Health and Medicine

FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.

FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.

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In reaction to the arrest of Dominique Strauss-Khan for allegations of rape in May, Kavita Ramdas and Christine Ahn argue in a piece for Foreign Policy in Focus that gender bias is embedded in the global policies and practices at the IMF, which unfairly target women. Kavita Ramdas is the former president and CEO of the Global Fund for Women and a visiting scholar at the Center on Democracy, Development, and the Rule of Law.

In reaction to the arrest of Dominique Strauss-Khan for allegations of rape in May, Kavita Ramdas and Christine Ahn argue in a piece for Foreign Policy in Focus that gender bias is embedded in the global policies and practices at the IMF, which unfairly target women. Kavita Ramdas is the president and CEO of the Global Fund for Women and a visiting scholar at the Center on Democracy, Development, and the Rule of Law.

As Dominique Strauss-Kahn, head of the world’s most powerful financial institution, the International Monetary Fund (IMF), spends a few nights in Rikers Island prison awaiting a hearing, the world is learning a lot about his history of treating women as expendable sex objects. Strauss-Kahn has been charged with rape and forced imprisonment of a 32-year-old Guinean hotel worker at a $3,000-a-night luxury hotel in New York.

While the media dissects the attempted rape of a young African woman and begins to dig out more information about Strauss-Kahn’s past indiscretions, we couldn’t help but see this situation through the feminist lens of the “personal is political.” 

For many in the developing world, the IMF and its draconian policies of structural adjustment have systematically “raped” the earth and the poor and violated the human rights of women. It appears that the personal disregard and disrespect for women demonstrated by the man at the highest levels of leadership within the IMF is quite consistent with the gender bias inherent in the IMF’s institutional policies and practice.

Systematic Violation of Women’s Human Rights

The IMF and the World Bank were established in the aftermath of World War II to promote international trade and monetary cooperation by giving governments loans in times of severe budget crises. Although 184 countries make up the IMF’s membership, only five countries—France, Germany, Japan, Britain, and the United States—control 50 percent of the votes, which are allocated according to each country’s contribution.

The IMF has earned its villainous reputation in the Global South because in exchange for loans, governments must accept a range of austerity measures known as structural adjustment programs (SAPs). A typical IMF package encourages export promotion over local production for local consumption. It also pushes for lower tariffs and cuts in government programs such as welfare and education. Instead of reducing poverty, the trillion dollars of loans issued by the IMF have deepened poverty, especially for women who make up 70 percent of the world’s poor.

IMF-mandated government cutbacks in social welfare spending have often been achieved by cutting public sector jobs, which disproportionately impact women. Women hold most of the lower-skilled public sector jobs, and they are often the first to be cut. Also, as social programs like caregiving are slashed, women are expected to take on additional domestic responsibilities that further limit their access to education or other jobs.

In exchange for borrowing $5.8 billion from the IMF and World Bank, Tanzania agreed to impose fees for health services, which led to fewer women seeking hospital deliveries or post-natal care and naturally, higher rates of maternal death.  In Zambia, the imposition of SAPs led to a significant drop in girls’ enrollment in schools and a spike in “survival or subsistence sex” as a way for young women to continue their educations.

But IMF’s austerity measures don’t just apply to poor African countries. In 1997, South Korea received $57 billion in loans in exchange for IMF conditionalities that forced the government to introduce “labor market flexibility,” which outlined steps for the government to compress wages, fire “surplus workers,” and cut government spending on programs and infrastructure. When the financial crisis hit, seven Korean women were laid off for every one Korean man. In a sick twist, the Korean government launched a "get your husband energized" campaign encouraging women to support depressed male partners while they cooked, cleaned, and cared for everyone.

Nearly 15 years later, the scenario is grim for South Korean workers, especially women. Of all OECD countries, Koreans work the longest hours: 90% of men and 77% of women work over 40 hours a week.  According to economist Martin Hart-Landsberg, in 2000, 40 percent of Korean workers were irregular workers; by 2008, 60 percent worked in the informal economy. The Korean Women Working Academy reports that today 70 percent of Korean women workers are temporary laborers.

