Chapter 2
The World That Changes The World:
How philanthropy, innovation and entrepreneurship are transforming the social ecosystem. Eds Willie Cheng, Sharifah Mohamed. Jossey Bass, 2010
Unmet Social Needs
Scanning the World’s Social Issues
By Tan Chi Chiu,
Board Member, Lien Centre for Social Innovation
Standfirst
The needs of societies remain fairly constant although the context in which they exist and the strategies for amelioration continually change. How needs are identified and solutions are prioritized remain important questions. Philosophical, economic and pragmatic ways of thinking about needs dictate the emphasis and priorities at various times of history. Yet there has been little in the way of a globally concerted approach to addressing global needs before the Millennium Summit and the Millennium Development Goals (MDG). Imperfect though these goals are and controversial as are the methodologies, they remain historically the most important global initiative ever in an attempt to reduce poverty through interventions in the areas of hunger, health, education, environment and global partnerships for development. The MDG have seen progress, but have been set back by the global recession of 2008. This chapter attempts to survey the important global trends that impact the social needs of societies and which provide the drivers of change. While cognizant of existing frameworks for categorization or prioritization of needs, this chapter does not seek to endorse any of them, but instead considers the world’s greatest social issues that are at the forefront of global attention and for which significant changes in causation, context or strategy for amelioration are evident. The issues are dealt with at two levels: Firstly, fundamental needs of existence and survival such as freedom from poverty and the need for food, water and health, and secondly the higher order issues such as climate change, which is threatening to unleash new waves of migrations, add to the litany of natural disasters and exacerbate the already worrying problems of water and food security amongst the most vulnerable. At the same time, new geo-political conflicts, oppressions of indigenous populations and economic migrations add to the complex matrix of emerging social needs. More developed countries are not exempt from their own needs as industrialization and affluence come with their own set of social pathologies that need to be addressed, such as a widening rich-poor divide, ‘diseases of civilization’, problems of an ageing population and family integrity. It is not the purpose of this chapter to recommend comprehensive solutions to all of these global problems. However, it is noted that solutions have their own hierarchy from individual self-help through family and community support, to state and international policy interventions, with contributions from the non-governmental sector filling in the gaps. Solutions lie in supporting the development of good governance, taking advantage of science and technology, forging unity in a fractious world, increasing contributions of the non-governmental sector and hopefully enhancing the consciousness of the corporate world of their social obligations.
Fundamental human needs range from the requirements for humankind to exist and survive to the need for people to thrive beyond physiological sustenance to higher levels of social, emotional and psychological fulfillment. The variables are the etiology of unmet needs and the way in which these needs come to be met by societies. What are these needs? Human needs are complex, interrelated and difficult to categorize, let alone prioritize for action. How needs are perceived and discussed varies with changing context and through the course of societal development and social progress. Abraham Maslow in 1943 proposed his ‘Hierarchy of Needs’ in his seminal psychology paper: A Theory of Human Motivation. This theory proposes a grossly oversimplified pyramid of needs with the most basic at the bottom and the most esoteric at the top. At the bottom are ‘physiological needs’ of breathing, food, water, sex, sleep, homeostasis and excretion. Then follows ‘safety needs’, security of body, employment, resources, morality, family, health and property. One up from this are the needs of ‘love/belonging’ comprising friendship, family, sexual intimacy. Then come ‘esteem’ which includes self-esteem, confidence, achievement and respect of and by others. Finally at the top of the pyramid is ‘self-actualization’ which covers morality, creativity, spontaneity, problem solving, freedom from prejudice and acceptance of facts. In reality, all these human needs are interconnected and interrelated making it excessively reductionist to isolate them in categories. However it is convenient for the sake of discussion to look at needs in this way, because traditionally, addressing social needs does imply attention to the bottom two levels which may be regarded as the elements necessary for existence and survival, in the belief that higher orders of needs will naturally arise from the fulfillment of more basic needs. Herein is found one of the reasons for the many different definitions and classifications of needs. Some ‘needs’ turn out to be ‘means’ for the achievement of more fundamental requirements of human living. For example, the Young Foundation’s analysis of unmet needs in Britain classifies society’s needs as: Food (incontrovertibly a fundamental need), then shelter; warmth; a decent home; transport; income and freedom from debt; employment; possessions and activities; skills and qualifications; mental health and psychological fulfillment in areas consistent with the top two tiers of Maslow’s Hierarchy. This construction no doubt reflects Britain’s relatively developed status. The most pressing needs of less developed and poorer nations will be somewhat differently construed.
Addressing unmet social needs can also be done from an economic cost-benefit point of view, exemplified by the Copenhagen Consensus, which seeks to establish priorities for global welfare using methodologies based on the theory of welfare economics. Through conferences held from 2004 to 2009, priority areas for attention were identified. For instance, the 2004 conference ranked tackling HIV/AIDS, hunger/malnutrition, trade liberalization and malaria containment as most important, followed by improving agricultural technologies, lowering barriers to migration of skilled workers and improving infant and child nutrition, leaving as lowest priority any strategies to redress climate change. The 2009 conference did away with group rankings and merely listed in order of cost efficiency priority, 30 strategies for global problems, with nutrition and health higher up and once again climate change strategies lower down. However there has been considerable criticism of the analytical framework used and of biases due to panel composition and the limited parameters they were asked to work within, such as an unrealistically limited hypothetical global budget of US$50B to solve all problems. The Copenhagen Consensus prioritizes solutions based on resource optimization, rather than prioritizing problems by importance, which may well be pragmatic, but may not be what is truly impactful. For example, malaria eradication was deemed highly cost effective compared to ameliorating climate change. But this may miss the ‘wood for trees’ in that saving individual lives is important, but some would deem less impactful than saving entire populations from starvation, homelessness and death, even if it is more expensive per life saved doing so.
Turning from theory to practice, in September 2000 at the ‘dawn of a new millennium’, in an ambitious effort to demonstrate determination and global efforts to reduce extreme poverty, world leaders adopted the United Nations Millennium Declaration. Specific objectives became known as the Millennium Development Goals (MDG), with a series of temporal targets and a deadline of 2015. These goals were: Eradicate poverty and hunger; achieve universal education; promote gender equality and empower women; reduce child mortality; improve maternal health; combat HIV/AIDS, malaria and other diseases; ensure environmental sustainability and develop a global partnership for development. Even these goals contain a mixture of basic and higher order needs. The MDG are perhaps as laudable as they are imperfect. Praised on the one hand for their breathtaking vision of sweeping targets in reducing poverty, they are also roundly criticized for being detached from the ‘political economies’ of countries, depending on unwieldy top-down solutions that disenfranchise local community stakeholders and focusing only on quantifiable goals that may well leave social inequities unchanged. Nonetheless, the MDG remains historically the most coherent global strategy to tackle poverty on a worldwide scale and needs to be seen as a benchmark, even if progress has been halting. The 2009 MDG progress report said that more than halfway to 2015, despite major advances in the fight against poverty and hunger, progress has slowed and even reversed as a result of the global economic and food crises and the objectives will likely not be met by 2015.
