As incomes rise around the world, health experts expect a more troubling figure to increase as well: the number of diabetics in developing countries.

In China and India – two of the world’s most populous nations with fast-paced economies – the prevalence of diabetes is expected to double by 2025. Between 15 and 20 percent of their adult population will develop the disease as household budgets increase, diets change to include more calories and new health problems emerge.

But China, India and other developing countries are not fully prepared to deal with the rising trend of diabetes. And a growing number of diabetics aren’t getting the care they need to prevent serious complications, Stanford researchers say.

Even with insurance, many diabetics don’t have essential medications that could help them manage their conditions. In many cases, people are spending a great deal of their household incomes to pay for their treatment, said Jeremy Goldhaber-Fiebert, an assistant professor of medicine who led the research team.

“Public and private health insurance programs aren’t providing sufficient protection for diabetics in many developing countries,” said Goldhaber-Fiebert, a faculty member at Stanford Health Policy at the university’s Freeman Spogli Institute for International Studies. “People with insurance aren’t doing markedly better than those who don’t have it. Health insurance and health systems need to be re-oriented to better address chronic diseases like diabetes.”

Findings from the study are online and will be published in the Jan. 24 edition of Diabetes Care, the journal of the American Diabetes Association. The journal article was co-authored by Jay Bhattacharya, an associate professor of medicine and Stanford Health Policy faculty member; and Crystal Smith-Spangler, an instructor at Stanford’s Department of Medicine and an investigator at the Palo Alto VA Health Care System.

Failure to adequately manage diabetes will lead to more severe health problems like blindness, heart disease and kidney failure. It also harms the otherwise healthy, Goldhaber-Fiebert said.

Diabetes often strikes people at an age when they’re taking care of children and elderly parents. To sideline these primary caretakers as dependants will lead to a heavy burden for communities and create an obstacle for economic growth, he added.

Using responses to a global survey conducted by the World Health Organization in 2002 and 2003, Goldhaber-Fiebert and his colleagues examined data from 35 low- and middle-income countries in Asia, Latin America, Africa and Eastern Europe to determine whether diabetics with insurance were more likely to have medication than those without insurance.

They also wanted to know whether insured diabetics have a lower risk of “catastrophic medical spending,” a term the researchers define as spending more than 25 percent of a household income on medical care.

“Surprisingly, diabetics with insurance were no more likely to have the medications they need than uninsured diabetics,” Goldhaber-Fiebert said. “They were also no less likely to suffer catastrophic medical spending.”

There are many reasons why health insurance may not protect diabetics in developing countries against high out-of-pocket spending. In some cases, there’s a lack of sufficient medication – such as insulin – that regulate glucose levels. Without those drugs, there’s a greater risk of complications that often lead to more hospitalizations and more expenses.

In other cases, co-payments and deductibles are too high. Sometimes, drugs and medical services to prevent diabetes complications are not covered. And doctors and hospitals don’t always accept insurance.

“Better policies are needed to provide sufficient protection and care for diabetics in the developing world,” Goldhaber-Fiebert said.

Without medications to manage diabetes and prevent secondary complications, the condition will worsen and the burden of catastrophic spending will increase, he said.

“It’s important to get ahead of the curve and prepare so there’s an infrastructure in place to deal with these health and cost issues,” he said.

While preventing diabetes in the first place would be ideal, programs and policies must be established to care for the many cases that will surely continue to exist.

“There isn’t a single country that’s managed to entirely arrest or reverse the trend of diabetes,” he said. “Programs that focus on primary prevention are extremely important, but the reality is that the developing world faces hundreds of millions of diabetes cases that are unlikely to all be prevented.”

In an opinion piece for Al Jazeera, Rajaie Batniji uncovers the role of medical professionals involved in acts of torture. With a lens to the unrest in Syria, Batniji calls for an international body to identify, monitor, and disqualify those complicit in torture and genocide.

In an opinion piece for Al Jazeera, Rajaie Batniji uncovers the role of medical professionals involved in acts of torture. With a lens to the unrest in Syria, Batniji calls for an international body to identify, monitor, and disqualify those complicit in torture and genocide.

Doctors have a long history of complicity in torture, but the torture of political dissidents holds a privileged place.  In Saddam Hussein's Iraq, surgeons removed the ears of men who failed to report for military service or defected from the army. In the Soviet Union, psychiatrists held political dissidents in mental hospitals with false diagnoses, in order to isolate and punish them. It is in this tradition of medical torture of dissidents that the Syrian healthcare establishment may be heading.