Selling Mother Earth

IMF policies have also raped the earth by dictating that governments privatize the natural resources most people depend on for their survival: water, land, forests, and fisheries. SAPs have also forced developing countries to stop growing staple foods for domestic consumption and instead focus on growing cash crops, like cut flowers and coffee for export to volatile global markets. These policies have destroyed the livelihoods of small-scale subsistence farmers, the majority of whom are women.

“IMF adjustment programs forced poor countries to abandon policies that protected their farmers and their agricultural production and markets,” says Henk Hobbelink of GRAIN, an international organization that promotes sustainable agriculture and biodiversity. "As a result, many countries became dependent on food imports, as local farmers could not compete with the subsidized products from the North. This is one of the main factors in the current food crisis, for which the IMF is directly to blame."

In the Democratic Republic of Congo (DRC), IMF loans have paved the way for the privatization of the country’s mines by transnational corporations and local elites, which has forcibly displaced thousands of Congolese people in a context where women and girls experience obscenely high levels of sexual slavery and rape in the eastern provinces. According to Gender Action, the World Bank and IMF have made loans to the DRC to restructure the mining sector, which translates into laying off tens of thousands of workers, including women and girls who depend on the mining operations for their livelihoods. Furthermore, as the land becomes mined and privatized, women and girls responsible for gathering water and firewood must walk even further, making them more susceptible to violent crimes.

We Are Over It

Women’s rights activists around the globe are consistently dumbfounded by how such violations of women’s bodies are routinely dismissed as minor transgressions. Strauss-Kahn, one of the world’s most powerful politicians whose decisions affected millions across the globe, was known for being a “womanizer” who often forced himself on younger, junior women in subordinate positions where they were vulnerable to his far greater power, influence, and clout. Yet none of his colleagues or fellow Socialist Party members took these reports seriously, colluding in a consensus shared even by his wife that the violation of women’s bodily integrity is not in any sense a genuine violation of human rights.

Why else would the world tolerate the unearthly news that 48 Congolese women are raped every hour with deadening inaction? Eve Ensler speaks for us all when she writes, “I am over a world that could allow, has allowed, continues to allow 400,000 women, 2,300 women, or one woman to be raped anywhere, anytime of any day in the Congo. The women of Congo are over it too.”

We live in a world where millions of women don’t speak their truth, don’t tell their dark stories, don’t reveal their horror lived every day just because they were born women.  They don’t do it for the same reasons that the women in the Congo articulate – they are tired of not being heard. They are tired of men like Strauss-Kahn, powerful and in suits, believing that they can rape a black woman in a hotel room, just because they feel like it. They are tired of the police not believing them or arresting them for being sex workers. They are tired of hospitals not having rape kits. They are tired of reporting rape and being charged for adultery in Iran, Pakistan, and Saudi Arabia.

Fighting Back

For each one of them, and for those of us who have spent many years investing in the tenacity of women’s movements across the globe, the courage and gumption of the young Guinean immigrant shines like the torch held by Lady Liberty herself. This young woman makes you believe we can change this reality. She refused to be intimidated.  She stood up for herself. She fought to free herself—twice—from the violent grip of the man attacking her. She didn’t care who he was—she knew she was violated and she reported it straight to the hotel staff, who went straight to the New York police, who went straight to JFK to pluck Strauss-Kahn from his first-class Air France seat.

In a world where it often feels as though wealth and power can buy anything, the courage of a young woman and the people who stood by her took our breath away. These stubborn, ethical acts of working class people in New York City reminded us that women have the right to say “no.”  It reminded us that “no” does not mean “yes” as the Yale fraternities would have us believe, and, most importantly that no one, regardless of their position or their gender, should be above the law.  A wise woman judge further drove home the point about how critically important it is to value women’s bodies when she denied Strauss-Kahn bail citing his long history of abusing women.

Strauss-Kahn sits in his Rikers Island cell. It would be a great thing if his trial succeeds in ending the world’s tolerance for those who discriminate and abuse women. We cannot tolerate it one second longer.  We cannot tolerate it at the personal level, we must refuse to condone it at the professional level, and we must challenge it every time it we see it in the policies of global institutions like the International Monetary Fund.