This chapter will discuss some of the world’s most pressing social needs and the current trends that influence both causation and strategies for amelioration. The issues can neither be neatly compartmentalized nor exhaustively covered and while cognizant of the many existing frameworks for classification and prioritization of needs, none of them are adopted as they are. This discussion instead considers the world’s greatest social issues that are at the forefront of global attention and for which noteworthy changes in causation, context or strategy for amelioration are evident. The issues are dealt with at two levels: Firstly, fundamental needs of existence and survival such as freedom from poverty and the need for food, water and health, and secondly the higher order issues that substantially affect human survivability and prosperity, such as environment, natural disasters, human displacements and modern conflicts. But some topics, such as education will not be discussed separately as its issues of access, especially by females, need for teachers, infrastructure and funding, and the relationship with poverty are all relatively well known and unchanged. Neither will the highest order of societal needs dealing with emotions, psychological wellbeing and self-actualization be addressed except in the context of the concluding section on the needs of emerging societies, which face the consequences of development, industrialization and affluence. These too will require attention to preserve the health and integrity of societies in the future as developing countries catch up.
It is also not the purpose of this chapter to recommend comprehensive solutions to all of these global problems. It is duly noted that solutions, like needs, also exist in a hierarchy, from self-help to family and community support, then facilitative and infrastructural support such as education, health care and viable market economies afforded by local and national governments and finally global attention through international agreements for action such as the MDG, with non-governmental contributions pervading all the levels, attempting to fill in the gaps. The most effective solutions are noted to lie in supporting the development of good governance, taking advantage of science and technology, forging unity in a fractious world, increasing contributions of the non-governmental sector and hopefully enhancing the consciousness of the corporate world of their social obligations.
Poverty
About half the world or about 3 million people live on less than US$2.50 a day. Using a new threshold for extreme poverty of US$1.25 a day (purchasing power parity) in 2005 prices, the World Bank concludes that there were 1.4 billion people living in extreme poverty in 2005. Recent increases in the price of food have had a direct and adverse effect on the poor and are expected to push an estimated 100 million more people into absolute poverty.
The global discussion on poverty has been checkered. In the sixties and seventies, at the height of its stature and the hope reposed in it, the United Nations led the thinking on poverty, equating its solution with industrialization, which was a strategy with a modicum of success. But in the seventies and eighties, with the onslaught of the global recession, the IMF and World Bank dominated development with emphasis on ‘structural adjustments’ of third world economies. The social consequences were disastrous leading to new poverty reduction strategies and human development programs in the nineties with emphasis on reduction of extreme poverty as linked to population growth, environmental degradation, migration flows, discrimination especially of women and governance. Income levels per se became less important than national economic development. The World Bank and IMF also worked through international organizations in a way that tended to bypass local national policy responses. A reason for this is that it is impossible to consider ‘poverty’ in isolation because it is multifaceted and sustainable solutions need to be at the national and international levels rather at the local level. The causes and consequences of poverty are interactive, intertwined and also constitute a vicious circle. Poverty leads to hunger, unsuitable living conditions, lack of water and sanitation, disease, malnutrition, failure of education, gender inequality, lack of economic opportunities, lack of access to health care and shortened life-spans. The poor are also disproportionately affected by conflict, disasters and other consequences of global warming and economic fluctuations. Alleviation of poverty must therefore address every element in the matrix, to achieve wide ranging and mutually reinforcing outcomes. In recognition of this the MDG targets address issues of hunger, education, health and environment simultaneously, to halve the number of extremely poor by 2015. But even this target is often considered too modest. Extreme poverty being poverty that kills, it has been estimated that even if the targets are achieved in 2015, more than 80% of extremely poor people will still likely die.
Progress has been made towards achieving the MDG through accelerating development and prosperity in East Asian countries, whereas in sub-Saharan Africa, little has changed. Nonetheless overall, poverty rates are estimated to have fallen from 52% in 1981 to 42% in 1990 and to 26% in 2005. Yet today there are 54 countries that are poorer than they were in 1990. In 37 countries, poverty is rising. In 55 countries, GDP has diminished and development aid is shrinking.
Direct financial aid is not a solution embraced by development and aid agencies. Facilitating economic opportunities is always preferred. Microfinance initiatives such as by the Grameen Bank of Bangladesh or ACCION International in Latin America have been highly effective in directly improving the economic output of communities. In 2006, microfinance institutions provided loans to 113 million clients at the bottom of the pyramid worldwide. Other specific poverty alleviation strategies that deserve greater attention include constructing social safety nets to minimize the consequences on the poor of any global economic recession and higher food and energy prices. Because for millions in the world today, jobs provide little relief due to pitifully low pay, or work is simply unavailable to women, promoting equitable access to economic resources and job opportunities across all groups is crucial. In sub-Saharan Africa over half the workers live in households where earnings are less than US$1 per person per day – the ‘working poor’.
As multilateral solutions are most effective, forming partnerships with civil society, NGOs, the private sector and foundations to develop participatory, pro-poor, urban and rural development strategies is an advantage not to be neglected in an interconnected world. To develop the infrastructure and services of societies is to enhance productivity of enterprises and facilitate integration into the global economy. At the same time it is necessary to promote urban development to upgrade slums and provide basic services. Finally to integrate the least developed countries into the multilateral trading system is to avail them of the benefits of the global marketplace. The relevance to poverty reduction of strategies to deal with issues of food, water, health, environment and marginalized peoples will be readily apparent in subsequent sections.
Food
Some 27 to 28 percent of children in developing countries are estimated to be underweight or stunted. In 2006, the number of such children is estimated to be more than 140 million. Two regions that account for the bulk of the deficit are South Asia and sub-Saharan Africa. The situation is set to worsen with rising populations, shortage of arable land, decreasing yields, competition from biofuels, water scarcity and climate change bringing drought and flood. At the same time, urbanization creates demands for higher value and resource intensive items such as meat, thus driving up prices and reducing affordability.
