A Berkeley school of public health prof recently posted to the SPH listserv a great NASA link to high altitude photos of the southern California fires. You can click through several days worth of pics and see what conditions were like prior to the fires as well as tell when the winds kicked up as they carried dust plumes in areas unaffected by fire (for instance Oct 22nd).

The point the prof made was that as bad as the air is there, the particulate matter density of 200-300 micrograms per cubic meter (10x greater than average figures for US cities) is still less than the levels typically seen in biomass-burning homes in the developing world.

More efficient, hotter burning charcoal stoves are one immediate solution to indoor particulate matter (i.e. soot) in low-income homes. In Uganda for instance, Kampala residents use a huge amount of charcoal (my own estimate…) every day. The city’s air, not to mention the air in individual homes, has a great deal of suspended soot – you can easily smell it across the city during the peak cooking hours. Venture Strategies for Health and Development in Berkeley, together with an innovative Kampala for-profit stove manufacturer, are marketing the hotter burning stoves through targeted subsidies financed in part with carbon credits.

Perhaps one silver lining to the devastation in southern California will be greater awareness of the importance of high air quality.

Laurie Garrett, author of incisive books on public health and senior fellow on global health at the Council on Foreign Relations, recently spoke at the World Bank on the pressing significance of the profit motive in scaling effective health services. If you have time, I recommend reading the full PDF (hat tip to the Acumen Fund blog). Incentivized healthcare as a donor priority has been on the agenda for at least the past 15 years (see more recent World Bank 2004 World Development Report) and donor-supported health programs incorporating large numbers of private healthcare providers can be found in Taiwan and South Korea as early as the 1960s.  (If you can find a copy of this publication, worth a checking out: Kim, Ross and Worth (1972). The Korean National Family Planning Program: Population Control and Fertility Decline.  The Population Council: New York.  Use WorldCat to search your local libraries.)

Although the ideas are not new, the convergence of some donors’ calls for greater accountability and growth of pragmatic social ventures underscore the role of effective healthcare markets in low-income countries.   As always, Garrett is a compelling writer. The following excerpt sums up her call for productive investment in health:

For decades global health has been treated as a charity. Billions of people the world over have, for decades, been dependent on the kindness of strangers for their health and survival. While other fields of development may have encouraged capitalist solutions, health has been treated as if it were too sacred to be besmirched by profits. In the wealthy world every aspect of health, from record-keeping to pill-making; ambulance driving to hospitalization, is a profit center. We seem to feel that if you are living in France, Denmark, Canada, Japan – in those places it’s ok for hundreds of companies and thousands of individuals to realize profits from the health enterprise. We just don’t think that is ok in poor countries.

I think it’s time to tell truth to power: The charity model of global health is racist. It assumes that the health leaders of the poor nations of the world will endlessly get on bended knee, and with outstretched arms beg for alms. It doesn’t matter to whom the begging is directed – the World Bank, USAID, Bill Gates, Bono – it is still begging. The charity model offers no supply or resources guarantees over time. Yet it expects targeted achievements, realized in very short time windows, allowing the donor to brag about the numbers of lives saved, thanks to his beneficence.

I think it’s time to get out of the charity model, and get serious about investment. My take-home message is this: Invest in small businesses, even micro-finance approaches to health. Do not invest in models that promote health by subsidizing outside corporate interests. Rather, build local economies and businesses, employ the unemployed, and do so aggressively.

The second piece of this is related to supplies: sterile syringes, medicines, latex gloves, autoclaves — build global scale supplies procurement and distribution centers. Give the little guy in Malawi a chance to purchase essential supplies as part of an international pool, arguing down unit prices in favor of volume purchasing. Why should a small pharmacist in Lilongwe pay more for aspirin than Wal-Mart?