Book-Blogging: Dancing in the Glory of Monsters

DITGOM

The Great African Wars of the late 20th and early 21st centuries killed five million people, and it’s likely that you never heard a word about them.

If you did manage to hear something about them, it’s near-certain certain that the reports included verbiage better left to Joseph Conrad’s Heart of Darkness: a piece of land the size of Western Europe minimized to one, giant Hobbesian morass; rebel groups killing, raping and pillaging their way westward for the sake of killing, raping, and pillaging; corrupt politicians, vicious mercenaries, and outsiders all trying to cash in on fabulous, El Dorado­-esque bounties.

Based on reporting done by Jason Stearns in his masterful account of these wars, Dancing in the Glory of Monsters, all of this is true – but what it conceals with its horrors and its shock value is far more pivotal and interesting. Stearns’s ten years of research and reporting on the Democratic Republic of Congo – including being on the ground during the Second War – yields a nuanced, expansive view of the conflict, shining a light on the structures and strictures that allowed the above horrors to fester and metastasize. It is equal parts heartbreaking, enraging, and numbing.

Both wars are dizzying in their scope, complexity, and sheer number of actors. Before diving into the alphabet soup of nine countries and twenty rebel groups that took part, it’s useful to take a step back for context.

(The next few paragraphs are an extremely-simplified overview of the recent history of the conflict, so if you already know about it, and just want a review of the book, scroll down…)

In the early 1990s, Rwanda’s extremist, Hutu-controlled Habyarimana government (the Rwandan Armed Forces, or FAR) was under attack by the moderate Hutu/Tutsi-controlled Rwandan Patriotic Front (RPF), a rebel group formed by Rwandan exiles who fought alongside, and backed by, Yoweri Museveni’s Ugandan rebels (the National Resistance Army) in the 1980s. The RPF eventually won, but only after an estimated 800,000 Tutsis (and moderate Hutus) were slaughtered by FAR, the interahamwe (militia groups full of young people), and villagers coerced into killing. That group – collectively, the genocidaires – fled west, into Zaire. There, they reorganized in the refugee camps, effectively controlling them, while building an insurgency to wrest control of Rwanda back from the RPF – ostensibly with explicit support from the longtime dictator of Zaire, President Mobotu Sese Seku. While building strength, the genocidaires attacked the Tutsi Banyamulenge, of eastern Zaire, a group that had been historically repressed by Mobuto’s regime.

Rwanda – led in everything but title by Vice President and former RPF leader Paul Kagame – was understandably worried about the growing threat of another war with the genocidaires. Counseled by Ugandan President Museveni against an overt attack on Zaire, Kagame helped turn a group of Zairian exiles into a rebellion named the Alliance of Democratic Forces for the Liberation of Congo-Zaire (AFDL).[1] Kagame was the puppet-master of the AFDL, running the show while controlling the ostensible leader, Laurent Kabila – a one-time failed rebellion leader from the 1960s.[2]

Mobuto’s army, the Zairian Armed Forces (FAZ), was weak by design; he knew that a strong army could depose him, but a weak one was harmless. Though joined by the genocidaires and the Angolan rebel group UNITA, they failed to put up much of a fight, and the rebellion took city after city with ease. Mobotu, already stricken with pancreatic cancer, fled to Morocco, where he soon died.

Now President of the renamed Democratic Republic of the Congo (DRC), Kabila worried that his former allies/puppet-masters were too powerful, and kicked out their forces. This didn’t sit well with the RPF, which re-grouped in the eastern region and, with the Banyamulenge of East DRC, formed the Rally for Congolese Democracy (RCD); Uganda initially jointly-supported this group. The RCD, under the command of Rwandan RPF leader James Kabarebe, made a daring attempt on Kinshasha, which was foiled at the last minute by the Angolan, Namibian, and Zimbabwean armies, as those governments had mining and political interests under a Kabila regime, and were theoretically committed to jointly defending the DRC (through their involvement in the South African Development Community, or SADC).