A July 6 report by Amnesty International documents the treatment of Wassim, a 21-year-old protester in the Syrian town of Talkalakh. After an injury from a soldier's bayonet, Wassim was taken to al-Bassel hospital, which had been occupied by Syrian security forces. As he reported: "The nurses, men and women […] swore at me and beat me hard and one female nurse punched me repeatedly with all her strength on my chest. Some were taking off their shoes and slapping me with them. I could hear many voices asking: 'You want freedom, eh?'" The report states he later had his wounds stitched without anesthesia, before being beaten on these wounds by hospital staff.  

Wassim's is not an isolated incident. In May, Reuters documented the case of a protester who had lost sensation in his legs who requested to see a doctor in jail. He told the news agency: "The doctor hit my knees with his legs, and asked: 'There, is it better now?' and then he slapped me". Most pervasively, reports suggest that even when doctors have not been involved in direct abuse, they have falsified the causes of injuries and released information about patients to the Syrian regime's security forces. The result is a public distrust of hospitals, and a clear incentive for injured protestors to avoid the healthcare system. 

The medical torture of political dissidents holds a privileged place because it can be perversely justified. The torture of dissidents may be seen as an act of loyalty to the state. Doctors acting on behalf of the state, such as military doctors, have what is called "dual loyalty" - loyalty to both their patient and a third party.

In addressing the issue of dual loyalty, Physicians for Human Rights has proposed guidelines that physicians not be present when torture takes place, and calls on them to report all human rights violations, especially when they interfere with their loyalty to patients. Like the medical professionals from the US recently implicated in the torture and abuse of prisoners at Guantánamo Bay and Iraq, some Syrian doctors may have valued their contribution to the security of the state more than their adherence to the norms of their profession. 

But, in their pursuit of perceived enemies of the state, have these physicians become enemies of the profession? Doctors involved in torture should be pursued as enemies of medicine: their crimes documented, their professional credentials revoked, and their ability to practice internationally thwarted.

Identifying and disqualifying doctors involved in torture

While it is exceedingly unlikely that Bashar al-Assad, an ophthalmologist, will go back to correcting cataracts in London - where he trained - if his regime is overthrown, other physicians culpable in his regime's torture will seek to continue clinical practice abroad.

Even with continued instability, it is likely that physicians and other elites will seek to emigrate. Could doctors involved in abuse head to Europe, North America or neighbouring Arab countries and continue to operate? How will they be identified? Critically, the majority of Syrian physicians that have not been complicit with abuses must be distinguished from those who have. 

Unfortunately, the medical profession has no method for identifying or punishing doctors complicit in torture. We rely on human rights organisations to provide sporadic documentation of medical torture.

With limited access and competing priorities - such as being able to provide medical care while working in countries where torture occurs - these organisations have a narrow scope for documenting the occurrence of torture. In an excellent Lancet article, Len Rubenstein and Melanie Bittle argue that the World Health Organization is best positioned to play a leading role in documenting attacks on medical functions in conflict, and this should include those attacks committed by physicians.

Among the suggestions put forth by Rubenstein and Bittle are a UN Security Council resolution providing a mandate for the WHO to pursue investigations, and the use of mobile devices for securely and quickly transmitting information about abuse. By documenting medical complicity in torture, we give physicians under incredible pressures incentive to oppose orders from their superiors and the state.

The greatest challenge, however, is enforcement, and the punishment of physicians complicit in torture. No international body retains information on professional qualifications. Like most other professions, medicine has proclaimed a need to be self-regulating, yet it has no system in place to disqualify or sanction physicians on a global level (national licensing bodies exist in most countries, but there is little to no international coordination). To this day, investigations continue of Rwandan doctors now practising in Europe and Africa, accused of involvement in the 1994 genocide.

Of course, their crimes were far more widespread than those in Syria today, as doctors oversaw the killing of hundreds of patients and staff in their hospitals, but the challenge of enforcement is nearly identical. Even if medical complicity in torture does not warrant imprisonment, it ought to warrant professional disqualification - and as of yet, no institution or process is in place to disqualify a physician from practising internationally. 

Honouring the heroism of Syrian doctors

Attacks on the healthcare system are common - perhaps inevitable - in modern war, but doctors don't always become complicit. In Bahrain, the Salmaniya medical centre was raided, and its doctors beaten and jailed for treating protesters. In Libya, Misurata hospital came under fire, deterring the sick from seeking care and endangering staff and patients.

