TED Conversations

Nassim Assefi

doctor~novelist~creative curator~activist~thrillionaire, ZocDoc


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What's the most effective model of global health aid/development, given interventions can have complex, unpredictable and longterm impacts?

A debate is raging between those who believe humanitarian aid is corrupt, ineffective, and harmful (eg Dambisa Moyos of the world) and those who believe it is the moral imperative of wealthier nations to help the poor (Bill Gates, Nick Kristof, Paul Farmer, etc). As an idealistic young doctor with a privileged life and education, I wanted to give back to the world, starting some 20 years ago when I joined my first NGO. Since then, I've seen many different models of global health with variable effectiveness--Doctors Without Borders approach of relieving suffering but not building infrastructure, more standard NGOs that combine the two, large UN agencies (eg UNICEF, WHO, UNFPA, ICRC), medical diplomacy (free exportation of Cuban health workers), social entrepreneurship (eg Acumen Fund), missionaries, Gates Foundation/Global Fund/World Bank, international medical research posing as aid, etc. While objective successmetrics and monitoring and evaluation plans are now the standard part of most health interventions, what do we really know about the longterm, complex outcomes of our well-intentioned health interventions? Have we propped up an illegitimate government or strengthened a democratically-oriented one? Have we destroyed local economies or sustained them? Have we exacerbated brain drain or created jobs for internationals who want to return home? Weakened local infrastructure or strengthened it? Educated or misled? Oppressed the people we were supposed to help or empowered them? Please help me figure out the most effective way to use my medical and public health skills to improve health in a global context, and in doing so, help many others who are struggling with these issues. I would love to hear your experiences, perspectives, and ideas about how to do global health work right and how you might measure the complex, longterm impacts of what you propose. (Meanwhile, ironically, the US still lacks a decent, universal, and cost-effective health care system.)


Closing Statement from Nassim Assefi

This question continues to be an open and complex one. Philosophically, I tend to agree most with Vivienne and Samuel, but that still doesn't leave me with a concrete answer for how to spend my time and energy as a global health doctor who wants to have maximum impact or do most "good." Certainly, I believe in the long view, in the possibility of unintended negative or positive consequences of humanitarian action, in the importance of sustainability and environmental preservation, that we have to pay attention to local leadership and resources and avoid being humanitarian colonialists (and hypocrites who can't even pass a universal health care bill in our own country). Yes, we need solidarity, not just charity. We need trade and social entrepreneurship as well as aid. I believe health and health care are human rights, and perhaps having global health insurance for every citizen on earth is not a crazy ideal. One day, I hope to explore these ideas further in a narrative nonfiction book on the subject. In the meanwhile, you can follow me on Twitter to contiinue the conversation (@nassefi) or on my website once I update it (www.nassimassefi.com). Thanks to all who participated in this discussion. Thank you for caring and sharing.

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  • Feb 15 2011: First of all I want to say that I am not a doctor and I have no direct experience of humanitarian help in developing countries. But I have watched several TED talks about this subject, reading newspapers and discussing with friends.
    In my opinion imposing the help from the "developed nations" is partially wrong. Our life still is undeniably better but we cannot impose it as such. We should think historically how we get here: it was a slow process, it was done step by step. It means as a population we got use to it, the development of our life style was also followed at the same time by an awareness of it. We didn't have a model to aim to, we made our own model step by step, tuning it to the characteristics of our own culture. And now we are pressing the Third World to get to our standards skipping all the intermediate steps. This cannot work. Those people are losing their own culture trying to copy our one. Culturally, they should be able to develop their own culture independently.
    What we can do is to educate them to do so. From the health care point of view we have to realize that the biggest improvements were not about the use of drugs, nowadays we don't leave better and longer because of them, but about a better culture: hygiene first of all, good diet, reduced heavy physical work thanks to technology. Prevention is the real deal, not drugs. From this point of view giving a basic knowledge about hygiene first and the basic use of modern drugs would be much more effective on the long term. Drugs are effective only if taken the right way, otherwise they make things worse: people in Africa are given drugs against tuberculosis for free, but they don't complete the treatment because there are not enough supply for everybody and those who gets the pills share them with their relatives; in this way nobody gets cured and p strains of pathogens develop that are resistant to the drugs. A school can be better than a sickbay.
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      Feb 15 2011: Humanitarian colonialism is one of the subjects of my forthcoming novel, Say I Am You, so I couldn't agree with you more on your first point, Matteo. Education, especially of girls, is probably the most potent global health intervention we can do when you look at long-term outcomes. Yes, prevention is important. But there should be some equalizing of access to technology and pharmaceuticals. See my comment to Steve Garguilo's thread. Making antiretrovirals available to African AIDS patients is one such powerful example.

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