Uganda and Rwanda had a falling out during the summer of 2000, and their subsequent internecine “war within a war” in DRC’s third city, Kisangani, caused the deaths of many Congolese. Uganda backed its own rebel group, the Movement for the Liberation of Congo (MLC); years later, the group’s head Jean-Pierre Bemba, would be tried by the ICJ for crimes against humanity. So, the DRC was split into rough thirds: Kabila’s government forces in the southwest, the Rwanda-backed RCD in the east, and the Uganda-backed MLC.

Kabila was assassinated by one of his guards in early 2001, and his son Joseph was picked to succeed him. Deemed more pragmatic than his Mobotu-like father, Joseph Kabila called for peace, and in late 2002 a peace accord was signed that created a unity government, with MLC’s Bemba as Vice President.

After that fragile peace, Laurent Nkunda, a Congolese Tutsi who fought with the RPF, created another rebel group, the CNDP, and continued fighting the government in what is known as the Kivu Conflict. In 2009, Kigali – previously supportive of Nkunda – made a deal with Kabila and the DRC: they’d arrest Nkunda if they could enter the DRC to attack the Democratic Forces for the Liberation of Rwanda (FDLR), a Hutu Power group.

A peace agreement between the CNDP and Kabila’s government was signed on March 23rd, 2009. If you’ve been following recent events, that date may stand out, as it’s what the current rebel group, M23, is named after. M23 was founded by Bosco Ntaganda, a former CNDP commander, and current International Criminal Court awaitee. M23 is alive and well, having recently signed a peace agreement with Kabila’s government.

(Back to the book review)

It’s no small feat to take the reader through this litany of acronyms and shifting allegiances coherently, and it’s even more difficult to make it engaging and readable. Stearns accomplishes both.

He does the latter by interviewing everyone – from the pastor of a small village in central DRC, Kasiki, where the RCD massacred almost everyone; to the professorial and erstwhile leader of the RCD, Wamba dia Wamba; to Paul Kagame. Personal stories flesh out the narrative, giving it a human touch that sticks with you.

One of the more horrific consequences of the wars – any wars, really – is that the vast majority of casualties were incidental; 98% of victims were killed by kwashiorkor and malaria, not by bullets or machetes. About half of the victims were children, 60% of whom died before they were five years old. In Stearns’s interviews, the short-term and long-term tolls of this are evident, and wrenching.

It’s a tough book to read, in part because it defies the “good vs. bad” narrative we’ve grown up on – it’s just gray, all gray. The Rwandan Tutsis, victims of one of the worst genocides in the 20th century, come across as self-interested, heavy-handed killers, at times; the Congolese rebels led by Laurent Kabila don’t see to be rebelling for anything, just against Mobotu’s regime; the international community is feckless and unable, or unwilling, to fund an appropriate intervention after the Rwandan genocide and during the wars. All gray.

I could go on – this review doesn’t even touch on the mineral wealth, and how vital it may have been to the continuation of the Second Congo War. But you should just read the book.



[1] The Rwandans went so far as to force all of the AFDL leaders in a Kigali guesthouse in the hopes of making them a team

[2] An interesting anecdote about Kabila: in the 60s, he was counseled and trained by Che Guevarra, who traveled to Zaire to help instill revolutionary fervor. Gueverra left seven months later, after failing; he said that the Conogolese “weren’t ready for the revolution.”

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The FDA Just Made it Easier for Physicians to Treat C. Diff Cheaply and Effectively. With Poop.

(Via Project Millennial)

Contrary to expectations several weeks ago, on Monday the Food and Drug Administration relaxed regulations on the use of a cheap, safe, and very effective treatment for one of the most deadly hospital acquired infections, clostridium difficile (or c. diff). This is great news for individual patients and our health care system as a whole.

About that treatment: it’s not a hot new pharmaceutical – it’s poop.  Fecal microbiota for transplantation (or FMT), to sound a bit more clinical. A fecal transplant.