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The Center on Democracy, Development, and the Rule of Law (CDDRL) is pleased to announce that undergraduate senior honors student Yihana von Ritter was awarded The Firestone Medal for Excellence in Undergraduate Research for her outstanding thesis examining HIV/AIDS policy in Papua New Guinea. Von Ritter was presented with the award at a ceremony held on June 11 during commencement weekend at Stanford University.

Larry Diamond with Yihana von Ritter (Firestone awardee)
Von Ritter, a political science major, spent the summer of 2010 on the Papua New Guinea island of Karkar, where she performed extensive field research. She interviewed over 40 government officials, medical personnel, religious and civic leaders, youth, and HIV positive individuals. Her thesis entitled "Between Hope and Despair: An Assessment of HIV/AIDS Policy in Papua New Guinea," underscored the fact that while only 1% of Papua New Guinea's adult population is AIDS-infected, a public health crisis is looming if preventative policies are not swiftly adopted.

According to her thesis co-advisor Professor Emeritus David Abernethy, Von Ritter's thesis received the Firestone Medal­--awarded to the top ten percent of honors theses in social science, science, and engineering--for its remarkable combination of social science analysis and informed policy advocacy.

"Von Ritter provides policy-relevant recommendations in her thesis to enhance interagency communication and encourage active government leadership (in Papua New Guinea)," said Abernethy. Von Ritter also worked closely with Francis Fukuyama, FSI senior fellow and CDDRL faculty member, who provided guidance and support during the thesis writing process.

Purun Cheong and Kamil Dada were both recipients of the CDDRL Undergraduate Honors Program "Best Thesis Award" for their outstanding research and policy-relevant scholarship. Cheong, an international relations major, critically evaluated the failed United Nations state-building efforts in East Timor in his thesis, "When the Blind lead: The United Nations in East Timor-Lessons in State Building."

After spending a summer conducting research in Pakistan, Dada, a political science major, wrote "Understanding International Democracy Assistance: A Case Study of Pakistan," a sobering account of democracy assistance to Pakistan. Cheong and Dada were both advised by CDDRL director Larry Diamond.

CDDRL congratulates the 2011 graduating class of CDDRL Undergraduate Honors

Students:

Purun Cheong

International Relations

"When the Blind Lead: The United Nations in East Timor- Lessons in State Building"

Kamil Dada

Political Science

"Understanding International Democracy Assistance: A Case study of Pakistan"

Sarah Guerrero

International Relations

"Automation Nation: Electronic Elections, Electoral Governance and Democratic Consolidation in the Philippines"

Ayesha Lalji

International Relations

"Unleashing the Cheetah Generation: How Mobile Banking Enables Access to Capital for the Poor in Developing Countries"

Lauren Swartz

International Relations

"Agribusiness as a Means of Economic Development: Case Studies of Chile and Mexico"

Ann Thompson

History

"The Other Side of the Coin: The US Military and Afghan Women in Contemporary Counterinsurgurgency Operations"

Yihana von Ritter

Political Science

"Between Hope and Despair: An Assessment of HIV/AIDS Policy in Papua New Guinea"

Ari Weiss

International Relations

"Israel: Managing Diversity with Democracy"

 Check out more photos of this event on our Facebook Page: http://www.facebook.com/StanfordCDDRL

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Daniel Posner is Total Professor of Political Science at the Massachusetts Institute of Technology, and currently a fellow at the Center for Advanced Study in the Behavioral Sciences.  His research focuses on ethnic politics, research design, distributive politics and the political economy of development in Africa. His work investigates, among other topics, the sources of ethnic identification and the political, social and economic outcomes that ethnicity affects-coalition-building, voting, collective action, public goods provision, and economic growth-with special attention to the mechanisms through which it has its impact. His methodological approach is to find creative ways to maximize leverage for making strong descriptive and causal claims, through the use of experiments (in the lab, in the field, and occurring "naturally"), new data sources (including the re-appropriation of data collected for other purposes), and the adoption of techniques from other disciplines such as satellite geography, public health, and behavioral economics.