Despicable as these attacks are, they have come to be expected as a feature of conflict. Attacks on the healthcare system have been documented in almost all recent conflicts including in Afghanistan, Kosovo, Nepal, Iraq, and the occupied Palestinian territories. In most cases, doctors have acted admirably, and sometimes heroically: seeing the sick in their homes, in secretive and makeshift clinics, risking their lives to provide care. Under oppressive regimes, doctors may be risking their lives just by refusing to be complicit in torture. 

In Syria, a group known as the "Damascus Doctors" has been organising on Facebook to provide hidden clinics in areas of protest, as reported by CNN. These doctors are upholding a tradition of professionalism and protest that existed since at least 1980, when more than 100 healthcare professionals were arrested for striking to demand the lifting of Syria's state of emergency, in place since 1963 (as of 1990, at least 90 of them remained missing). These doctors, like many others who have opposed the regime, were subjected to gruesome physical and psychological torture. 

The overwhelming majority of Syrian physicians have likely been acting heroically. It is in their honour that we should pursue aggressive international efforts to document and disqualify those physicians complicit in torture. This will require emboldened international institutions, cooperation among national licensing bodies, and the courage of doctors, journalists, activists and human rights organisations in documenting and reporting medical torture. 

In reaction to the arrest of Dominique Strauss-Khan for allegations of rape in May, Kavita Ramdas and Christine Ahn argue in a piece for Foreign Policy in Focus that gender bias is embedded in the global policies and practices at the IMF, which unfairly target women. Kavita Ramdas is the former president and CEO of the Global Fund for Women and a visiting scholar at the Center on Democracy, Development, and the Rule of Law.

In reaction to the arrest of Dominique Strauss-Khan for allegations of rape in May, Kavita Ramdas and Christine Ahn argue in a piece for Foreign Policy in Focus that gender bias is embedded in the global policies and practices at the IMF, which unfairly target women. Kavita Ramdas is the president and CEO of the Global Fund for Women and a visiting scholar at the Center on Democracy, Development, and the Rule of Law.

As Dominique Strauss-Kahn, head of the world’s most powerful financial institution, the International Monetary Fund (IMF), spends a few nights in Rikers Island prison awaiting a hearing, the world is learning a lot about his history of treating women as expendable sex objects. Strauss-Kahn has been charged with rape and forced imprisonment of a 32-year-old Guinean hotel worker at a $3,000-a-night luxury hotel in New York.

While the media dissects the attempted rape of a young African woman and begins to dig out more information about Strauss-Kahn’s past indiscretions, we couldn’t help but see this situation through the feminist lens of the “personal is political.” 

For many in the developing world, the IMF and its draconian policies of structural adjustment have systematically “raped” the earth and the poor and violated the human rights of women. It appears that the personal disregard and disrespect for women demonstrated by the man at the highest levels of leadership within the IMF is quite consistent with the gender bias inherent in the IMF’s institutional policies and practice.

Systematic Violation of Women’s Human Rights

The IMF and the World Bank were established in the aftermath of World War II to promote international trade and monetary cooperation by giving governments loans in times of severe budget crises. Although 184 countries make up the IMF’s membership, only five countries—France, Germany, Japan, Britain, and the United States—control 50 percent of the votes, which are allocated according to each country’s contribution.

The IMF has earned its villainous reputation in the Global South because in exchange for loans, governments must accept a range of austerity measures known as structural adjustment programs (SAPs). A typical IMF package encourages export promotion over local production for local consumption. It also pushes for lower tariffs and cuts in government programs such as welfare and education. Instead of reducing poverty, the trillion dollars of loans issued by the IMF have deepened poverty, especially for women who make up 70 percent of the world’s poor.

IMF-mandated government cutbacks in social welfare spending have often been achieved by cutting public sector jobs, which disproportionately impact women. Women hold most of the lower-skilled public sector jobs, and they are often the first to be cut. Also, as social programs like caregiving are slashed, women are expected to take on additional domestic responsibilities that further limit their access to education or other jobs.

In exchange for borrowing $5.8 billion from the IMF and World Bank, Tanzania agreed to impose fees for health services, which led to fewer women seeking hospital deliveries or post-natal care and naturally, higher rates of maternal death.  In Zambia, the imposition of SAPs led to a significant drop in girls’ enrollment in schools and a spike in “survival or subsistence sex” as a way for young women to continue their educations.

