We conducted a cluster-randomized trial to measure the effect of community-level mask distribution and promotion on symptomatic SARS-CoV-2 infections in rural Bangladesh from November 2020 to April 2021 (N = 600 villages, N = 342,183 adults). We cross-randomized mask type (cloth vs. surgical) and promotion strategies at the village and household level. Proper mask-wearing increased from 13.3% in the control group to 42.3% in the intervention arm (adjusted percentage point difference = 0.29 [0.26, 0.31]). The intervention reduced symptomatic seroprevalence (adjusted prevalence ratio (aPR) = 0.91 [0.82, 1.00]), especially among adults 60+ years in villages where surgical masks were distributed (aPR = 0.65 [0.45, 0.85]). Mask distribution and promotion was a scalable and effective method to reduce symptomatic SARS-CoV-2 infections.
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A randomized trial of community-level mask promotion in rural Bangladesh during COVID-19 shows that the intervention increased mask-use and reduced symptomatic SARS-CoV-2 infections.
This talk is based on the co-authors' recent paper "How Much Will the Pandemic Change Egyptian Governance and for How Long?" The Egyptian regime has reacted in an unexpected way to the global pandemic—with civilian, technocratic, and expert bodies leading the way and even some (admittedly officially patrolled) political debate being allowed to emerge. This talk examines these recent developments and evaluates whether they mark a real change in Egyptian governance, and if so, why, what kind, and will it last.
Co-Authors Bios
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Amr Hamzawy is currently a senior research scholar at the Center on Democracy, Development, and the Rule of Law at Stanford University. He studied political science and developmental studies in Cairo, The Hague, and Berlin. He was previously an associate professor of political science at Cairo University and a professor of public policy at the American University in Cairo. Between 2016 and 2017, he served as a senior fellow in the Middle East program and the Democracy and Rule of Law program at the Carnegie Endowment for International Peace, Washington, DC. His research and teaching interests as well as his academic publications focus on democratization processes in Egypt, tensions between freedom and repression in the Egyptian public space, political movements and civil society in Egypt, contemporary debates in Arab political thought, and human rights and governance in the Arab world. His new book On The Habits of Neoauthoritarianism – Politics in Egypt Between 2013 and 2019appeared in Arabic in September 2019. Hamzawy is a former member of the People’s Assembly after being elected in the first Parliamentary elections in Egypt after the January 25, 2011 revolution. He is also a former member of the Egyptian National Council for Human Rights. Hamzawy contributes a weekly op-ed to the All Arab daily al-Quds al-Arabi.
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Nathan Brown is Professor of Political Science and International Relations at The George Washington University. He is also a non-resident Senior Fellow at The Middle East Program at the Carnegie Endowment for International Peace and serves on the board of trustees at the American University in Cairo. His contributions span a wide range of topics, including Islamist movements, Egyptian politics, Palestinian politics, and Arab law and constitutionalism. Dr. Brown served as the president of the Middle East Studies Association between 2013 and 2015. He was previously named a Guggenheim Fellow and a Carnegie Scholar by the Carnegie Corporation of New York and is a former fellow at the Woodrow Wilson International Center for Scholars. His previous research was funded by the United States Institute of Peace and two Fulbright fellowships. He received the Oscar and Shoshana Trachtenberg Award for Scholarship from George Washington University in 2015 and the Harry Harding teaching award from the Elliott School of International Affairs in 2014. His dissertation received the Malcolm Kerr award from the Middle East Studies Association in 1987. Dr. Brown is the author of six books, including Arguing Islam after the Revival of Arab Politics (Oxford: Oxford University Press, 2016), and When Victory is Not an Option: Islamist Movements in Arab Politics (Ithaca: Cornell University Press, 2012). He received his B.A. in political science from the University of Chicago and his M.A. and Ph.D. in politics and Near Eastern Studies from Princeton University.
Dr. Monica Teran has experience in the analysis focus on the domains of disparities in health services and response to population health needs of the health system governance using spatial statistical methodology and Geography of health approach that takes into account spatial variation in socioeconomic factors and accessibility to services. Since September 2017 she is a member of Sistema Nacional de Investigadores, SNI (National System of Researcher) in Mexico, CONACYT.
Following in the footsteps of last year’s international conference on violence and policing in Latin American and U.S. Cities, on April 28th and 29th of 2015, the Poverty Goverance and Violence Lab(PovGov) at Stanford’s Center on Democracy, Development and the Rule of Law (CDDRL) turned Encina Hall at the Freeman Spogli Institute of International Studies (FSI) into a dynamic, instructive and stimulating discussion platform. The exchange of experiences, expertise and ideals that flourished within this space helped create a “dialogue for action,” as speakers and participants explored the various dimensions of youth and criminal violence in Mexico, Brazil and the United States, while advocating for the importance of opening up adequate pathways to hope. The event was sponsored by the Center for Latin American Studies, The Bill Lane Center for the America West, The Mexico Initiative at FSI, and the Center on International Security and Cooperation.
