Globalization: The Crucial Phase 9781934536797

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GLOBALIZATION THE CRUCIAL PHASE

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GLOBALIZATION THE CRUCIAL PHASE e di t e d b y

Brian Spooner

University of Pennsylvania Museum of Archaeology and Anthropology Philadelphia

library of congress cataloging-in-publication data Globalization : the crucial phase / edited by Brian Spooner. pages cm ISBN 978-1-934536-78-0 (hardcover : alk. paper) ISBN 1-934536-78-4 (hardcover : alk. paper) 1. Globalization--Social aspects. 2. Globalization--Health aspects. 3. Urban anthropology. 4. Demographic anthropology. I. Spooner, Brian, editor of compilation. II. University of Pennsylvania. Museum of Archaeology and Anthropology, issuing body. HM545.G56 2015 303.48’2--dc23 2014042398

© 2015 by the University of Pennsylvania Museum of Archaeology and Anthropology Philadelphia, PA All rights reserved. Published 2015 Published for the University of Pennsylvania Museum of Archaeology and Anthropology by the University of Pennsylvania Press. This publication was made possible with support from the Michael J. Kowalski Museum Term Fund.

Printed in the United States of America on acid-free paper.

Contents

Figures Tables Contributors Preface

vii x xi xv

Introduction 1 Globalization via World Urbanization: The Crucial Phase Brian Spooner

1

Part One: Assessment 2 Development Trends Among the World’s Socially Least Developed Countries: Reasons for Guarded Optimism Richard J. Estes 3 Human Genetic Diversity in a Global Context Theodore G. Schurr 4 The Global Financial and Economic Crisis: a Drama in Three Acts Mauro Guillén and Sandra L. Suárez 5 “Where Everything Is Political”: Architecture Against Politics in Global Dubai Cameron Hu

23 71 115

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Part Two: Habitat 6 If There Is Food, We Will Eat: An Evolutionary and Global Perspective on Human Diet and Nutrition Janet M. Monge

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Contents

7 Aspects of Animal Production in Global Food Supply David Galligan, James Ferguson, Alan Kelly, Zhengxia Dou, and Zhiguo Wu 8 Issues in Global Health Nancy Biller and Neal Nathanson 9 Global Oral Health Robert J. Collins 10 Cities: Threats and Opportunities for Women’s Health Marjorie Muecke 11 Pharmaceuticals and the Competitive Logic of Global Clinical Trials Adriana Petryna

195

211 227 235

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Part Three: Application 12 Preparing Lawyers for Practice in an Era of Global Urbanization: A Proposal for Transnational Clinical Partnerships Sarah Paoletti 13 Towards a Comprehensive Response to Victims of Sex Trafficking Huiquan Zhou 14 Globalization and the University: A Relationship Worth Studying? Alan Ruby 15 Academically Based Global Service Learning Joseph S. Sun, John D. Keenan, Megan Doherty, and Christina Catanese

279 319

343 359

Figures

2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10 2.11 2.12 3.1 3.2 3.3

Average WISP Scores by Continent, 1970–2011 (N=160) Percent Change in Average WISP Scores by Continent, 1970–2011 (N=160) Average WISP Scores by Development Groupings, 1 970–2011 (N=160) Percent Change in Average WISP Scores for Development Groupings, 1970–2011 (N=160) Rank Ordered Average Regional WISP Scores and Percent Changes in WISP, 2000–10/11 (N=19 Regions) Average WISP Scores for SLDCs by Continental Region, 1970–2011 (N=41) Percent Change in Average WISP Scores for SLDCs by Continental Region, 1970–2011 (N=41) Average WISP Scores for African SLDCs by Geographic Subregion, 1970–2011 (N=32) Percent Change in Average WISP Scores for African SLDCs by Geographic Subregion (N=32) Average WISP Scores for Asian SLDCs by Geographic Subregion, 1970–2011 (N=8) Percent Change in Average WISP Scores for Asian SLDCs by Geographic Subregion (N=8) Distribution of WISP Scores by Country and Development Zone, 2009 (N=160) A simplified human mitochondrial DNA tree A simplified Y chromosome parsimony tree Map showing mtDNA haplogroups around the world