His most recent co-authored book, Coethnicity: Diversity and the Dilemmas of Collective Action (Russell Sage, 2009) employs experimental games to probe the sources of poor public goods provision in ethnically diverse communities. His first book, Institutions and Ethnic Politics in Africa (Cambridge, 2005), explains why and when politics revolves around one dimension of ethnic cleavage rather than another. He has received several awards for his work, including the Luebbert Award for best book in Comparative Politics (2006 and 2010), the Heinz Eulau Award for the best article in the American Political Science Review (2008), the Michael Wallerstein Award for the best article in Political Economy (2008), the best book award from the African Politics Conference Group (2006), and the Sage Award for the best paper in Comparative Politics presented at the APSA annual meeting (2004). He has been a Harvard Academy Scholar (1995-98), a National Fellow at the Hoover Institution (2001-02), a Carnegie Scholar (2003-05) and, this year, a Fellow at the Center for Advanced Study in the Behavioral Sciences (2010-11). He currently serves on the editorial boards of World Politics, PS, and the Annual Review of Political Science. He is the co-founder of the Working Group in African Political Economy (WGAPE). He received his BA from Dartmouth College and his PhD from Harvard University. Before moving to MIT, he taught for twelve years at UCLA.

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Daniel Posner Total Professor of Political Science Speaker Massachusetts Institute of Technology
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The February 10 Liberation Technology seminar titled, Can ICT Improve Clean Water Delivery Systems in Slums? Lessons from Kibera was led by two Stanford students, Katherine Hoffman, M.A. Candidate in International Policy Studies and Global Health together with Sunny Jeon, PhD candidate in Political Science. Hoffman and Jeon presented on the topic of the M-Maji system, a start-up non-profit project that uses mobile phones to empower communities with better information about water availability, price, and quality. M-Maji emerged from the Designing Liberation Technologies course taught at the Stanford d.school, which is dedicated to using mobile phone technology for health improvement in Kibera.  

The M-Maji project was conceived to confront a specific need in one of Africa's largest informal settlements: Nairobi's Kibera slum. Kibera holds about one quarter of Nairobi's population, but lacks a formal water and sanitation system. In short, water in Kibera is scarce, costly, uncertain, and often contaminated. The cost of water can rise up to over $3 per square meter during a shortage, and often takes up 20% of residents' income. Water is uncertain because about 40% of vendors in Kibera do not have access to a constant supply of water, especially since many of the connections that they do use are illegal. Additionally, water is often contaminated because water pipes run through sewer areas and are often plastic, since metal pipes would be taken as scrap. The result of these conditions is that the average person spends about 55 minutes per day looking for water, and about 68% of residents use informal water kiosks to access water.

M-Maji is a mobile platform designed to address problems facing both the seller and buyer of water in Kibera. Sellers report information about water availability and price at their water kiosk, enabling them to attract customers. Meanwhile, buyers access the system to find information about where water is available, at what price and at what level of quality. A third feature of the platform enables complaints and feedback regarding water sources. By coordinating and centralizing water information from multiple sources, M-Maji is designed to empower residents with better information about water availability, price, and quality, which ultimately helps to improve access to clean water.

There are several key reasons why a mobile platform that tackles the information side of the problem may be effective in solving the water problem in Kibera:

  1. The water market is distorted, but not coordinated. Also, there is significant variation between neighborhoods.
  2. Information asymmetry exists that is not solved by other sources or tools.
  3. M-maji is needs-driven.
  4. Relative to other interventions, M-Maji is cost-sensitive and low tech.

Although fieldwork conducted by the M-Maji team has indicated great potential for the platform's success, the team has also faced many challenges in implementation. One example stems from the platform's use of USSD sessions. Like SMS, these sessions allow short messages (up to 182 characters) to be exchanged. Users must enter a short code to begin a session, which then lasts about 2 minutes. However, the team has faced significant difficulty in getting mobile operators to allow access to USSD (in Swahili), as well as to negotiate rate agreements with mobile operators. The involvement of gangs and government in the water market introduces another challenges. In some cases, gangs bribe utility people to restrict the supply to push up prices, which may hinder the eventual effectiveness of the M-Maji tool.