But IMF’s austerity measures don’t just apply to poor African countries. In 1997, South Korea received $57 billion in loans in exchange for IMF conditionalities that forced the government to introduce “labor market flexibility,” which outlined steps for the government to compress wages, fire “surplus workers,” and cut government spending on programs and infrastructure. When the financial crisis hit, seven Korean women were laid off for every one Korean man. In a sick twist, the Korean government launched a "get your husband energized" campaign encouraging women to support depressed male partners while they cooked, cleaned, and cared for everyone.

Nearly 15 years later, the scenario is grim for South Korean workers, especially women. Of all OECD countries, Koreans work the longest hours: 90% of men and 77% of women work over 40 hours a week.  According to economist Martin Hart-Landsberg, in 2000, 40 percent of Korean workers were irregular workers; by 2008, 60 percent worked in the informal economy. The Korean Women Working Academy reports that today 70 percent of Korean women workers are temporary laborers.

Selling Mother Earth

IMF policies have also raped the earth by dictating that governments privatize the natural resources most people depend on for their survival: water, land, forests, and fisheries. SAPs have also forced developing countries to stop growing staple foods for domestic consumption and instead focus on growing cash crops, like cut flowers and coffee for export to volatile global markets. These policies have destroyed the livelihoods of small-scale subsistence farmers, the majority of whom are women.

“IMF adjustment programs forced poor countries to abandon policies that protected their farmers and their agricultural production and markets,” says Henk Hobbelink of GRAIN, an international organization that promotes sustainable agriculture and biodiversity. "As a result, many countries became dependent on food imports, as local farmers could not compete with the subsidized products from the North. This is one of the main factors in the current food crisis, for which the IMF is directly to blame."

In the Democratic Republic of Congo (DRC), IMF loans have paved the way for the privatization of the country’s mines by transnational corporations and local elites, which has forcibly displaced thousands of Congolese people in a context where women and girls experience obscenely high levels of sexual slavery and rape in the eastern provinces. According to Gender Action, the World Bank and IMF have made loans to the DRC to restructure the mining sector, which translates into laying off tens of thousands of workers, including women and girls who depend on the mining operations for their livelihoods. Furthermore, as the land becomes mined and privatized, women and girls responsible for gathering water and firewood must walk even further, making them more susceptible to violent crimes.

We Are Over It

Women’s rights activists around the globe are consistently dumbfounded by how such violations of women’s bodies are routinely dismissed as minor transgressions. Strauss-Kahn, one of the world’s most powerful politicians whose decisions affected millions across the globe, was known for being a “womanizer” who often forced himself on younger, junior women in subordinate positions where they were vulnerable to his far greater power, influence, and clout. Yet none of his colleagues or fellow Socialist Party members took these reports seriously, colluding in a consensus shared even by his wife that the violation of women’s bodily integrity is not in any sense a genuine violation of human rights.

Why else would the world tolerate the unearthly news that 48 Congolese women are raped every hour with deadening inaction? Eve Ensler speaks for us all when she writes, “I am over a world that could allow, has allowed, continues to allow 400,000 women, 2,300 women, or one woman to be raped anywhere, anytime of any day in the Congo. The women of Congo are over it too.”

We live in a world where millions of women don’t speak their truth, don’t tell their dark stories, don’t reveal their horror lived every day just because they were born women.  They don’t do it for the same reasons that the women in the Congo articulate – they are tired of not being heard. They are tired of men like Strauss-Kahn, powerful and in suits, believing that they can rape a black woman in a hotel room, just because they feel like it. They are tired of the police not believing them or arresting them for being sex workers. They are tired of hospitals not having rape kits. They are tired of reporting rape and being charged for adultery in Iran, Pakistan, and Saudi Arabia.

Fighting Back

For each one of them, and for those of us who have spent many years investing in the tenacity of women’s movements across the globe, the courage and gumption of the young Guinean immigrant shines like the torch held by Lady Liberty herself. This young woman makes you believe we can change this reality. She refused to be intimidated.  She stood up for herself. She fought to free herself—twice—from the violent grip of the man attacking her. She didn’t care who he was—she knew she was violated and she reported it straight to the hotel staff, who went straight to the New York police, who went straight to JFK to pluck Strauss-Kahn from his first-class Air France seat.

In a world where it often feels as though wealth and power can buy anything, the courage of a young woman and the people who stood by her took our breath away. These stubborn, ethical acts of working class people in New York City reminded us that women have the right to say “no.”  It reminded us that “no” does not mean “yes” as the Yale fraternities would have us believe, and, most importantly that no one, regardless of their position or their gender, should be above the law.  A wise woman judge further drove home the point about how critically important it is to value women’s bodies when she denied Strauss-Kahn bail citing his long history of abusing women.