31 32 40 40 42 46 47 48 48 50 50 61 73 74 75

viii Figures 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 5.1 5.2 5.3 5.4 7.1

Map showing distribution of NRY haplogroups around the world 76 A simplified human mtDNA phylogeny showing deep African roots 78 A phylogenetic tree of the Y-chromosome haplotypes and their percent frequencies in two Ethiopian groups and Senegalese 79 A map of Eurasia and northeastern Africa depicting the peopling of Eurasia as inferred from the extant mtDNA phylogeny 81 A model of the diffusion/migration of modern humans into Europe and North Africa 84 A view of Europe during the last glacial maximum 85 Spatial frequency distribution of mtDNA haplogroup H based on population analysis 86 Ethno-linguistic groups in the People’s Republic of China ~1983 88 The frequency distribution of the O3-M122 haplotypes in East Asian and other continental populations 89 Distribution of Y-chromosome haplogroup C3c associated with Genghis Khan and his male relatives 94 Genghis Khan statue in front of the Mongolian Parliament 95 The gilded statue of Migjid Janraisig (Avalokitesvara) 95 A schematic of maternal gene flow in and out of Beringia 97 Y-chromosome haplogroups found in Inuit and Danes 98 The World and Palm Jumeirah 144 Dubai From Above 147 Jebel Ali Port 149 Dubai’s Sheikh Zayed Road 156 An example of energy consumption of a hypothetical 199 extensive system 7.2 Global corn and wheat yield (1,000 kg/hectare) 202 7.3 Adult dairy cow populations from 1961 to 2007 (FAO data) for the U.S. and China. 206 7.4 Annual Milk yield/cow (kg) and total societal milk yield for the U.S. and Chinese Dairy Industries. 208

8.1 8.2 8.3 8.4 8.5 13.1 15.1 15.2 15.3 15.4 15.5 15.6 15.7 15.8

Figures ix Projected increase in the world’s population, by developed and developing regions 213 Status of the world’s fisheries, 1950–2000 214 World hunger map, 2009 215 The “Preston curve” showing the relationship between life expectancy and per capita income 1900 to 1990 217 Life expectancy, England and Wales, 1751–1990 218 Contemporary Organizational Mix for Handling Trafficking Cases 328 Implementation of service learning 361 Hands-on clinical experience focusing on prosthetics and orthotics. 363 Paradigm for Service Learning 364 Hands-on projects are an important part of service learning, but sustainability considerations demand community partnership and ownership 365 Students learn to implement their design and make the transition theory to practice 366 The iterative of engineering design is never as clear as it is in the middle of the night revising plans based on what was learned earlier that day in the field 366 The availability of a clean, reliable supply of drinking water means less time is spent carrying water each day from a distant source 368 Improved access to information and educational resources translates to a greater desire to complete education 368

Tables

2.1 Indicators on the Weighted Index of Social Progress (WISP) by Subindex, 2011 (41 Indicators and 10 Subindexes) 2.2 Statistical Weights Used in Constructing the Weighted Index of Social Progress 2.3 Countries Grouped by Continents & Subcontinents Marked by Development Groupings, 2011 (N=162) 2.4 Alphabetical Listing of SLDCs by WISP Scores and Ranks for 2000 & 2011 (N=41) 2.5 Socially Least Developed Countries (SLDCs) Ranked Ordered by 2011 WISP Scores (N=41) 2.6 SLDC Subindex Performance Ranked Ordered by WISP Index Score, 2011 (N=41) 2.7 Tripartite Distribution of WISP Subindex Scores, 2011 (N=41) 7.1 Comparison of estimated water consumption efficiency of the 2007 U.S. and Chinese Dairy industries using the Penn State Water model 8.1 Books on global health 8.2 Deaths among children under age 5 that could be prevented utilizing proven interventions 13.1 Time line of the U.S. response to sex trafficking 13.2 Core Institutions and Legislations of the Anti-Sex Trafficking System in U.S. 13.3 Improving the U.S. Anti-trafficking System 14.1 U.S. Institutions with largest numbers of International Students 2011/2012