It’s always great to see the work of one of our researchers shouted out in the New York Times. It’s even better when it becomes the scientific basis of an argument thrown into the mix of a presidential campaign.
Nicholas Kristof asserted in his column on Sunday that when women are involved in the political process and given the capacity to shape public policy, everyone benefits, particularly when it comes to health.
Kristof, who covers human rights, women’s rights, health and global affairs for the Times, wrote in his column:
Put aside your feelings about Hillary Clinton: I understand that many Americans distrust her and would welcome a woman in the White House if it were someone else. But whatever one thinks of Clinton, her nomination is a milestone, and a lesson of history is that when women advance, humanity advances.
Grant Miller of Stanford University found that when states, one by one, gave women the right to vote at the local level in the 19th and early 20th centuries, politicians scrambled to find favor with female voters and allocated more funds to public health and child health. The upshot was that child mortality rates dropped sharply and 20,000 children’s lives were saved each year.
Many of those whose lives were saved were boys. Today, some are still alive, elderly men perhaps disgruntled by the cavalcade of women at the podium in Philadelphia. But they should remember that when women gained power at the voting booth, they used it to benefit boys as well as girls.
Miller, an associate professor of medicine and core faculty member of Stanford Health Policy, first wrote about this issue in the Quarterly Journal of Economics in 2008, arguing that women’s choices appear to emphasize child welfare more than those of men.
He presented evidence on how state-to-state suffrage rights for U.S. women from 1869 to the adoption of the 19th Amendment in 1920, which gave all women the right to vote, helped children benefit from scientific breakthroughs.
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Simple hygienic practices — including hand and food washing, boiling water and milk, refrigerating meat and the renewed emphasis on breastfeeding — were among the most important innovations in the 19th and early 20th centuries to help protect children from often-fatal diseases such typhoid fever, smallpox, measles and scarlet fever.
As women became more and more involved in state and federal politics, Miller found, child mortality declined by 8 to 15 percent, or 20,000 fewer child deaths each year.
“Public health historians clearly link the success of hygiene campaigns to the rising influence of women,” Miller wrote, citing examples with data and graphs.
That women have been — and can be — so influential seems like a no-brainer, but it’s nice to have the science to back it up.
One of the key objectives of introducing a compulsory health insurance is to provide citizens, regardless of socioeconomic status, with financial risk protection against unexpected catastrophic expenditures in the face of illness. South Korea and Taiwan achieved universal health coverage (UHC) through mandatory social insurance schemes in 1989 and 1995, respectively. Despite both countries' efforts to achieve the goal of financial risk protection for more than two decades, past research has demonstrated that household out-of-pocket (OOP) payment still accounts for more than one-third of total health expenditures in both countries. When OOP payment represents a significant share of financial sources for health care, one should be particularly concerned about the distribution of such payments, in particular, catastrophic health expenditures, across households of differing economic levels. This talk sets out to examine the change in the incidence and distribution of catastrophic health expenditures before and after the introduction of the National Health Insurance programs in South Korea and Taiwan.
Given similarity in the health and National Health Insurance (NHI) system characteristics observed in South Korea and Taiwan, substantial variation in the distribution of catastrophic payment among households was noted. The rich are more likely to incur catastrophic payment in South Korea, but the opposite trend is noted in Taiwan. Further assessment on the impact of universal health coverage (UHC) on reducing catastrophic headcount (defined as the proportion of households incurring catastrophic health payment) is observed in Taiwan, but not in South Korea. We found that when South Korea introduced the NHI program with a limited benefit package and high copayment, it produced little effect (if not none) in reducing financial burden in terms of proportion of catastrophic headcount. On the contrary, the impact of universal health coverage on catastrophic headcount ranged from -1.82% to -4.08% for Taiwan, due to the provision of a rather comprehensive benefit package with modest copayment. While UHC is a well-lauded policy goal and may be a magic word for many countries striving for the achievement, it is definitely not a panacea to resolve the incidence of catastrophic payment and potential medical impoverishment. To provide sufficient financial protection against unexpected medical expenses, the design of the benefit coverage and risk sharing mechanism is key to the success of effectively achieving UHC.
Bio
Jui-fen Rachel Lu, Sc.D., is the Fulbright Visiting Scholar at Center for East Asian Studies, Stanford University, and a Professor at Chang Gung University (CGU) in Taiwan, where she teaches comparative health systems, health economics, and health care financing and has served as department chair (2000-2004), Associate Dean (2009-2010) and Dean of College of Management (2010-2013). She earned her B.S. from National Taiwan University, and her M.S. and Sc.D. from Harvard University, and she was also a Takemi Fellow at Harvard (2004-2005). Prof. Lu is currently the President of Taiwan Society of Health Economics (TaiSHE) and an Honorary Professor at Hong Kong University (2007-2017). Dr. Lu was also the recipient of IBM Faculty Award in 2009.
