Sentinel Cities: a systems theory analysis of global disease management

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Sentinel Cities: a systems theory analysis of global disease management A Topic for Critical Public Issues Oxford Round Table, Oxford, UK, 2013 Darla V.

2 Sentinel Cities: a systems theory analysis of global disease management A Topic for Critical Public Issues Oxford Round Table, Oxford, UK, 2013 Darla V. Lindberg, Professor of Architecture The Pennsylvania State University, USA Pathologies of Power: Health, Human Rights, and the New War on the Poor by Paul Farmer is a plea for a working definition of human rights that would not neglect the most basic rights of all: food, shelter, and health. The capacity to suffer is, clearly, a part of being human. But not all suffering is equivalent. It is possible to speak of extreme human suffering, and an inordinate share of this sort of pain is currently endured by those living in poverty. The poor are the chief victims of structural violence a form of violence based on the systemic ways in which a given social structure or institution harms people by preventing them from meeting their basic needs.

When social status denies access to social progress Time to rethink the institutional design A third of the 2 Billion people in the developing countries suffer from malnutrition.

3 When social status denies access to social progress Time to rethink the institutional design A third of the 2 Billion people in the developing countries suffer from malnutrition. Twenty-five percent of their children die before their fifth birthday. Less than 10 per cent of the 15 million children who died this year had been vaccinated against six most common and dangerous children s diseases. Vaccinating every child costs 3 per child. But not doing so costs us five million lives a year. (Farmer) These are classic examples of structural violence. Structural violence is visited upon all those whose social status denies them access to the fruits of scientific and social progress. Farmer argues neither culture nor pure individual will is at fault; rather, historically given processes and mechanics constrain individual agency.

Global Appeals to Policy Resistance When we thought it was about resource management from the top down, Science

committed more than $35 billion to fight the diseases of the world s poor Since 1999 Bill and Melinda Gates

HIV/AIDS, malaria, tuberculosis, and other long, under-funded diseases plus a half dozen other massive new efforts,

4 Global Appeals to Policy Resistance When we thought it was about resource management from the top down, Science argued for money in 2006 The New World of Global Health January 2006 A cadre of deep-pocketed, impassioned players committed more than $35 billion to fight the diseases of the world s poor Since 1999 Bill and Melinda Gates Foundation $6 billion roughly the budget of the World Health Organization (WHO) during the same time to battle HIV/AIDS, malaria, tuberculosis, and other long, under-funded diseases plus a half dozen other massive new efforts, matinee idols and world leaders Bono, Angelina Jolie, Richard Gere, Jimmy Carter, Bill Clinton, Tony Blair, Kofi Annan, Jeffrey Sachs

Global Appeals to Policy Resistance Missing the Target treatment not getting to the people who needed it most The biggest AIDS donor Global Fund country owned and inclusive claiming transparency and

5 Global Appeals to Policy Resistance Missing the Target treatment not getting to the people who needed it most The biggest AIDS donor Global Fund country owned and inclusive claiming transparency and accountability as a means to avoid top-down approaches to delivery. Aidspan, a New York-based watchdog of Global Fund complete autonomy comes at a steep price. No one is working together. Missing the Target, by 600 treatment activists, a much more systematic approach to designing accountability, such as setting goals, measuring progress, and assessing and addressing barriers is needed. There needs to be an implementation architecture.

6 Because collective decisions favor the status quo Society has a bias towards stability but life is rarely stable and hardly static

Broader context Why this is interesting and the critical role of design thinking For most of us, design is invisible In fact, the secret ambition of design is to

The automobile, the freeway, the airplane, the cell phone, the air conditioner, the high-rise have achieved design nirvana.