Even though the proportion of people worldwide suffering from under-nutrition has fallen since the early 1990s, the number of people with food insecurity has risen. The Food and Agriculture Organization (FAO) in its 2009 report “The State of Food Insecurity in the World” tells us that currently about one in six people in the world, or 1.02 billion people are undernourished and that the number was rising even before the food and economic crisis of 2008, which has exacerbated the situation. This suggests that the World Food Summit target of reducing the number of undernourished people by half to no more than 420 million by 2015 (as one of the MDG goals) will not be reached if the trend continues. The causes are blamed on conflicts, famine, economic crises, natural disasters, environmental degradation, poor agriculture infrastructure, high domestic food prices, lower incomes and increasing unemployment. In trying to cope, people are reducing their dietary diversity, eschewing essential nutrition, while spending less on items like education and health care, thus producing a further downward spiral in quality of life. There are more hungry people in the world than at any time since 1970. The long term trend is due largely to reduced aid and private investments earmarked for agriculture. In 1980, 17 percent of aid contributed to donor countries went to agriculture. By 2006 that fell to 3.8 percent.
The FAO states that the focus should be on increasing food production, yet the opposite has happened over the years. A healthy agriculture sector can provide an economic and employment buffer in times of crisis, especially in poorer countries and investment in agriculture must increase to reverse the trend. FAO wants due attention to be given to developing the rural non-farm sector in parallel with agriculture and to developing safety nets, principally the protection and support of smallholder or subsistence farmers, which are integrated with broader social assistance programs that increase long term sustainable productivity and a more diversified economic base.
A modern trend posing both potential benefits and risks is that of ‘farming abroad’. According to the UN some 30 million hectares of developing world have been targeted by scores of government-backed farming companies. Richer nations such as Britain, America, China, South Korea and Saudi Arabia are leasing land in Africa and Asia to grow food primarily to preserve price stability and security of their own food requirements. Even Libya has leased agricultural land in Ukraine. In the process, theoretically, much local employment is created, capital is injected and technology is transferred. But such a practice can also deprive already food insecure countries of essential land to grow their own food and leave their people vulnerable to exploitation, especially smallholders who will not benefit from commercial farming technology. Subsistence farmers can be squeezed out of land, workers and the scarcest resource, which is water. Farming abroad also smacks of neo-colonialism with all its negative connotations, with the potential for socio-political upheavals that do anything but increase the host countries’ own food security. For example, riots broke out in Philippines when the public learnt that land had been leased to China and the same happened in Madagascar with respect to South Korea. In both instances, agreements had to be cancelled to preserve public order and in the latter case, the government was overthrown by a coup.
Another factor that needs to be addressed is the gross mal-distribution of food in the world. Developed nations suffer surfeit of food while many developing countries languish, a consequence of the economic realities of the global food market that cannot easily be overcome. This mal-distribution is also represented by where food that is consumed lies in the food chain. For example, in USA and Canada people consume on average 800,000 kilograms of grain per year, mainly as meat, poultry, eggs and milk, whereas in India, people consume less than 200,000 kilograms a year, mostly as a direct food source, leaving little for conversion to meat protein.
What needs to happen for food–insecure nations is to have better control over their resources, access to opportunities, development, economic and policy tools to produce or procure more food, and improved governance at the national and local levels so that appropriate resources are placed where needed to boost agricultural output in tandem with general development. There should be stronger focus on small scale farming in rural areas and sustaining viable local and national markets for produce. What was difficult to do during the 2008 economic crisis was for international capital markets to come to the rescue of poor countries because the turmoil was truly global. Worse, food prices will likely rise again as economies recover from the recession.
A culture of multi-cropping early-maturing varieties of grains, which is already established in China and other parts of Asia, can be spread to other parts of the world. Since multi-cropping depends in part on the moisture in the soil, improvements in irrigation efficiency, such as with low pressure sprinkler or drip feed systems, must occur in tandem. Science could further come to the rescue through techniques for cloning and genetic modification of food. The former is based on the mapping and cloning of genes in food crops, a long standing practice in agriculture. One good example is New Rice for Africa (NERICA), a crossbreed of highly productive Asian and resilient African rice varieties, which can produce 200 percent more than traditional crops. This has helped alleviate hunger and turn around the fortunes of many farmers in sub-Saharan Africa. Genetically modified crops are transgenic, or have received genes from other species. The purpose is to produce crops that can be grown quicker, are more resistant to pests, drought and flood and contain enhanced levels of essential nutrients that could help alleviate hunger. Examples include quick growing rice needing less water for cultivation, rice that contains 30 more times beta carotene, purple tomatoes that contain antioxidant anthocyanins and cassava boosted with additional iron, proteins and vitamins. Resistance to genetically modified foods by environmental organizations and public interest groups may be misplaced in the light of the potential solution offered to world hunger and malnourishment .
Finally, the world’s insatiable appetite for energy must be satisfied by more innovative means than supplanting food agriculture with biofuel production. The massive conversion of grain into biofuels was a response to skyrocketing petroleum prices. Governments need to remove incentives to convert food into fuel, a move that will stabilize grain prices worldwide and reduce the global tensions associated with the competition between food and fuel.
Water
The problem of water provision will likely worsen in the future, as water tables fall, agricultural requirements rise in tandem with populations and megacities suck up water for domestic and industrial use. Some 1.1 billion people in developing countries have inadequate access to water and 2.6 billion people lack basic sanitation, with a consequence that some 1.8 million children die from diarrhoea each year. Close to half of all people in developing countries suffer at any given time from a health problem caused by lack of water and sanitation. The economic cost of water shortage is staggering. Sub-Saharan Africa for example loses 5% of GDP or $28.4 billion annually due to this alone .It has been estimated that by 2015, nearly half the world’s population, more than 3 billion people, will live in countries that are ‘water stressed’, that is have less than 1700 cubic meters of water per capita per year, mostly in Africa, Middle East, South Asia and northern China. 2015 is also the target year for the Millennium Development Goals for water and sanitation. It is a mixed picture with significant progress in providing safe drinking water to the world’s population but without commensurate progress in providing sanitation.
Nearly half of the world’s land surface consists of river basins shared by more than one country and more than 30 nations receive more than one-third of their water from outside their borders. Take the Euphrates and Tigris Rivers. Turkey is building new dams and irrigation projects thus affecting Syria and Iraq. Syria in turn is also damming the Euphrates thus further depriving Iraq. This combined with a 2 year drought and lack of a water conservation strategy by Iraq and its farmers have left the river in Iraq more diminished than ever before in history. As usual, the poor suffer disproportionately as farms of rice and wheat shrivel up and fishing boats remain grounded. Agricultural output has been halved from what it was 2 years ago. Another example is the Mekong which originates in China and meanders through Myanmar, Thailand, Cambodia and Vietnam and is the lifeblood of 61 million people. But as many as 53 dams have been built or under way, with another 66 under study. This threatens the subsistence livelihood of millions of people dependent on farming and fishing and can unleash new waves of migrations.