The announcement, in bureaucratic English: the FDA

… intends to exercise enforcement discretion regarding the IND [Investigational New Drug Application – the FDA’s process for testing a new therapeutic - Mike] requirements for the use of FMT to treat C. difficile infection not responding to standard therapies provided the treating physician obtains adequate informed consent from the patient or his or her legally authorized representative for the use of FMT products.  Informed consent should include at a minimum, a statement that the use of FMT products to treat C. difficile is investigational and a discussion of its potential risks.

In everyday English: we won’t come after you for treating your patients with a fecal transplant. Go for it. But let’s back up a bit to explain what c. diff is, what a fecal transplant is, and why this is so important [1].

What’s c. diff?

C. diff is one of the most pernicious hospital acquired infections around, a pesky bacteria that causes an estimated 14,000 American deaths and $1 billion in spending annually. Patients – usually the elderly –  pick up the bacteria from an unsanitary setting in the hospital; maybe a physician or nurse didn’t wash his or her hands, or the patient’s bed/room/bathroom wasn’t adequately cleaned (c. diff can’t be killed by many disinfectants, though bleach is effective).

Simply having c. diff in one’s colon isn’t typically enough to provoke an all-out assault – the bacteria just remains in the colon, controlled by the thousands of other bacteria and fungi that collectively makes up the gut “flora,” or microbiome.

Things get dicey once the microbiome is modified. C. diff is more difficult to treat than most other bacteria; a powerful antibiotic such as ciprofloxacin (every traveler’s favorite) will wipe out much in the gut microbiome, but not c. diff. Once the other bacteria is killed off, c. diff spreads, causing inflammation of the colon, which manifests symptomatically as diarrhea, abdominal pain, and fever in mild cases, septicemia in severe. Treatment has historically involved metronidazole or a vancomycin/rifaximin combo, which (typically) does works on c. diff.

But those antibiotic courses are long – up to a month – and only work initially 60% of the time; less often for a second or third bout of c. diff. Sometimes, a patient will have to be in a hospital bed to receive the treatment (in an isolation bed, which are always in high demand).

Fecal Transplants: Less Gross Than They Sound – and Extremely Effective

Enter fecal transplants. The theory behind the therapy is pretty simple: if the patient’s microbiome has changed, re-establishing floral homeostasis may bring the patient back to normal. The specific methods vary a bit, but in the most common, donor feces are collected, analyzed to ensure they’re bereft of a number of dangerous bacteria, diluted by saline or milk, then inserted into the patient’s colon by a nasoduodenal tube.

For reasons that basically amount to “eww, gross,” the procedure was historically used sparingly. Astudy published in the New England Journal of Medicine earlier this year changed that; researchers at the University of Amsterdam conducted a randomized controlled trial to study the efficacy of fecal transplants versus vancomycin therapy (with or without bowel lavage) for patients with recurrent c. diff infections.

So, what were the results? The researchers terminated the study, because the fecal transplants were overwhelmingly effective – 81% of treatment patients responded to the treatment after one transplant, versus 31% and 23% in the two control groups. Patients that were supposed to be in the control group were then given a fecal transplant instead.

CDIFF

A few caveats about the study: it only speaks about recurrent infections (theoretically, the treatment may be less effective in patients infected for the first time), though an accompanying editorial by theNEJM board made it clear they believe the results are transplantable to initial infections; it was unblinded, so researchers knew which group a patient was in [2]; it was made up of mostly elderly patients; it didn’t include sicker ICU patients. None of those limitations seem debilitating enough to cast much doubt about the results, though.

You can see why relaxing regulations on this treatment can be pretty beneficial for patients and the system as a whole: a shorter, cheaper, more effective treatment is a win-win-win for the patient, for the community (an in-demand hospital bed opens up for a patient that needs it), and for the country.

The main issue with the FDA’s announcement is that it doesn’t go far enough; theoretically, it only covers treatment for patients that didn’t respond to standard therapy (i.e., metronidazole or vancomycin/rifaximin). At the very least, it should encourage future research on fecal transplants and the microbiome more generally – not only for c. diff, but potentially for other debilitating bowel diseases such as Crohn’s and irritable bowel syndrome [3].