26 28 30 49 52 58 60

206 212 221 321 325 337 347

Contributors*

Nancy Biller Administrative Director of Global Health Programs, School of Medicine Christina Catanese Master of Science candidate in Applied Geoscience, School of Engineering and Applied Science Robert J. Collins Clinical Professor, School of Dental Medicine Megan Doherty Associate Director of Academic Programs, School of Engineering and Applied Science Zhengxia Dou Associate Professor of Agricultural Systems, Center for Animal Health and Productivity, School of Veterinary Medicine Richard J. Estes Professor, School of Social Policy and Practice James D. Ferguson Professor of Nutrition, Center for Animal Health and Productivity, School of Veterinary Medicine David T. Galligan Professor of Animal Health Economics, Center for Animal Health and Productivity, School of Veterinary Medicine

xii Contributors Mauro Guillén Director, Lauder Institute, and Dr. Felix Zandman Professor in International Management, Wharton School Cameron Hu Near Eastern Languages and Civilizations (B.A. 2009), School of Arts and Sciences John D. Keenan Professor of Electrical and Systems Engineering, School of Engineering and Applied Science Alan Kelly Professor of Pathobiology, Center for Animal Health and Productivity, School of Veterinary Medicine Janet Monge Associate Curator-in-Charge and Keeper of Collections, Physical Anthropology Section, Penn Museum, and Adjunct Associate Professor, Department of Anthropology, School of Arts and Sciences Marjorie Muecke Assistant Dean, Global Health Affairs, School of Nursing Neal Nathanson Professor Emeritus, Microbiology and Associate Dean, Global Health Programs, School of Medicine Sarah Paoletti Practice Associate Professor, Law School Adriana Petryna Professor, Department of Anthropology, School of Arts and Sciences Alan Ruby Senior Fellow, Higher Education Division, School of Education



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Theodore G. Schurr Professor, Department of Anthropology, School of Arts and Sciences, and Consulting Curator, American and Physical Anthropology Sections, Penn Museum Brian Spooner Professor, Department of Anthropology, School of Arts and Sciences and Curator for Near Eastern Ethnology, Penn Museum Sandra L. Suárez Associate Professor, Department of Political Science, Temple University Joseph S. Sun Vice Dean for Academic Affairs, School of Engineering and Applied Science Zhiguo Wu Research Associate Professor, Clinical Studies, Center for Animal Health and Productivity, School of Veterinary Medicine Huiquan Zhou Doctoral candidate, School of Social Policy and Practice *All appointments are University of Pennsylvania except where otherwise noted.

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Preface

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n 1999, I invited Lee Cassanelli (in History and African Studies) and Mauro Guillén (in Management and Sociology) to work with me (in the Museum, Anthropology, South Asian and Near Eastern Studies) to design a course on “Globalization in Historical Perspective.” The occasion was a call from the then Dean of the College of Penn’s School of Arts and Sciences (SAS) for a new series of original team-taught interdisciplinary courses that would form a five-year experimental Pilot Curriculum for the General Requirement part of the BA degree. In the following years the course gradually developed into a program: we added research seminars, engaged in discussion of methodological problems, and formulated longer term objectives. Most importantly we began to work out a clearer formulation of the essential continuities between the functions of the Museum and of education and research more generally throughout the modern curriculum as it continues to change. In 2005 with help from the SAS Instructional Technology Program we began work on a website (www.globalizationstudies.upenn.edu). A year later the Penn Institute for Urban Research (PIUR) provided funding for us to develop a campus-wide Faculty Forum on Globalization. As our Forum became known, an increasing number of faculty and students from a variety of disciplines and professions in each of Penn’s twelve schools joined us and began to recontextualize their work from international to global. What’s the difference? Briefly, international connects—from one to other national locations; global reconceptualizes—in terms of trajectories of world history, informed from the past, in expectation of what may come, as everything becomes more intensively interconnected. This reconceptualization