Following the formation of a partnership with an important local NGO in Kibera called Umande Trust, M-Maji is moving rapidly into the pilot stage. The team is currently working to carry out a randomized impact evaluation to obtain convincing estimates of M-Maji's cost-effectiveness and impact on water outcomes. With the help of the community partner, the team is running a six-month long pilot on the West side of Kibera. In addition to surveying 1000 households for the baseline survey, the team is also carrying out data collection on water prices and water quality. M-Maji will officially launch in May or June of 2011, and the team will continue to reassess the project to better meet user needs as the results of the pilot become available.

 

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In partnership with the Center for Health Policy (CHPPCOR) at Stanford, this research initiative brings together medical doctors, health economists, and political scientists seeking to understand infant mortality declines in the post-War Era. The research initiative develops new measures of political incentives for population health improvement embedded in finely grained political institutions.

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Paul Wise is a clinical professor of pediatrics and a CHP/PCOR core faculty member. His work focuses on children's health policy; health disparities by race, ethnicity and socioeconomic status; and the interaction of genetics and the environment as these factors influence child and maternal health.

Before coming to Stanford in July 2004, he was a professor of pediatrics at Boston University and vice-chief of Social Medicine and Health Inequalities at Brigham and Women's Hospital. He previously served as director of emergency and primary care services at the Children's Hospital of Boston, and as director of the Harvard Institute for Reproductive and Child Health at Harvard Medical School. He has also served as a special expert at the National Institutes of Health and as special assistant to the U.S. Surgeon General.

Wise has worked to improve healthcare practices and policies in developing countries. He is involved in child health projects in India, South Africa and Latin America, targeting diseases such as tuberculosis and AIDS. He currently chairs the steering committee of the NIH's Global Network for Maternal and Child Health Research, and he has served on many other boards and committees including the Physicians' Task Force on Hunger and the American Academy of Pediatrics' Consortium on Health Disparities. He has received honors from organizations including the American Public Health Association, the March of Dimes, and the New York Academy of Medicine.

He received a BA in Latin American studies from Cornell University, an MD from Cornell University and an MPH from the Harvard School of Public Health. He completed a residency in pediatrics at Children's Hospital Medical Center in Boston.

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Richard E. Behrman Professor of Child Health and Society
Senior Fellow, Freeman Spogli Institute for International Studies
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Dr. Paul Wise is dedicated to bridging the fields of child health equity, public policy, and international security studies. He is the Richard E. Behrman Professor of Child Health and Society and Professor of Pediatrics, Division of Neonatology and Developmental Medicine, and Health Policy at Stanford University. He is also co-Director, Stanford Center for Prematurity Research and a Senior Fellow in the Center on Democracy, Development, and the Rule of Law, and the Center for International Security and Cooperation, Freeman Spogli Institute for International Studies, Stanford University. Wise is a fellow of the American Academy of Arts and Sciences and has been working as the Juvenile Care Monitor for the U.S. Federal Court overseeing the treatment of migrant children in U.S. border detention facilities.

Wise received his A.B. degree summa cum laude in Latin American Studies and his M.D. degree from Cornell University, a Master of Public Health degree from the Harvard School of Public Health and did his pediatric training at the Children’s Hospital in Boston. His former positions include Director of Emergency and Primary Care Services at Boston Children’s Hospital, Director of the Harvard Institute for Reproductive and Child Health, Vice-Chief of the Division of Social Medicine and Health Inequalities at the Brigham and Women’s Hospital and Harvard Medical School and was the founding Director or the Center for Policy, Outcomes and Prevention, Stanford University School of Medicine. He has served in a variety of professional and consultative roles, including Special Assistant to the U.S. Surgeon General, Chair of the Steering Committee of the NIH Global Network for Women’s and Children’s Health Research, Chair of the Strategic Planning Task Force of the Secretary’s Committee on Genetics, Health and Society, a member of the Advisory Council of the National Institute of Child Health and Human Development, NIH, and the Health and Human Secretary’s Advisory Committee on Infant and Maternal Mortality.

Wise’s most recent U.S.-focused work has addressed disparities in birth outcomes, regionalized specialty care for children, and Medicaid. His international work has focused on women’s and child health in violent and politically complex environments, including Ukraine, Gaza, Central America, Venezuela, and children in detention on the U.S.-Mexico border.  