Most of the time, we live our lives within these invisible systems, blissfully unaware of the artificial life, the intensely designed infrastructures that support

7 Broader context Why this is interesting and the critical role of design thinking For most of us, design is invisible In fact, the secret ambition of design is to become invisible, to be taken up into the culture, absorbed into the background. The highest order of success in design is to achieve ubiquity. The automobile, the freeway, the airplane, the cell phone, the air conditioner, the high-rise have achieved design nirvana. They are no longer considered unnatural. Most of the time, we live our lives within these invisible systems, blissfully unaware of the artificial life, the intensely designed infrastructures that support them. When systems fail through accidents, disasters, crisis we become temporarily conscious of the extraordinary force and power of design, and the effects that it generates. Every accident provides a brief moment of awareness of real life, what is actually happening, and our dependence on the underlying systems of design. ----Bruce Mau

8 Examples of Complexity Thinking and Systems Theory Prior The dominant to the emergence model of of disease germ theory spread in was 1870 not of contamination

9 Examples of Complexity Thinking and Systems Theory The dominant model of disease spread was not of contamination

10 Examples of Complexity Thinking and Systems Theory But that people became sick from noxious air of places Yes, this is me with a condom on my head medical cartography served as a form of public health prophylactic protecting people from noxious air of places

Examples of Complexity Thinking and Systems Theory Design intended to keep people from the noxious air of places A 1684 depiction of Vitruvius (right) presenting De Architectura to Augustus The

11 Examples of Complexity Thinking and Systems Theory Design intended to keep people from the noxious air of places A 1684 depiction of Vitruvius (right) presenting De Architectura to Augustus The Education of the Architect 10. The architect should also have a knowledge of the study of medicine on account of the questions of climates, air, the healthiness and unhealthiness of sites, and the use of different waters. for without these considerations, the healthiness of a dwelling cannot be assured. The Site of a City For fortified towns the following general principles are to be observed. First comes the choice of a very healthy site. Such a site will be high, neither misty nor frosty, and in a climate neither hot nor cold, but temperate; further, without marshes in the neighbourhood. For when the morning breezes blow toward the town at sunrise, if they bring with them mists from marshes and, mingled with the mist, the poisonous breath of the creatures of the marshes to be wafted into the bodies of the inhabitants, they will make the site unhealthy.

12 Examples of Complexity Thinking and Systems Theory Medical cartography put disease on the map Adolph Muhry s Global Disease Map 1856

Examples of Complexity Thinking and Systems Theory The central tenet that a geographical link existed between disease & place the plague and leprosy came from

13 Examples of Complexity Thinking and Systems Theory The central tenet that a geographical link existed between disease & place the plague and leprosy came from the East Humboldtian Representations in Medical Cartography Contributed to views on environmental determinism of 19 th century Nicolaas A. Rupke and Karen E. Wonders

14 Examples of Complexity Thinking and Systems Theory That disease could travel from sources other than the air

15 Examples of Complexity Thinking and Systems Theory Imagining disease was very much a part of imagining place

16 Examples of Complexity Thinking and Systems Theory Globalization, still with a tacit understanding of medical geography

Examples of Complexity Thinking and Systems Theory 19 th century environmental determinism render borders a global threat A form of xenophobic environmental determinism

17 Examples of Complexity Thinking and Systems Theory 19 th century environmental determinism render borders a global threat A form of xenophobic environmental determinism where beliefs, values, approaches toward conflict, resources, collective behavior developed at the center represent cultural difference embodied in designed institutions

18 Systems Dynamics and Complex Feedbacks Water and Sanitation Problems are Urban Problems

19 Systems Dynamics and Complex Feedbacks Water and Sanitation Problems are Urban Problems

21 Characterizing Closed-Loop Systems Systems Dynamics and Complex Feedbacks

25 Characterizing Closed-Loop Systems Systems Dynamics and Complex Feedbacks

28 In Summary

30 New Technologies and Systems Models

31 Local Capacity Building Access to information, materials, tools, knowledge transfer processes

32 The Way Forward Capacity Development

33 at All Levels

UNESCO s Activity in Engineering, Science, and Technology for Poverty Reduction

Science and Development: Innovation Systems for Fighting Poverty American Physical Society April Meeting 2006-22-25 April, 2006 UNESCO s Activity in Engineering, Science, and Technology for Poverty Reduction