 

1. Let’s also back up to reiterate that I am not a doctor

2. This procedure would have been tough to double-blind, for obvious reasons.

3. Even further, actually – some research has indicated that the microbiome is important for everything from depression to obesity. For more, science reporter Carl Zimmer’s been beating the microbiome drum for some time, and this Radiolab episode about the gut touches on fascinating research

 

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mHealth Fail: Use of Sexual Health Information Texting Service Increased Infidelity and Risky Sexual Behavior in Uganda, Study Finds

mHealth, or mobile health, is one of the most exciting and innovative areas in global health; the ubiquity of mobile phones in sub-Saharan Africa and elsewhere has led many to pin their hopes on the technology to improve health outcomes, educate children and adults about the scourges of HIV and malaria, and connect individuals with virtual health care providers. There’s a sense that mHealth can’t go wrong.

Unfortunately, it seems that it can. Paradoxically, providing sexual health information to young adults via mobile phones in Uganda increased the incidence of risky sexual behavior and infidelity, according to a recent paper by Julian Jamison, Dean Karlan, and Pia Raffler of Innovations for Poverty Action (IPA).

In Uganda in 2009, Google, the Grameen Foundation, and MTN (a cell network provider in Uganda analogous in its ubiquity to AT&T or Verizon in the United States) collaborated on a project to create a health information messaging service, which allows individuals to send specific questions via text messaging. The multi-lingual service, which allowed users to ask questions in English or Luganda (an official language widely spoken in Uganda), used an algorithm to respond with a targeted answer based on the topic.

IPA, a non-profit founded by Karlan in 2002, “evaluates what works in fighting poverty using the most rigorous methodology available: the randomized controlled trial,” worked with the Google consortium to randomize sixty villages: half received “high-intensity marketing campaign by a professional marketing firm” and half received no special information (though the text messaging service was available to everyone).

The researchers hypothesized that having access to private, objective, and reliable sexual and reproductive health information would increase knowledge, change attitudes towards safe sex practices, and lead to more safe sex and less unsafe sex (which included infidelity).

Their results were surprising and discouraging:

We find no increase in health knowledge regarding HIV transmission or contraception methods, and no change in attitudes. Rather than seeing reductions in risky sexual behavior, we actually find higher incidence of risky sexual behavior, and more infidelity, although more abstinence as well. Overall, individuals perceive their behavior as being riskier, which could be an indication of better probabilistic assessments but is also likely a result of the riskier (self-reported) behavior and possibly a desire to answer the surveyor in a particular way.

Infidelity increased from 12% to 27% in the treatment group, and men showed a statistically significant increase in the number of sexual partners, from 0.63 to 1.04.

Karlan ChartWhy is there a higher incidence of risky sexual behavior and more infidelity among users of the service? The authors don’t have conclusive data, but suggest that “sexual sorting” may have occurred; women, having learned about the risks of unsafe sex, demanded safe sex (and, failing that, denied sex altogether). Men, who perhaps didn’t want safe sex, found another girl to have risky sex with, cheating in the process.

In this case, it seems that the conventional wisdom is wrong: providing health information in and of itself doesn’t appear to be enough to promote safe sexual practices; as the authors conclude,

…it would be appropriate to learn from this study that the mere introduction of an information technology, designed by development experts, but left to individuals to self-direct in terms of their usage, does not necessarily lead to the socially desired impacts set out in the original intention of a program.

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Tuesday Links

  • “Much more than a heart of darkness, the Congo is the heart of brightness.” – Countering the ever-present, all-too-simple explanation of the Democratic Republic of Congo as a giant morass of death, decay, and damnation
  • An epic rant against the use of the pie chart, during which the author quotes Edward Tufte, who compares using a pie chart with not knowing the difference between their/there/they’re and its/it’s. I love Tufte’s work, but here I think he’s being a bit overly-dogmatic; sure,  a poorly-conceived and poorly-executed chart is going to be awful, but that’s true of any chart. For quick glances – and for ensuring the viewer knows that the information he/she is looking at is the sum of a whole, a pie chart can be the most effective way to present the information
  • Steven Levy’s insider view of Project Loon, the audacious internet-by-balloon project by Google’s audacious arm, Google X, is great for a lot of reasons – like how, during research, if a civilian were to find one of the failed experiments, it read “HARMLESS SCIENCE EXPERIMENT” – but mostly because it highlights a guy named Rich DeVaul, a “rapid evaluator,” whose job is to evaluate seemingly-crazy ideas and “kill a project as fast as [he] can”
  • Malcolm Gladwell’s review of a biography of  Albert Hirschman is worth a read, as I imagine the biography is
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Monday Links