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The first Liberation Technology seminar of the winter quarter on January 6, featured Jonathan Zittrain, Professor of Law at Harvard Law School and co-founder of the Berkman Center for Internet & Society at Harvard University. Zittrain focused his talk entitled, Minds for Sale, on the variety of online platforms that harness the wisdom of crowds today, and closed with a discussion of the implications of these platforms. Categorizing these new tools by the breadth of their user base, Zittrain began by describing the platforms that pay the most money per task, require the most skill, and subsequently have the least participation. Key examples of these platforms are listed below, and organized by their decreasing level on skill.

  •  Xprize Foundation attempts to prompt radical breakthroughs through competitions for large quantities of prize money.
  • InnoCentive creates a marketplace between engineers and scientists to encourage innovation.
  • LiveOps, which bills itself as a contact center cloud, has developed a large set of independent contractors who are designated specific tasks when they sign in to the site. They may be assigned to answer calls placed to a restaurant or emergency hotline or to make political calls on behalf of Liveops clients.
  • Samasource offers "dignified digital work for women, children and refugees" located in developing countries.
  • Amazon Mechanical Turk (also known as Artificial Artificial Intelligence) allows users to participate in anonymous, minimally paid tasks. These tasks can be submitted by any party and are highly disaggregated among hundreds or thousands of users, each of whom receives a payout of between approximately one to fifteen cents for completing the task.
  • Soylent, which calls itself "a word processor with a crowd inside" embeds workers from Mechanical Turk into Microsoft Word. When users install the site's Shortn add-in into Microsoft Word, they can use the tool to have written samples shortened in two minutes. In order to achieve this, the written sample is disaggregated by paragraphs, and each paragraph is shortened within two minutes by a "Turker"-a user who accepts the task on Mechanical Turk.
  • Microtask enables disaggregating previously sensitive data to be work processed from a scanned image. The ultimate goal of this group is to put distributed work into video and computer games. For now, they disaggregate larger tasks into two-second tasks that can be distributed across a crowd.
  • Games With A Purpose (GWAP) has a game-like platform designed to get users to complete disaggregated tasks for virtual points, rather than for actual remuneration. One of its more popular activities quickly attracted 23,000 players who contributed 4.1 million labels to images they were presented with in The ESP Game. Many players routinely play more than 20 hours a week.

Next, Zittrain moved on to offer some additional examples, hypothetical scenarios and questions that highlight some of his own concerns about the potential of these technologies. One key question is whether this market may be too efficient at linking up solvers and payers, if certain tasks are not in fact beneficial for society. After all, it was highly contentious when Texas governor Rick Perry set up video cameras on Texas' border with Mexico and invited people to watch the video feeds and report if they saw anything suspicious. Similarly, a site called InternetEyes allows users to watch video feed from CCTV cameras in the UK for free, offering the chance to "earn reward money, have a chance at reducing crime, and potentially become a hero and save lives," instead of actual compensation.

In another example, the University of Colorado Police Department recently offered a $50 reward for identification of students shown to be smoking marijuana in photos from a large April 20 gathering. Hypothetically, the Iranian government could use Turkers to identify Iranian protestors through national ID photographs in the very same way; by Zittrain's calculations, this task could be disaggregated and carried out quickly at a cost of only $17,000 per protester identified.

Another cluster of issues relates to the use of anonymous users to carry out disaggregated tasks that may have the effect of exerting influence on others. For example, Turkers were recently offered the opportunity to write a positive 5 out of 5 review for a product on a website, which hundreds accepted and completed for a few cents at a time. Users on SubvertandProfit.com are paid to "Like" something on Facebook, "Digg" something, or show their approval of a site or product via some other social network. The users are remunerated for their effort, and the site also profits. Taking this a step further, these platforms also enable users to pay people to evince opinions on legislative issues they do not actually care about. For example, health insurers were recently caught paying Facebook gamers virtual currency to oppose the health reform bill. By enabling any task to be disaggregated and monetized, these new platforms can have highly controversial and unethical implications.

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