Water shortages are often exacerbated by conflict. For instance, Amnesty International has accused Israel of preventing Palestinians of the West Bank and Gaza Strip from having enough potable water while Israel in response claims that the Palestinians have been given more water than required under treaty obligations and that their problems stem entirely from mismanagement of their water supplies. The truth as always is probably somewhere in between, but this exemplifies the kind of situation that arises from a heady mixture of limited water resources, politics, war, and ethnic divides. Another example is the Brahmaputra River which originates on the Tibetan plateau and feeds north east India. Because of simmering territorial disputes with China, especially over Arunachal Pradesh, India is concerned that China may dam the Brahmaputra leaving north east India parched.
Groundwater resources are being rapidly depleted by a combination of increasing needs of farming and urbanization and poor resource management. India, once a shining example of good irrigation practices, now typifies this problem, where in the northern states of Punjab, Haryana and Rajasthan, groundwater has been so rapidly used up that there is a net loss of 109 cubic kilometers of water or 5 centimeters fall per year in the water table between 2002 and 2008. The consequences for the 114 million residents of the region include reduced agricultural output and conflict .
Where groundwater has not receded, contamination, such as with arsenic in Bangladesh, Ghana and Inner Mongolia or industrial chemicals in China, poses insidious but severe and inter-generational health issues for communities that have neither the means to deal with it nor the ability to move away. External interventions are often necessary, bringing in much needed water purifying technology and the funding to support its use.
The solution to water shortages amongst the poorest communities in the world lies in technology, politics and governance. Water harvesting technologies, such as desalination of sea water, are expensive but are likely to become better and cheaper in the future and more accessible to more countries. Genetically modified crops could be developed that need less water, but as noted earlier, there remains widespread unease about transgenic food. International treaties governing the use of trans-boundary rivers do not exist and in any case would be complex or non enforceable. Appropriate pricing of water to reflect its scarcity and value is obviously necessary, but in many countries this remains politically sensitive. In Taiwan for example, water makes up only 0.5-0.6 percent of household expenditure compared with 10 percent in Israel. Some countries provide highly subsidized or even free water as a human right; others like Singapore charge their people the full cost of water and even a ‘consumption tax’ on top to reinforce awareness of the scarcity of water.
Health
Despite rapid advances in medicine, health care issues require urgent attention if the most susceptible are to be saved. Infant mortality rates are falling, but remain as high as 165 per 1000 live births in Afghanistan. The under-five mortality rate tops out at 262 per 1000 live births in Sierra Leone. The causes are mainly malnutrition, pneumonia and diarrhea. Infectious diseases continue to afflict the poorest regions, with an estimated 40 million people living with HIV/AIDS, with 3 million deaths per year. Every year, there are 350-500 million cases of malaria with one million fatalities with African children accounting for over 80 percent of malaria victims worldwide. Other problems include River Blindness and resurgent drug-resistant Tuberculosis.
While effective HIV and AIDS treatment have been developed, controlling spread remains a challenge especially in sub-Saharan Africa, India, China, Central Asia and South East Asia. In particular, India, Indonesia and Pakistan have become new fronts in the battle against HIV/AIDS in Asia where already 5 million are affected in countries like Thailand, Cambodia and Philippines. Indonesia and South Asia suffer from the lethal combination of drug abuse with dirty needles and unprotected sex. Russia is facing an uncontrollable AIDS epidemic, with more than one million people infected, due to there being some two million intravenous drug abusers in Russia and the lack of a cogent strategy how to deal with them. AIDS will reduce economic growth by up to 1 percent of GDP per year and consume more than 50 percent of health budgets in the hardest hit countries. AIDS together with TB will likely account for the majority of deaths in developing countries in coming years. In some African countries, life spans will be reduced as much as 30 to 40 years generating more than 40 million orphans and contributing to an abnormal ‘youth bulge’ susceptible to poverty, crime and social instability.
The problem of pandemics is exemplified by Influenza A (H1N1). Pandemics are harder to prevent in this age of globalization and the accelerating pace of movement of people across borders. This is the way H1N1 quickly spread following its emergence in Mexico. It is fortunate that less than a year after its emergence, H1N1 waned in prevalence worldwide with no evidence of increased virulence in the strain. If it had been otherwise, once again, poorer communities would be at higher risk because they have poorer environmental sanitation and health care services and in all probability cannot afford the vaccine that has become available.
Global health problems do not result merely from the de facto existence of diseases that require treatment. They are largely to do with the political and economic choices of governments, widening of the rich-poor divide through globalization, conflict, climate change and environmental degradations.
The recession of 2008 was one such global phenomenon that saw donor countries reducing aid for healthcare in developing countries. A UNAIDS/World Bank report found that many patients are struggling to gain access to life saving drugs because of the global economic downturn with the potential to affect the lives of 3.4 million people on anti-retroviral treatment and millions more who are yet to receive treatment but have no access to it. The report said that there is a strong risk that prevention programs for populations at higher risk will be cut, increasing the number of new infections and people who need treatment in the future.
Donor assistance to avail the poor of essential health care is but a band-aid. It is more important to view health issues as being inextricably linked to development and public health and solutions must address upstream issues such as governance, social stability, education and finance. This is exemplified by India, which has more than 20 percent of the world’s child deaths under five, the highest in the world. Save the Children in India notes that despite available of schemes and resources, these are not accessible to most people, health care facilities are poor and there is little political will to fund and implement even low cost health solutions that would make a huge difference. This can be a vicious cycle as societal ill health saps the system of resources, stretches the capacity of civil society and hampers the very development of sound political and economic institutions that will enable these health challenges to be better faced.
Changing the health landscape will require more than donor assistance, sporadic actions and piecemeal contributions. The finance and ‘muscle’ required can only be provided through international agencies such as WHO, UNICEF, World Bank, or large private drivers of change such as the Bill and Melinda Gates Foundation which has a special focus on biotechnology solutions to healthcare needs, such as developing vaccines to Malaria and HIV.
Environment
Climate change has enormous impact on societies with the poor as usual disproportionately affected. As drought desiccates, rains or floods inundate previously arable regions, rural-urban migrations accelerate even more, leading to increased problems of the urban poor and unemployed with attendant social and law and order issues for mega cities. In addition, an increasing number of cities will face serious air and water quality problems that are already troubling conurbations such as Mexico City, Sao Paulo, Lagos and Beijing. The only saving grace, in environmental terms, is that cities have been found to produce less carbon dioxide per capita than the countryside due to urban families living more compactly, doing less damage to fragile ecosystems, burning less fuel and producing fewer children.