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Genetically Modified Mosquitoes Could Save Thousands of Lives. Is There a Cost?

A small village of 3,000 people in northeastern Brazil is playing a possibly-seminal role in the history of global health; trials that hold the possibility of saving thousands of lives from extreme morbidity and mortality are currently being conducted there. Just as significantly, the trials are highly controversial, and are likely re-ignite the perma-smoldering debate about genetically modified organisms.

mosq

Mandacaru, an isolated village of 3,000 in the state of Pernambuco, Brazil, has served as host to one of the first trials of genetically-modified mosquitoes in the wild, and the initial results are in: the indigenous A aegypti mosquito population fell precipitously, by 96%. It’s likely that, as a result, hundreds of Brazilian lives were spared the pain and mortality resulting from dengue fever.

Oxitec, the British biotechnology company that created the process of modifying mosquitoes, said in a press release that “The result if a major success, and shows an even greater level of effectiveness for Oxitec’s approach than that demonstrated in previous evaluations in Brazil and the Cayman Islands.” Part of the success is due to Mandacaru’s isolation, which allowed continual releases of modified mosquitoes to snuff out the indigenous population.

Here’s a simplified version of how the process works: Oxitec inserts two genes into lab-grown A aegypti mosquito eggs; one’s a marker to track the modified mosquitoes, the other a “time-bomb” gene that triggers the lethal over-manufacture of a protein that interferes with new cell formation. Millions of mosquitoes are then bred before the females are killed and the males are released into the wild; they quickly mate with indigenous A aegypti females, passing along the inserted genes. Within days – before the female’s larvae grow enough to begin looking for a human blood meal – the mosquitoes die. Modified mosquitoes are released every few weeks, and slowly begin to take over the population – which means that, over time, the number of blood-hungry mosquitoes falls.

A aegypti mosquitoes are the primary vector for dengue fever, a viral disease that causes excruciating pain (it’s also known as “breakbone fever”). The implications for severely decreasing dengue – or even wiping it out entirely – are massive; estimates on the incidence of dengue infection vary, but 50 million to 390 million people are infected each year, causing about 25,000 deaths. There is no cure; treatment is palliative, consisting of fluids, painkillers, and blood transfusions for those who suffer from a severe case. Research on a dengue vaccine is ongoing, so preventing transmission involves mosquito control strategies – spraying pesticides, eliminating standing water sources, and similar measures.

The approach pioneered by Oxitec isn’t without its critics, as recent articles in the New Yorkerand Mother Jones outlined. Like crops and other organisms under the broad genetically-modified organism (GMO) umbrella, the debate is about fear of the “unknown unknowns.” For example, in 2010, a Deloitte survey found that more than a third of Americans were extremely concerned or very concerned about GMO food – despite the reigning scientific consensus that GMO foods are no different than conventional foods.

food

Many are wary of the unintended consequences of genetically-modified mosquitoes, noting that no one knows the long-term repercussions on the fauna of mosquito-less areas, or what the potential human consequences could be.

Even those who are more sanguine on the use of genetically modified mosquitoes in general are wary of over-reliance on one for-profit organization specifically. A geographic area would be reliant on Oxitec’s mosquitoes, which require continual releases at regular intervals. Currently, the technique is only useful in isolated areas, and scaling it would require modified mosquitoes to be released in multiple areas simultaneously, a potential coordination issue for interested countries.