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is an emerging challenge for academia as a whole and for education in general. It is a special challenge for museums, particularly university museums such as Penn’s Museum of Archaeology and Anthropology, because of the change in their public function over the past century: they were designed to present a cultural map of the world, at a time when Western culture was unquestionably hegemonic; they now need to reorganize their collections and redesign their exhibits to present the world more openly and flexibly, as we see it in the 21st century. The collections that were assembled from the mid-19th to the mid-20th centuries can be used to visualize the world in terms of trajectories of interconnectedness, increasing social complexity, and the global interaction and inter-mingling of cultural traditions. Our association with PIUR followed closely on the news that a significant threshold in world history had been crossed: urbanization had progressed to the point where over half of the world’s population now lived in cities. We became more aware of increasing urbanization on a global scale as not only a key process, but perhaps the primary engine, of globalization. The proportion of urban to non-urban population in the world had risen at an accelerating rate through the twentieth century, from just ten percent in 1900. Forecasts for 2050 vary from sixty to seventy five percent. This accelerating increase in urbanization, parallel to the globalization process, suggested we should look more closely at the relationship between them. Once alerted, we saw that not only had there been an increase in rural to urban migration, but that cities had been reaching into the countryside. At the same time as cities grew in relative size, their influence and control over non-urban populations also grew. The relationship between globalization and urbanization is so close that we can gloss globalization as world urbanization. Both traditional cities in the West and the urban centers of Asian civilizations are outgrowing their national environments and becoming global cities. New cities in Africa and elsewhere are mushrooming to outgrow and transcend their colonial heritage. Social interaction between urban populations in different countries is becoming globally more significant than what is going on in any individual country. Works with titles like “The Endless City” (Burdett and Sudjic 2007) and “The Generic City” (Koolhaas 1995) have already been published. The urban-rural distinction we were accustomed to at an earlier stage of social science, in the first half



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of the 20th century, has lost its significance. What still looks like countryside and wilderness is now dependent on city-based institutions and being re-designed for the benefit, if not the direct use, of urban populations. It is already difficult to find any part of the world that is entirely independent of city-based activity, whether political, economic, or simply cultural. The next step was a conference, which we held in the Penn Museum on October 17, 2009. We brought together the diverse disciplinary and professional work (that was by then being regularly represented in our monthly Forum meetings) for a public event that would allow us to work out a holistic approach to what we had come to understand as: Globalization as World Urbanization. We met for a full day of presentations and discussion. There were fifteen speakers altogether on the program, and six poster exhibits outside the auditorium. The inter-disciplinary and inter-professional discussion generated by the conference built on the work of the Faculty Forum. As a result, we were able to involve a broad selection of specialists from all the fields of research and application that are active in the modern world. As our work continued since then, we became increasingly aware that Penn’s contribution to this field and its potential for future work is distinctive and demands broader circulation. But what is globalization? While this fundamental question is dealt with seriously in the introductory chapter, certain aspects of it that involve the design of this volume need to be treated here. Specifically, is globalization a final product that we can define and describe or is it rather a stage on a long-term trajectory of change and growth that we are currently passing through? The fact that we need to ask this question draws attention to the confusion that surrounds the whole topic of change in the modern world. We have adopted a paradigm, “globalization,” that imagines a future condition, which tends to distract us from what we need to be doing: which is to understand the processes of change in the world around us now. In this book, we argue that the confusion is due to the accelerating rate of change and growth—which challenges our need to know what to expect, because it is too fast for us to be able to feel we know what is coming. In this phase that we are now passing through, the rate of change is so fast that it is geographically and socially uneven, with the result that it exhibits the contrasts between communities at different stages of the process. These contrasts