The Red Cross found that global warming and climate change when superimposed on already vulnerable, poor, rapidly urbanizing communities creates ‘super disasters’. Rising sea levels will destroy habitable low lying territories such as the Maldives, which is a relatively poor nation dependent on fishing and very limited agriculture for subsistence. Already there are plans on the table for the Maldives to use money from tourism to buy land elsewhere for their people to live on if they ever become submerged. A colony of Carterets Islanders has already been relocated to the Papua New Guinean island of Bougainville, as their tiny south Pacific home becomes inundated by a sea level that has risen 10 cm in the past 20 years. This must be the first in a new category of ‘climate refugees’ that the world will need to deal with. Loss of land through rising seas will be an increasingly more common phenomenon in the future. The top 20 port cities exposed to coastal flooding are in Asia, with six of them in China. The combined value of their flood-exposed assets is forecast to be almost US$9.2 trillion, with US$1.2 trillion of that amount in Hong Kong. Pre-emptive population shifts are already taking place. Australia is reportedly considering banning people from living along coastal areas which are threatened by rising sea levels.
Climate change has a major impact on food security when drought and flood reduce arable lands particularly in countries dependent on subsistence agriculture. Two-thirds of the world’s major deltas, the most fertile lands on earth and home to half a billion people are at risk due to land subsidence and rising sea levels. The Yellow, Yangtse and Pearl River deltas of China, the Nile of Egypt, Chao Phraya in Thailand and the Rhone in France top the list of endangered deltas. The second tier includes the Ganges in Bangladesh, Irrawaddy in Myanmar, Mekong in Vietnam and the Mississippi in the United States. 85 percent of the 33 largest delta regions suffered severe flood in the past decade, affecting a quarter of a million square kilometers of territory. If Himalayan glaciers melt, water supplies to two of the world’s largest grain producers, China and India will be at risk. These are the world’s two largest wheat produces and also dominate the rice market. What happens to these two food giants will have tremendous impact on food prices and food security everywhere.
Climate change is also blamed for an increasing number of natural disasters, with the number attributable to climate change increasing by nearly a third in the last four decades. In the last 20 years, the number of recorded disasters has doubled from about 200 to more than 400 per year. Disasters caused by floods are more frequent – up from about 50 in 1985 to more than 200 in 2005 – and floods damage larger areas than they did 20 years ago. From 1988 through 2007, over 75 percent of all disaster events were climate-related and accounted for 45 percent of deaths and 80 percent of the economic losses caused by natural hazards. The Mega-Stress for Mega-Cities report of the World Wide Fund for Nature found large variations in the ability of Asian cities to mitigate damage from floods and storm surges. Dhaka, Phnom Penh, Manila topped the list of vulnerable cities and most in need of developing adaptive capacity.
Amelioration strategies for global warming are contentious as there is no absolute consensus on whether human activity is the principal cause although this is now widely accepted. Neither is there consensus on whether it is a real priority based on cost-benefit analyses, as exemplified by the Copenhagen Consensus. Even if there are to be carbon dioxide emission curbs, any possible strategies may suffer reversals as the world’s most polluting economies focus on revving up their carbon spewing engines of growth to overcome the economic depression, while deflecting disproportionate responsibility to developing nations that are still struggling to progress. According to the World Resources Institute data in 2002, developed nations emit about nine times more carbon dioxide per capita than developing nations, varying from 13 times more for high income nations to 4 times for middle income nations. The United States per capita emission is 20 times higher than India, 12 times higher than Brazil and 7 times higher than China. The developing world is in no mood to sign up to obligatory carbon emission limits while developing countries like the United States duck and weave around their own obligations, all but ignoring the Kyoto Protocol. Poorer countries such as represented by the Group of 77 feel that they deserve a chance to catch up economically without being hobbled by mitigation frameworks dictated by developed powers. What is even more objectionable to many countries, both rich and poor is that carbon emissions caps as the prime strategy against global warming can be draconian and could retard communities in many countries on their road out of poverty and privation. This is despite notions of having the most developed countries help to pay developing countries to restrict carbon emissions and of the exchange of carbon credits through a ‘carbon market’.
The strategy developing countries are likely to take is exemplified by China whose unilateral actions to curb gas emissions have attracted praise at UN climate talks, thus putting the US under pressure to come up with its own commitments. At the same time, China is not holding back on its industrialization plans. It recently celebrated the production of its 10 millionth vehicle, putting it just behind the USA and Japan in motor vehicle output and is aggressively encouraging its people with tax incentives to buy cars but, importantly, with special subsidies for clean car technology.
All climate strategies will ultimately be determined by individual countries based on their own self interests and those of the governments currently in power. It is therefore no surprise that the long anticipated United Nations Climate Conference in Copenhagen in December 2009, which held out the hope of a global treaty to replace the Kyoto Protocol that would mandate emission cuts, specify verifiable targets and raise money for poorer nations to cope, degenerated into chaos and resulted only in a largely symbolic Copenhagen Accord that was long on rhetoric but incredibly short on tangible and legally binding commitments from member countries. At least half a dozen developing countries blasted the document as a cozy backdoor deal that excluded the poor and doomed the world to catastrophic climate change.
Perhaps the solution is more promising at a local level, bringing the emphasis comes back to the cities. It is posited that cities, owing to their density, offer the best and most efficient opportunity to have an impact on global warming gas emissions. It is further believed that it is possible to craft strategies for large scale mitigation or adaptations that reward the poor for their low carbon lifestyles and avoid disproportionately impacting the quality of life of the poor, by linking community development and climate change, through education, technical innovation and incentives for the poor to live low carbon emission lifestyles in exchange for a lower cost of living and improved household income.
Businesses also have a part to play. Corporations need to embrace ‘sustainable development’ as part of their corporate social responsibility, as exemplified by behemoth Wal-Mart’s commitment to 100 percent renewal energy, zero waste and selling products that help sustainable development, through working with its suppliers. This of course also reflects society’s demands on corporate culture. The Harvard Business Review and MITSloan Management Review in separate reports both affirm that sustainability is not the burden on bottom lines as once thought, but becoming environmentally friendly can lower costs and increase revenues. That is why sustainability should be a touchstone for all innovation and in future only companies that make sustainability a goal will achieve competitive advantage, a position that entrepreneurs in general nowadays accept.