It’s clear that the debate won’t be finished anytime soon. In the meantime, more trials will be undertaken, and more research will be conducted to attempt to better understand the long-term ramifications of introducing genetically-modified mosquitoes.

Photo Credit Via

 

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Friday Links

  • The comments section is getting fun for my article about why young, healthy people (read: me) should be OK with their premiums (potentially) increasing with the Affordable Care Act
  • High-risk, high-reward philanthropy – an interesting profile of the Laura and John Arnold Foundation. It sounds like it’s trying to take the venture capital mindset to public policy and intractable issues like poverty and obesity
  • On privilege - a paragraph I think rings very true for a lot of us: “A friend recently tried to console me by saying that I’ve failed at more things than most people have ever tried. Most people, I said, try more honestly. Most people do not owe so much to those who believe in them. That is another privilege we don’t discuss: The unrelenting luxury of high expectations, and with it, the chances to fail.”
  • Sterilization quotas in India – pretty horrifying. Not the right way to do family planning (as Amartya Sen delves into in his book Development as Freedom, which I’ll review soon enough)
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Want to Reduce Rape in Nairobi’s Slums by 60%? Teach Self-Defense

(Via Project Millennial)

In the slums of Nairobi – places with names like Umoja, Mathare, Karogocha, and Kibera – you’ll find moments of beauty and signs of hope everywhere. The smile of a schoolkid trying to catch a bubble during lunch break (pro tip: kids love bubbles). The teenager who invites you into his home to “check out his crib” Everyone, everywhere going out of their way to help a lost-looking foreigner be a little less lost.

IMG_3714 - Copy

But you will also find desolation, in the eyes of a man consumed by his consumption of chang’aa (a sometimes-homemade, sometimes-gang-made liquor often spiked with jet fuel and battery acid); desperation, in the eyes of a child who may not find a meal; hopelessness in the scope and scale of myriad heartbreaking issues confronting the men, women, and children living there.

IMG_3731

One of which is rape. Arguably the darkest statistic about life in the slums of Nairobi is the prevalence of rape: up to one in four teenage girls are raped each year – sometimes as a result of just going to the latrine.

So, when there’s an astoundingly successful intervention that significantly reduces rape, it’s worth shining a light on it[1]. Such is the case with a recent study out of Stanford University School of Medicine and Lucile Packard Children’s Hospital. It looked at whether teaching young girls a self-defense course would reduce the incidence of rape; it did, by a staggering amount.

Here’s how it worked: the self-defense course, developed by San Francisco-based NGO No Means No Worldwide, included verbal and physical self-defense techniques to prevent rape and sexual assault. It was taught to about 400 high school-age girls, aged 14-21, in Karogocho[2] and Kariobangi (two Nairobi slums), with another 120 girls serving as a control. The study was non-randomized “to prevent cross-contamination across study groups.” Importantly, the intervention was cheap – just $1.75 per trainee[3].

The results were staggering:

“In the 10 months after receiving self-defense training, more than half of these girls reported using what they had learned to fend off would-be attackers. The proportion of them who were raped fell from 24.6 percent in the year before training to 9.2 percent in the 10-month period after… In contrast, among girls who had life-skills classes, the proportion who became victims of rape remained about the same.”

That’s an absolute 15.4% drop, and a relative reduction of 63%.

Nairobi Chart

The researchers noted that rapes perpetrated by the two most common groups – boyfriends and relatives – dropped significantly. Additionally, almost 60% of girls trained in self-defense reported using the skills they learned, and those who were raped were vastly more likely to disclose it; for girls trained in self-defense, from 56% pre-training to 97% post.  In other words, the intervention was a resounding success.

Before you get too excited, a word of caution. This study doesn’t say that teaching self-defense techniques anywhere, for any age group, will lead to such a profound reduction in rape. The slums of Nairobi may be a unique case; perhaps their atrociously high initial rates make reducing the incidence there “easier,” and mother myriad actors could also play a role. It also wasn’t a randomized controlled trial; we must consider the chance that there are confounding factors at play. The external validity of the intervention hasn’t been shown – the intervention may be less effective in other areas of Kenya, or even other areas of Nairobi.[4] We just don’t have enough data to say, and more studies need to be undertaken in different contexts.

