhoods just southwest (Federal Hill) and north (Canton, Fells Point) of the harbor are predominantly white. The relatively sparsely populated section in the center is the more commercial downtown. East and West Baltimore are predominantly black. The green (ie, white) strip in the center is Mt. Vernon, whereas the area at the center top with more green (white) and red (Asian) includes the Charles Village neighborhood, where Hopkins' Homewood undergraduate campus is located.

The Johns Hopkins medical campus, including the School of Public Health where I'm a student, is in the predominantly blue (black) area on the middle right of the map above.

One thing that struck me as odd at first is that there are a bunch of green dots (ie, white households) in the middle of Patterson Park, the big green space included in this zoomed in map:

On further thought, I think the maps are showing averages of the data from the entire census tract. The tract that includes Patterson Park also includes some surrounding blocks, which are predominantly white. The distribution of differently colored dots on the map represents the race breakdown within that tract, but the location  of the dots within the tract on this map is completely random. If you play with the tool, you'll find that tracts are highlighted when you mouseover them, and that the spacing of dots within the tract is uniform -- this also accounts for the sudden changes in density you see in some places at the edges between tracts.

Finally, below is a closeup of the area I live in. At the top center of this map is Charles Village (including the Hopkins undergraduate campus). I live near 25th street, which bisects this map horizontally, in the transition between the predominantly white and Asian area in Charles Village and the mostly black neighborhoods in between Mt. Vernon and Charles Village:

h/t @edwardcarr