Natural Disasters
Non-climatic natural disasters such as earthquakes, tsunamis and volcanic eruptions add to those associated with climate change such as typhoons and floods. There appears to be a rise in the incidence of disasters in recent years. In 2008 the International Council for Science noted that disasters had increased steadily from 100 per decade in the period 1900-1940 to 2800 per decade in the 1990s. A World Bank study in the same year noted that mass disasters had increased by 30 percent in the last few decades. This exponential rise was accounted for by climatic disasters with seismic disasters accounting for a constant 11%. Unfortunately 90% of natural disasters occur in Asia, where the vast majority of the world’s poor also resides. After the Indian Ocean Tsunami of 2004, despite the contributions of the international community, swathes of affected territories and settlements in Indonesia, Sri Lanka and elsewhere are yet to be comprehensively rebuilt due to inefficiencies, incompetence and corruption. Desperate needs for housing, livelihoods, shelter and healthcare remain unmet.
But here is also where disaster preparedness, mitigation and long term developmental assistance find a nexus which presents both opportunities and risks to the resilience and independence of affected communities in their struggle for survival and progress. Disasters should no longer be seen as exogenous events for societies to respond to, but must be understood in the context of socio-economic, demographic and political forces that determine the vulnerability of societies. Disaster preparation and amelioration must therefore be grounded in development and operated by partnerships between communities, non-profit entities and governments, all taking a long term view of sustainable restitution and development rather than a short term view of surviving a disaster. The January 2010 earthquake of Haiti is a prime example of a nation suffering the consequences of the worst possible combination of factors. Already beset for decades by poverty, social problems, unstable governments, corruption, slipshod building standards and environmental degradation, it is also on the regional hurricane track and a major tectonic fault line. Already having suffered six catastrophic killer hurricanes and storms from 2002 to 2008, Haiti had neither defenses nor capacity to sustain its epic earthquake. On the other hand, an example of a concerted attempt to fortify a vulnerable community against disaster is the National Society for Earthquake Technology (NSET) – Nepal, a non profit organization set up in 1993 to develop earthquake resistance engineering technologies and engage the government and local communities to retroactively shore up unsound high risk buildings or prospectively to ensure the earthquake resistance of structures such as schools and hospitals while educating the public on earthquake awareness and safety drills. NSET thus harnesses developmental resources towards strengthening local communities against disaster while engaging in community development.
This kind of strategy is supported by the UN Under-Secretary general for Humanitarian Affairs and Emergency Relief Coordinator John Holmes, who in October 2009, following a string of natural disasters in Asia such typhoons in the Philippines and earthquakes in Indonesia, said that the world had spent US$12 billion on humanitarian resources to disasters the year before and 99 percent of those killed by natural phenomena were in the Asia-Pacific region. He recommended that about 10 percent of development and disaster response funds should really go into disaster risk reduction as an investment in protecting communities. He was also of the opinion that all development measures should have disaster risk reduction measures built into them, such enforcing building codes to minimize the impact of the next disaster. He linked disaster preparedness to adaptation to climate change which is a major source of natural disasters and felt that disaster preparedness should be part of climate change mitigation negotiations. Recipients of humanitarian aid on their part must ensure that donors have confidence that cash and resources reach target communities and are not lost through corruption, pilferage and misuse. Unfortunately, the countries often most in need of humanitarian disaster relief assistance are also those least reliable in this respect.
Finally, there needs to be shift in the mindsets of the governments of richer nations to provide humanitarian funding on an impartial basis. Aid must be impartial to be effective and credible. Aid offered on the basis of strategic self interest, protection of oil resources or political considerations demeans the aid and renders it a cynical exercise divorced from the humanitarian ideal. Realpolitik however dictates otherwise. A world bank study has shown that donors from OECD countries tend to give bilateral aid and cash if the recipient country has reserves of oil, is a trading partner and has sound institutions, whereas non-OECD countries are less motivated by self interests but tend more to address the degree of real need. One solution is to assemble a large number of donor countries so that there is a balance of those with and without agendas and where complementary agendas even out the field of play. This strategy has been adopted by the UN General Assembly, which has used a ‘Central Emergency Response Fund’ to provide quick responses to humanitarian emergencies around the world. Over two years (2008-2009), the fund accumulated US$804 million from 115 donor countries. Despite the encouraging response, countries are unlikely to divest their responsibilities for humanitarian assistance to the UN and the wielding of such assistance as a tool of international diplomacy and strategic influence will no doubt continue. It is also then left to non-governmental organizations to fill in the gaps where possible.
Human Displacements
Human displacements can be voluntary or not. When voluntary, it is often referred to as economic migration. Migrant workers that prop up many economies are a new social phenomenon accompanying globalization. Burgeoning numbers demand humane provision of their employment and social needs as well as sensitive handling of issues of marginalization, rights, discrimination and stereotyping. The need to provide economic and political rights to migrants has become a significant social imperative in the 21st century, especially when the United Nations has determined that the majority of migrants are lowly skilled working without job security in host countries. In his remarks to the Third Meeting of the Global Forum for Migration and Development in Athens in November 2009, UN Secretary General Ban Ki Moon said that there are now 214 million international migrants and if managed well, the transfer of skills, technology and remittances will benefit countries through the migrants’ contributions to development. But migrants are often the focus of social tensions, polemic politics, discrimination and hatred. Many are victims of human trafficking and sexual exploitation. In some parts of the world, migrants face appalling working conditions. He appealed for host nations to ensure that migrants are well treated, integrated and availed of education, health care and other vital services. However it is clear that the economic recession of 2008 has left migrant workers even more vulnerable than ever. They are often made scapegoats for unemployment and subject to predatory practices out of desperation to work. While laws and policies for the humane treatment of migrant workers are well developed in many developed nations, the same must be done by many emerging economies that do not yet pass muster in this respect.
Despite migrant workers being generally a beneficent phenomenon, in some cases rampant migration from low income countries hollow out their talent pools and leave local services even more impoverished than ever before. For example, doctors and nurses from the Philippines and South Africa flock to USA, Canada, Europe and the Middle East, thus depriving the sending country’s indigenous population of essential medical services. This ‘brain drain’ accounts for an estimated 1.5 million skilled expatriates from developing countries being employed in high income countries and this number is set to rise. Back in 2001, this problem led to an unprecedented appeal by the South African High Commissioner to Canada for Canadian health ministers to stop recruiting doctors, nurses and allied health professionals from South Africa. High Commissioner Andre Jacquet said, “Targeted recruiting of this nature…has already affected South Africa’s ability to reform the poor health infrastructure inherited from our apartheid past, and this leaves us even less able to grapple with the serious HIV-AIDS pandemic.” Obviously what is needed is an ethical approach by more developed nations in their efforts to recruit for their own economies, while developing countries struggle to lift their communities to the level at which their talented citizens are not also desperately seeking a better life elsewhere.