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are greater than at any time in the past, and possibly greater than will ever occur in the future, making this the crucial phase of growth and change, not only of the whole historical process of globalization but of world history— hence the subtitle of the volume. This book is about our current research as we move through this unprecedented phase of growth and change that may be a tipping point into a qualitatively new future. If we put together the insights of two of the most interesting writers in this field so far: when 75% of the world’s human population lives in cities in the second half of this century, they may be living on 2% of the world’s land surface (Burdett and Sudjic 2010:54–69), but as our remote communication technologies and practices continue to evolve at the same pace we will be able to live an urban life without living in close, dense proximity (Castells 2000, vol. I:429–431). At the same time, we have moved from living in poorly connected relatively static communities of scores, hundreds, or thousands, to a potentially global but dynamic community of billions. As the size of our arenas of social interaction continues to expand and our interaction continues to intensify, human collective ability is likely to advance to a point where not only will urban life look entirely different from the urban life we are accustomed to today, but there will be a qualitative shift in what it means to be human. But this volume focuses on the present. All the chapters have been written since the conference and updated to represent the current situation. By demonstrating how multiple different disciplinary and professional approaches are necessary for understanding change in the modern world, but can now be brought together into a holistic discussion, they show also that where academic and professional work used to be kept scrupulously separate, now they are more productive in interdependence. Since the human mind works by association, as much as, or even more than by logic, there will always be academic insights that lead to significant practical developments. But the field of academic endeavor has become so broad that we need to know how we are choosing where to focus our attention. The balance between challenging philosophical problems and urgent practical problems has changed. The pursuit of knowledge needs to be harnessed to the effort to solve the problems of survival and quality of life in the modern world. Good policy must be informed by the best research. The relation-



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ship between the Museum and the disciplines and professions of academia is changing. The Museum that was designed to use archaeology and anthropology to provide a cultural map of the pre-modern world now needs all these disciplinary and professional approaches to visualize the changing modern scene in world-historical terms. Archaeology and anthropology continue to provide the keys to coordination. Brian Spooner

ACKNOWLEDGMENTS Besides PIUR and the Penn Faculty Forum on Globalization, the conference was co-sponsored by the Department of Anthropology, the South Asia Studies Center, Lauder CIBER and the Penn Museum. Among others who helped we are particularly grateful to Misha Chakrabarti, Linda Koh, Emily Wengel, Sandra Zhao.

REFERENCES Burdett R., and D. Sudjic, eds. 2010. The Endless City. London: Phaidon. Castells, M. 2004. The Information Age. Oxford: Blackwell. Koolhaas, R. 1995. The Generic City. In Small, Medium, Large, Extra-Large, ed. J. Sigler. New York: The Monacelli Press.

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1 Globalization via World Urbanization The Crucial Phase Brian Spooner

The future is already here; it’s just unevenly distributed. —W. Gibson 1993

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lobalization is on everyone’s lips, but poorly grasped, and inadequately explained. Like many other terms that are common in everyday conversation, such as democracy or capitalism, its currency trumps our ability to give it an exact meaning. Since it was not coined as a scientific term, we cannot restrict its use to the objectives of social scientists. Definitions in the literature vary with the special interests of each writer. But it flourishes in general usage because it captures the accelerating rate of change we see all around us, much of which extends our day-to-day experience beyond the local and national into the global. Globalization is not a new term. It was introduced in 1904 in French, and appeared first in English in 19301. However, it did not take on until the 1990s, after the collapse of the Soviet Union forced us to re-evaluate world affairs. The fall of the Iron Curtain after 1989 took us by surprise. Until then our models for understanding international interaction had been essentially static. Most people saw the world in terms of the Cold War, a static paradigm that satisfied our need for perceptual order. This bipolar model that had emerged in the routinization of affairs after World War II enabled