Her research focuses on 1) the equity issues of the health care system; 2) impact of the NHI program on health care market and household consumption patterns; 3) comparative health systems in Asia-Pacific region. She is a long-time and active member of Equitap (Equity in Asia-Pacific Health Systems) research network and was the coordinator for the catastrophic payment component of Equitap II research project which involved 21 country teams and was jointly funded by IDRC, AusAID, and ADB. Professor Lu has also been appointed to serve as a member on various government committees dealing with health care issues in Taiwan.
Okimoto Conference Room, Encina Hall 3rd Floor, East Wing
Rachel Jui-fen Lu
Visiting Scholar, Center for East Asian Studies
Stanford University
Stanford students belong to the first generation that could witness the end of extreme global poverty — in what would be one of humankind's greatest achievements — the head of the World Bank said during a recent talk on campus.
But their generation, he said, is also likely to experience the first global pandemic since the 1918 influenza that killed more than 50 million people.
Jim Yong Kim, president of the World Bank, said innovations in health, education and finance are behind the World Bank's twin goals of ending extreme poverty and boosting shared prosperity for the bottom 40 percent of the global population.
Speaking at the inaugural conference of the Stanford Global Development and Poverty Initiative on Oct. 29, Kim lauded faculty and students for their multidisciplinary approach in tackling poverty and improving public health. He is an infectious disease physician who oversaw World Health Organization initiatives on HIV/AIDS.
"Seeking transformative solutions to challenges of development and poverty that are necessarily cross-disciplinary is exactly what a great university should be doing," Kim said in his speech at Stanford.
The World Bank announced last month that the number of people living on less than $1.90 a day is expected to drop to 9.6 percent of the global population by the end of the year. That is down from 36 percent in 1990.
The bank has pledged to cut that rate to 3 percent by 2030.
"We expect the extreme poverty rate to drop below 10 percent for the first time in human history," he said. "This is the best news in the world today. And this is the first generation in human history that has been able to see that potential outcome."
Promoting prosperity
One of the co-founders of Partners in Health, Kim was the keynote speaker at the daylong conference, "Shared Prosperity and Health," which drew together Stanford faculty and researchers, plus government and NGO officials from around the world.
Kim's talk was optimistic about the newly adopted U.N. Sustainable Development Goals, with an ambitious agenda to end poverty and hunger, ensure healthy lives, empower women and girls and attain quality education for all children by 2030.
While those goals seem lofty, Kim pointed to the accomplishment of bringing down extreme poverty to 10 percent, a figure many had once said was impossible.
Ninety-one percent of children in developing countries now attend primary school, up from 83 percent in 2000, he said. And the number of people on antiretroviral drugs for treatment of HIV in sub-Saharan Africa has increased eightfold in the last decade.
"But we're humbled by the challenges ahead," Kim said. "Rising global temperatures will have devastating impacts on poor countries and poor people – and, as we saw with Ebola, major pandemics are likely to disproportionately affect the poor."
Pandemic threats
Kim said that most virologists and infectious disease experts are certain a pandemic will sweep the world in the next 30 years. He said that would lead to more than 30 million deaths and anywhere from 5 to 10 percent of lost GDP.
He blasted the global community for taking eight months to respond to the Ebola crisis in West Africa, noting that Guinea, Sierra Leone and Liberia had among the fastest growing economies in Africa before the outbreak killed more than 11,000 people – most of whom were poor.
In an effort to speed up financial aid the next time such an outbreak occurs, the World Bank is developing the Pandemic Emergency Facility, which would disburse funding immediately to national governments and responding agencies.
Rajiv Shah, the administrator for the U.S. Agency for International Development from 2010-2015, spoke earlier at the conference about his work leading the U.S. efforts to contain Ebola.
"Three small countries with total population of maybe 30 million people had such weak health systems with so little domestic investment – in one country $6 per capita health investment per year – that when Ebola became a crisis there was no first-line of defense," he said.
By October 2014, the U.S. was pouring hundreds of millions of dollars into containment efforts, including the establishment of a 2,500-personnel military deployment to hit Ebola on the ground. Shah said President Obama "stayed extraordinarily true to the science" of containment at the source.
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Stunted children
Moving beyond containment of epidemics, Kim said the most important investment developing countries could make in their people starts when a woman becomes pregnant. Using a combination of health, nutrition and education will have lifelong benefits for each child, as well as for the country in which each prospers.