Ethnic discriminations and displacements are emergent issues because of economic plight, political repression or the sometimes ‘own goal’ of irredentist insurgency. While such oppressions are not new in history, the problems and needs of ethnic minorities and repressed populations have gained unprecedented worldwide attention due to communications technology. Some communities at risk have recently come to global attention, such as ethnic Tamils of Sri Lanka , the Rohingas and the Karen tribe of Myanmar, and the Tibetans and Uigurs of China. Whole nations remain economically suppressed by their own incompetent dictators. North Korea and Myanmar come to mind. Humanitarian efforts on behalf of these people remain challenging in the face of these regimes’ xenophobia, paranoia and complete lack of interest in the life and liberty of their own people.
In 2008, the UNHCR conducted a pilot study of Global Needs Assessment of refugees worldwide and concluded that there were urgent needs to improve the asylum access system, monitoring of refugees’ welfare, training and capacity building for countries managing refugees, to better protect women and children against violence and sexual abuse. The role of Non Profit Organizations will be on one hand to reduce suffering through relief activities and on the other hand to increase pressure on governments to adopt more humane approaches in their rule of their peoples on one hand and more humane treatment of displaced people on the other. At the same time, countries receiving refugees will have to balance their international obligations against domestic resistance to receiving more immigrants, as exemplified by the raging debate in Australia following a number of thwarted landings of Sri Lankan refugees.
Modern Conflicts
The American reaction to the horrific events of ‘nine-eleven’ was a concerted assault in the first place on Afghanistan and Iraq and in the second place on civil liberties and human rights in its propagation of the ‘war on terror’. The Bush administration was seen to use the event as an excuse to pursue aggressive policies that would previously have been unthinkable, such as the poorly justified 2003 war on Iraq and the mistreatment of prisoners in Abu Ghraib and Guantanamo Bay prisons. These conflicts have allegedly been motivated more by the imperative of energy security (read ‘oil’) than anything else.
The bombing of Afghanistan to root out Osama bin Laden immediately led to some 3500 civilian deaths and massive population displacement. After 5 years of conflict in Afghanistan and Iraq, the situation actually worsened, with escalating inter- tribal conflicts, terrorist attacks, breakdown of law and order, and failure of local government to retake control of the security of their countries. Increasingly non-state combatants or terrorists using asymmetrical warfare strategies mire these countries in endless internal conflict, destabilizing society, retarding social stability and economic progress. Pakistan could be next to slide into a state of incessant internal warfare, given the impunity with which indigenous terrorist groups allied to Al Qaeda attacked its main cities in recent times.
These protracted conflicts have been and will continue to be responsible for a global increase in refugees in the hundreds of thousands, reversing several years of decline from successful repatriations in Afghanistan, Sierra Leone, Liberia and Angola. The United Nations High Commission for Refugees (UNHCR) reports that the numbers rose from 9.9 million in 2006 to 11.4 million in 2007. The corresponding numbers for internally displaced persons were 24.2 and 26 million. Half of all refugees were from Afghanistan and Iraq. The situation places demands neighboring countries such as Pakistan, Iran, Syria, Jordan and recipient countries as far away as Hong Kong and stretches the resources of governmental and non governmental organizations in their efforts to accommodate and care for the refugees and displaced persons. Asylum applications rose by 10 percent in the first half of 2009 compared with the same period in 2008, with about 185,500 claims across 38 European countries, USA, Canada, Japan, Australia, New Zealand and South Korea, the largest sources unsurprisingly including Iraq, and Afghanistan.
The climate in which the needs of peoples affected by these conflicts are being met by humanitarian agencies and social activists was also changed by the response. Amnesty International said in October 2001, shortly after the September 11, 2001 attacks: “In the name of fighting ‘international terrorism’, governments have rushed to introduce draconian new measures that threaten the human rights of their own citizens, immigrants and refugees…It appears that some of the initiatives currently being discussed or implemented may be used to curb basic human rights and to suppress internal opposition. Some of the definitions of ‘terrorism’ under discussion are so broad that they could be used to criminalize anyone out of favor with those in power and criminalize legitimate peaceful exercise of the right to freedom of expression and association. They could also put at risk the right to privacy and threaten the rights of minorities and asylum-seekers.” In March 2003, alarmed at how far measures in USA and abroad had gone, Amnesty went on to say, “The ‘war on terror’, far from making the world a safer place, has made it more dangerous by curtailing human rights, undermining the rule of international law and shielding governments from scrutiny. It has deepened divisions among people of different faiths and origins, sowing the seeds for more conflict. The overwhelming impact of all this is genuine fear—among the affluent as well as the poor.”
The impact on NGOs is that with a loose definition of ‘terror’, there is concern that the ‘war on terror’ will also affect all those working honestly for peace and social justice for all, as even they would come under scrutiny for perhaps appropriately criticizing policies of any number of nations and organizations around the world, including those from the West. This potentially has enormous impact on the work of non governmental organizations around the world, especially those going beyond merely providing humanitarian assistance and engaging in sometimes strident advocacy.
The world’s remaining superpower the United States sets the tone for the management of modern conflicts. Post President George W. Bush, President Barrack Obama has set a less uncompromising tone for his administration and his military and has placed multilateralism and diplomacy back in the front and centre of his foreign policy, repudiating the hard line of his predecessor’s administration. In his acceptance speech for his Nobel Peace Prize, he made a philosophical case for ‘just wars’, yet emphasized that, “All nations – strong and weak alike – must adhere to standards that govern the use of force…America cannot insist that others follow the rules of the road if we refuse to follow them ourselves. For when we don’t, our action can appear arbitrary, and undercut the legitimacy of future intervention – no matter how justified… I believe that the United States of America must remain a standard bearer in the conduct of war…We lose ourselves when we compromise the very ideals that we fight to defend. And we honor those ideals by upholding them not just when it is easy, but when it is hard.” He thus drew a line beneath eight years during which America largely set aside universal standards of human rights, dismissing and sweeping away all opposition, in its single-minded determination to protect its own people from terrorism.