Strauss-Kahn sits in his Rikers Island cell. It would be a great thing if his trial succeeds in ending the world’s tolerance for those who discriminate and abuse women. We cannot tolerate it one second longer.  We cannot tolerate it at the personal level, we must refuse to condone it at the professional level, and we must challenge it every time it we see it in the policies of global institutions like the International Monetary Fund.

Nathan Eagle, Founder and CEO of txteagle spoke at the weekly Liberation Technology Seminar Series on Dececember 2, 2010 about mobile phone usage in the developing world.

Although txteagle began in 2007 as a purely academic project, the current goal of the company and of its founder and CEO, Nathan Eagle, is to give one billion people a five percent raise. In his presentation, Eagle described the context for which txteagle was designed, how the company's focus has evolved over the past three years, and what steps the company is taking to move closer to achieving this goal in the future.

Eagle began by offering some background information to explain the initial impetus behind txteagle. Today, about 63% of global mobile phone usage takes place in the developing world, making airtime usage in emerging markets worth about $200 billion a year. Mobile phone users at the so-called "Base of the Pyramid" typically spend 10% of their income on mobile phone airtime. Through his experience living in emerging markets and teaching mobile application development in universities across sub-Saharan Africa, Eagle began to see that a significant opportunity space existed to reduce the cost of airtime for people at the base of the pyramid, in effect giving these people a raise.

Mobile applications developed as a part of MIT's Entrepreneurial Research on Programming and Research on Mobiles (EPROM) project offered some insights into the potential of mobile-based tools. In Rwanda, where electricity is a prepaid service, one of Eagle's former students quickly cornered a significant share of the market by creating scratch cards for crediting one's electricity bill via mobile phone. In Eastern Kenya, a program called SMS Blood Bank was created to enable real time monitoring of blood supplies at local district hospitals in Eastern Kenya. Although SMS reporting of low blood levels resolved the huge amount of latency in the system of local district hospitals (where responses to dips in supply had typically taken up to 4 weeks), the price of reporting blood levels via SMS represented a pay cut for local nurses; despite nurses' initial enthusiasm, SMS reporting tapered off within weeks. When the idea of sending about 10 cents of airtime to compensate nurses for each SMS report of blood level data proved a success, the model behind txteagle was born.

Designed as a means to monetize people's downtime, txteagle has grown rapidly through partnerships with over 220 mobile operators in about 80 countries around the world. In turn for helping these operators analyze their customer data, txteagle has gained access to about 2.1 billion mobile subscribers. Partnering with txteagle is a winning proposition for mobile operators, since the airtime compensation mobile subscribers receive from txteagle improves operators' Average Revenue per User (ARPU), a statistic that had been plummeting as more and more poor people became mobile phone users. By enabling people to carry out work via web browsers or SMS and compensating them via mobile money or airtime, txteagle has become a market leader at efficiently gathering data in the developing world.

Since txteagle was first created, the company has attempted to move from an outsourcing/back-office model to an emphasis on work that leverages a person's unique local knowledge and information. Typically outsourced tasks such as forms processing, audio transcription, inventory management, data cleaning, tagging, and internet search, tend to be less rewarding to the worker. By focusing on local data instead, txteagle enables unprecedented insight into emerging markets, all while optimizing engagement with local customers. Typical tasks include: maps and directions, local market prices and businesses, survey research and polling, and other forms of local knowledge gathering.

One of txteagle's central initiatives, GroundTruth, leverages this local knowledge-based model to carry out better market research. Today, global brands are already spending about $125 billion annually in emerging markets to engage the "next billion," but they typically carry out this research in a sub-optimal way. Through the txteagle platform, Eagle suggests, brands and organizations can use advertising money to design better products and services, conduct market research, and carry out brand engagement. Recent success cases include the use of txteagle to help a program of the United Nations to reach survey respondents directly and to enable the World Bank to obtain better local market price data at lower cost. 

Although txteagle's rapid growth and early successes have been encouraging, the company has ambitious goals for the next two years. The company began by focusing on outside sales through its GroundTruth market research program. Next year, the company  hopes to generate syndicated data and ultimately to create a self-source platform enabling anyone to conduct their own population-level surveys.  By continuing to focus on improving the quality of both their data and workers over time, txteagle aims to have an even greater positive impact on the incomes of the hundreds of millions of mobile phone users at the base of the pyramid.