The World Bank estimates that 26 percent of all children under age 5 in developing countries are stunted, which means they are malnourished and under-stimulated, risking a loss of cognitive abilities that lasts a lifetime. The number climbs to 36 percent in sub-Saharan Africa, giving those children limited prospects in life."This is a disgrace, a global scandal and, in my view, akin to a medical emergency," Kim said. "Children who are stunted by age 5 will not have an equal opportunity in life. If your brain won't let you learn and adapt in a fast-changing world, you won't prosper and, neither will society. All of us lose."
From 2001 to 2013, the World Bank invested $3.3 billion in early childhood development programs in poor countries. Kim said innovative policymaking and financial tools allowed the bank to help Peru cut its rate of child stunting in half to 14 percent in just eight years.
"Progress is possible – and it can happen quickly. But we must do even more,"he said.
Kim said the world set a target in 2012 to reduce stunting in children by 40 percent. But that would still leave 100 million children malnourished and undereducated. The bank and world leaders should pledge to end stunting for all children by 2030, he said.
"With partners like the Global Development and Poverty Initiative and the entire Stanford community, I'm full of hope that we can indeed be the first generation in human history to end extreme poverty and create a more just and prosperous world for everyone on the planet."
Following in the footsteps of last year’s international conference on violence and policing in Latin American and U.S. Cities, on April 28th and 29th of 2015, the Program on Poverty and Governance (PovGov) at Stanford’s Center on Democracy, Development and the Rule of Law (CDDRL) turned Encina Hall at the Freeman Spogli Institute of International Studies (FSI) into a dynamic, instructive and stimulating discussion platform. The exchange of experiences, expertise and ideals that flourished within this space helped create a “dialogue for action,” as speakers and participants explored the various dimensions of youth and criminal violence in Mexico, Brazil and the United States, while advocating for the importance of opening up adequate pathways to hope. The event was sponsored by the Center for Latin American Studies, The Bill Lane Center for the America West, The Mexico Initiative at FSI, and the Center on International Security and Cooperation.
For a link to the conference event page, click here.
To find out more about CDDRL's Program on Poverty and Governance, click here.
Please join us in a discussion of the role of NGOs in the field of human rights, and of the important role they play in the world today. Our speakers represent both the activist and grant-making sides of the NGO world.
Speaker Bios
Nick Deychakiwsky
Program Officer, Charles Stewart Mott Foundation
Nick Deychakiwsky is a Program Officer at the Charles Stewart Mott Foundation managing its Civil Society – United States and Global Philanthropy & Nonprofit Sector program areas. Between 2000 and 2006 he oversaw the Mott Foundation’s grantmaking in Russia, Ukraine, and Belarus. During the 1990s Nick lived in Ukraine, holding managerial positions at the International Management Institute – Kyiv, the Council of Advisors to the Parliament of Ukraine, the International Renaissance (Soros) Foundation, and the Eurasia Foundation.
Maurice I Middleberg
Executive Director, Free the Slaves
Maurice Middleberg is the Executive Director of Free the Slaves, a global leader in the fight to eradicate modern day slavery. The mission of Free the Slaves is to liberate slaves and change the condiitons that allow slavery to exist. Free the Slaves fosters long-term solutions to slavery, that encompasses building local capacity to fight slavery; community-based education and mobilization, strengthening legal protections and anti-slavery policies, and building critical assets in vulnerable households. Free the Slaves currently has programs in Brazil, Democratic Republic of the Congo, Ghana, Haiti, India and Nepal. Mr Middlberg's career spans more than thrity years, and covers global health, social justice and international development. He has held senior and executive positions at CARE, the Global Health Council, EngenderHealth and IntraHealth, and has worked for the U.S. Agency for International Development. A political scientist by training, he has held academic appointments at Columbia and Emory Universities.
Bechtel Conference Room, Encina Hall
616 Serra Street
Stanford, CA 94305
Maurice I. Middleberg
Executive Director
Speaker
Free the Slaves
Nick Deychakiwsky
Program Officer
Speaker
Charles Stewart Mott Foundation
Michael Callen is assistant professor of public policy at the Harvard Kennedy School of Government. His recent work uses experiments to identify ways to address accountability and service delivery failures in the public sector. He has published in the American Economic Review, the Journal of Conflict Resolution, and the British Journal of Political Science. He is an Affiliate of Evidence for Policy Design (EPoD), the Bureau for Research and Economic Analysis of Development (BREAD), the Jameel-Poverty Action Lab (J-PAL), the Center for Effective Global Action (CEGA), the Center for Economic Research Pakistan (CERP), Empirical Studies of Conflict (ESOC), and a Principal Investigator on the Building Capacity for the Use of Research Evidence (BCURE): Data and evidence for smart policy design project. His primary interests are political economy, development economics, and experimental economics.