Finally there needs to be greater protection for humanitarian workers working in places where non traditional actors are becoming involved conflicts such as those in Afghanistan, Iraq and Darfur. Combatants are wont to block relief efforts in war torn places and even kidnap or kill relief workers especially when they do not regard humanitarian agencies to be neutral. Another part of the problem is the tendency of some relief organizations to take the role of witnesses against discrimination and human rights abuses perpetrated by different sides in conflict or, through gaining access to needy communities, appear to be siding with one faction or another. Medicin Sans Frontieres for example is an organization with a mission of ‘expose’ that has resulted in their doctors and nurses being targeted. Truly neutral players such as the Red Cross are then not spared as all aid workers become indistinguishable in the field. Humanitarian efforts then need to be diverted to engage with tribal or militia chiefs to persuade them of the neutrality of the United Nations’ and other humanitarian agencies, to assure safety for humanitarian workers as well as access to those in need.
Developed Societies
Better developed and more economically successful societies have needs related to development that give rise to significant pathology in segments of society. Rich nations grapple with issues that come with globalization, beyond their obvious vulnerability to global markets as evidenced by the current meltdown. The Gini co-efficient is widening as the benefits of globalization are unequally spread throughout society, disproportionately affecting already marginalized groups such as the physically or mentally infirm, dysfunctional families, the elderly, unemployed, lowly educated and poor. Non-infectious diseases (‘diseases of civilization’) will pose increasing challenges in more developed countries where hypertension, diabetes mellitus, obesity and a variety of cancers become epidemics in their own right.
Healthcare is not a given in all developed countries either, the most stark aberration being the United States which is the only developed country not to provide universal health care to its people. Despite spending 16% of its GDP on health care, more than any other OECD country, depending on the source, upwards of 15% of the population or 47 million Americans are without health insurance and incredibly, medical cost is the biggest cause of bankruptcies in the United States. This is currently the subject of extremely contentious congressional debate as President Barack Obama’s administration attempts to redress the situation.
Mainly in developed countries, but also in the more advanced developing countries, ageing populations with increasing life spans place increasing demands on healthcare and social support structures. Danish researchers think that more than half of babies born in rich nations today will live to be 100 years old if life expectancy trends continue. A declining ratio of working people to retirees will see the economically viable increasingly hard pressed to shoulder the economic burden of their societies, while social services, pensions and health systems creak under strain unless this is mitigated by people also staying healthier in their later years.
The aged may face challenges of declining health, mobility, intellectual stimulation and activity levels. They may also face prejudice, discrimination and stereotyping. Communities need to provide for the aged in terms of appropriate homes with different levels of personal and medical support. Healthcare needs to be affordable to retirees and must be tailored to their needs. It may not be appropriate to manage the elderly with the same degree of elaborate intervention as for younger people, but to be more conservative, with an emphasis on integrated care involving family physicians, hospitals, step down facilities and community care services. The term ‘slow medicine’ was introduced by Dennis McCullough of Dartmouth Medical School USA, who advocates a family centered approach to the care of the elderly which preserves patient dignity, acknowledges the limitations of medicine and advocates a more rational approach to the care of the elderly without bankrupting them. There also needs to be a sensitive and comprehensive system for the community to help the elderly with ‘end-of-life’ issues.
In the meantime, governments attempt to keep their elderly as independent and functional for as long as possible through delaying retirement, encouraging continued or re-employment of elderly workers, pushing back the age at which retirement benefits kick in and mobilizing government and non government agencies to work together to keep the elderly integrated into their communities in active and meaningful ways. One important consideration is financial support. Public-private insurance schemes for the elderly are a recent phenomenon. South Korea, Canada, Japan, China and Hong Kong are likely to be the countries most in need of elderly insurance. Singapore as a rapidly developing and ageing society has watched with alarm the consequences of unmanaged ageing in other countries and has demonstrated considerable foresight with its ElderShield insurance plans already in place. It is also encouraging continued employment beyond a retirement age that is itself being progressively pushed back. It has formed a Council for the Third Age which promotes active ageing to enable seniors to achieve a better quality of life in the six dimensions of wellness – social, intellectual, physical, vocational, emotional and spiritual and it also partners community and commercial organizations to develop products and services that meet the various needs and interests of seniors.
The drive for both economic survival and affluence has its costs. Children are increasingly suffering the consequences of hyper-competitiveness in schools, with parents sharing in and adding to the pressure. Unquestioning rote-learning in highly disciplined competitive educational regimens kill the joy of learning and fill young minds with knowledge trivia they will likely never put to practical use for the purpose of taking themselves or their communities to higher levels. Going back to the basics is going to be the way to engender success and build resilience in the next generation. A normal childhood experience is increasingly rare with hot-house learning backed by wall-to-wall private tuition starting from pre-school and ending only when coveted university places have been secured. This, coupled with parental neglect and emotional deprivation from overworked parents has led to such psychological vulnerability that the rate of youth suicides has risen alarming, especially in Asian societies such as Japan, Korea and India. Singapore has not been spared, although it has moved rapidly to reduce its suicide rate.
In rapidly developing societies, education and independence of women, coupled with fertility control methods delinking sex from procreation have led to the institution of marriage coming under threat of ‘modern’ variant lifestyles including co-habitation and marriage in any combination of sexes, having children outside of marriage and single parenthood. Divorce rates which had been rising steadily for over a century seem to have dipped since the 1980s to a ‘low’ of 40%, but even this is thought to be due simply to fewer people getting married. With the institutions of marriage and family at risk in many countries, or with working parents each holding multiple jobs, quality upbringing of the next generation is a challenge. This is exacerbated when family influence is supplanted by a new and often risky social interaction order for youth mediated through the internet and other novel communication technologies. Childhood delinquency and youth engaging in premature sexual experimentation are on the rise, with all the attendant health and social consequences. A counter revolution in society is required to restore the basics. Dr Ron Haskins, a co-director of the Brookings Centre on Children and Families and former White House and Congressional adviser on welfare issues urges a return to traditional views about marriage and family believing how important two parents are, how married couples are wealthier, happier and better for the well-being of their children.Finally, are developed and richer societies actually happier? Studies doubt this and economists believe that beyond per capita income of USD$20,000 there is a diminishing or even negative return. The Gross Domestic Product (GDP), for decades hallowed as the indicator of a country’s progress says nothing of the less measurable aspects of societal happiness. Factors such as income distribution, education, healthy life expectancy, work-life balance, environmental sustainability and mental health are not measured by the GDP. The Young Foundation report “Sinking and Swimming – Understanding Britain’s Unmet Needs” identifies a sizeable segment of the British population that is dissatisfied with life on a high income. This segment includes couples without children, isolation, poor heath, purposelessness, chronic disability and separated spouses. Only one country, Bhutan, has in the wisdom of former King Jigme Singye Wangchuck eschewed the traditional way of measuring prosperity by adopting their unique ‘Gross National Happiness’ index that includes pollution, noise, illness, divorce rates cultural preservation and democratic freedoms into its assessment of its own social progress.