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 20 2011: I was very pleased to discover this webseries called "Beyond Good Intentions" by first time filmmaker and global aid worker, Tori Hogan: http://beyondgoodintentions.org/watchshare.php I've only watched the first episode but thought I'd share it here as it looks to be a good resource.

    Also just learned of a new "Critical Development Forum" at the University of Washington, run by students who are questioning aid approaches.

    Based on this discussion, I received an email from a Singaporean high school student asking intelligent questions about the efficacy of aid.

    Glad to know that others are discussing these issues!

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