But here’s what we can say: an intervention that costs $1.75 per trainee reduced the chance that a Nairobi teenager would be raped by 63%. Add that to the “signs of hope” column.



[1] If you’re thinking that this only treats the symptom and not the underlying cause of why rape occurs, you’re right. But the symptoms have to be treated while the underlying causes shift agonizingly slowly

[2] The study authors note that Karogocho is derived from the term for “chaos”

[3] Presumably, scaling the program would make it even less expensive

[4] A similar study conducted by No Means No Worldwide in 2011, also in Karogocho, found similar results, though

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Four Million Reasons Why Yesterday’s Senate Vote to Continue Our Food Aid Policy is an Awful Idea

(Cross-posted at PolicyMic)

In a rare show of bipartisanship, last night the U.S. Senate voted 66-27 to approve a “Farm Bill” that leaves food aid policy stuck in the 1950s. It’s a decision that will unnecessarily keep an estimated four million people from receiving American food aid while harmfully distorting local markets.

(via)

(via)

The omnibus “Agriculture Reform, Food, and Jobs Act of 2013,” passed 66 to 27, with support from Republicans and Democrats. The majority of its 10-year, $955 billion cost is spent on food stamps, but $1.4 billion is allocated to food aid; under the bill, food aid policy would be basically unchanged, leaving a sclerotic, inefficient system intact.

It didn’t have to be this way. President Obama’s 2014 Budget substantially altered American food aid policy, bringing it more in line with every other donor country in the world; it would have allowed 45% of emergency funds ($330 million) and $250 million of non-emergency funds to be used more efficiently, given as cash or vouchers in local markets.

Instead, except for a $60 million provision to buy food in local markets, the old, “Food for Peace” program is still in place: the United States government buys up surplus crops from American farmers, then donates it to NGOs to sell in developing countries –  a process known as “monetization.” A report by the Government Accountability Office estimated that monetization alone costs U.S. taxpayers tens of millions of dollars every year in waste.

Changes to the program – namely, ending both the Food for Peace program and monetization – would have substantially increased the number of beneficiaries reached, and begun to unravel the market-distorting effects of American crops being sold in local markets.

Right now, about 50 million people benefit from American food aid; for the same cost to American taxpayers, an estimated four million additional people would benefit under President Obama’s plan, according to USAID Administrator Rajiv Shah. The Center for Global Development believes that to be a conservative estimate, and persuasively makes the case that the real number is between four million and ten million.

Harder to measure, but arguably more harmful, is the effect that outside supply has on the local market. I discuss this more in-depth elsewhere, but suffice it to say that air-dropping staple crops into an established market will reduce the price of the local supply, which has a negative effect on the subsistence farmers who rely on their sales to feed, clothe, and educate their families.

None of this has been contested by the bipartisan opposition which formed once President Obama’s plan was rumored and subsequently announced. Instead, it argues that American farmers and shipping companies would be negatively affected by the proposed changed, and harkens back to President Eisenhower’s original goals for the program:

“When President Eisenhower signed into law legislation authorizing the program, he explained that the purpose was to ‘lay the foundation for a permanent expansion of our exports of agricultural products with lasting benefits to ourselves and peoples of other lands’,”

Notice who comes first in that explanation.

Members of the House, such as Eleanor Holmes Norton (D-D.C.) and Gerald Connolly (D-VA), are a bit more honest about their opposition to modernizing the program:

“Ms. Norton’s spokesman said she “thinks the president’s policy is correct,” but signed the letter as a courtesy to Mr. Cummings and because of a collateral concern that food stamps might be affected. Mr. Connolly, too, said that Mr. Obama’s plan would make sense in “an ideal world,” but that political realities are such that foreign aid cannot get funding unless domestic U.S. constituencies also benefit.”

It’s “just politics,” in other words. Unfortunately, “just politics” is keeping a sclerotic, inefficient, and harmful system in place that fails to assist millions of people and succeeds in distorting local markets.

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