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us to see a stable world, resting on a rough balance between American and Soviet power. When one of these two poles collapsed, we were left with the obvious default: unipolarity. But America’s inability to control the ethnopolitical conflicts that broke out in the next few years in the Balkans and in Central Africa quickly invalidated unipolarity as a useful model. Then the internationalization of terrorism, beginning with the first World Trade Center bombing in 1993, opened up our thinking to a completely new paradigm. During the forty-six years we were relying on the stability implied by our bipolar model, the world had not been standing still. It had continued to change—at an accelerating rate. Now a new wave of Internet and wireless technologies that facilitated remote interaction, first the World-WideWeb and then mobile phones, raised our day-to-day awareness of other parts of the world. The emerging globalization discourse made sense of this new experience. It was ready-made for the time: dynamic, conceived as process, assuming change and looking forward to a qualitatively new global community. The new word spread quickly through language communities that build new words from Latin roots (though other languages have had difficulty). Our adoption of it has been revolutionary, because despite the increasing acceptance of the idea of progress since the 18th century, this is the first time in human history that the present is seen in terms of an imagined future state. Unlike any previous paradigm for understanding the world around us, it envisages not the transformation of this world into the next (as in the Middle Ages), not a stable continuity of competition in current conditions (as in modern history), but assured progress towards a qualitatively new, globally interconnected community. We recognize that globalization, whatever else it may be, is change, accelerating open-ended change. Change is not new. It has always been with us, in even the earliest, smallest communities, if only as a natural outcome of the staggered life cycles of demographic process. For most of human history the rate of change has been slow. The results have been visible more in quantitative than in qualitative terms, so that, as our understanding of ourselves and the world around us has developed, we have not felt the need to study change itself. We have studied societies in terms of implicitly static situations, structures, organization, rather than as dynamic processes of change. Nevertheless, although we have become increasingly aware of change over the past half-century, we have made little progress in our ability to study and explain it as it is happening. Now that change is faster than



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it has ever been before, we can no longer ignore it. But we are unprepared. Accelerating change challenges our human need for order and predictability. Until recently, as our civilizations became larger and more complex we met this challenge by developing more and more intricate cultural rules for the regulation of public interaction. All our rules developed independently within each arena, each civilization, by a process of cultural elaboration, increasing the cultural divergence between different parts of the world. Human life everywhere, from the smallest communities to the largest, down to the middle of the last century was organized according to elaborated codes of behavior that made it possible for everyone to know what to expect even in the most complex social situations. The history of table manners provides a good example (cf. Elias 1982). However, in the middle of the 20th century we appear to have crossed a threshold in the growth process, after which the increasing growth and complexity of society has exceeded our ability to govern it with rules. Increasing opportunities to interact more frequently and with expanding numbers of people from different parts of the world have changed both our need to hold on to the relationships of the past and our need for rules. The progressive expansion of our arenas of interaction has brought more and more people from diverse backgrounds and different life experience into contact with each other, making our rates of innovation, and readiness to adopt new technologies, greater in the last two decades than in any previous period of world history. Our rules have begun to fade and our tolerance of uncertainty has risen. Yet we still need to know what to expect. We still instinctively reduce the stochastic phenomena of our daily experience to the cultural sense of order we share in our community, which is based on past experience. We are thus predisposed to analyze the world around us as we know it: that is, as it has been, rather than as it might become. However, at current rates of change, analyzing the present in terms of the past no longer answers our questions or solves our problems. The rate of change in our lives, now obviously qualitative as well as quantitative, has accelerated to the point where no analysis of current conditions is any longer productive or satisfying if it does not take into account the continuing change that underlies it. Acceleration in the rate of change began to be palpable in the middle of the last century. The boundaries between the world’s culturally and linguistically different civilizations have been blurring, and the rate of population growth and movement, and of the intensification of social interaction, has

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exceeded our ability to control daily life through continued cultural elaboration. The explosion of information in the past two decades has taken place against a changing social background that has received less attention, but is now often referred to as informalization (Wouters 2007), which is the relaxation and questioning of all social rules, from table manners to the composition of the family household. New electronic technologies, based on digitization, have opened up the possibility of storing, duplicating and spreading information in quantities that are practically unlimited. As the use of these technologies has expanded, the supply of information has outgrown our methods, as well as our abilities to process and evaluate. Informalization has made this process even more complex. In the past literacy, knowledge and information were controlled from the top down, and the elaboration of cultural rules of behavior worked similarly from the top down. Now that remaining restrictions on the flow of information are weakening, change is working from the bottom up. As a result absolute values are losing their definition, and regulation (which has been a growing problem since capitalism and other bottom-up processes began to emerge in 17th century England) is becoming more and more difficult. When we were not preoccupied with change, and were able to see our social world as stable, and to understand it in terms of what we had learned from the past, we could subscribe to values we considered absolute, because no one questioned them. We could accept information as knowledge. We could associate knowledge, like property, with social status. Now, however, information is data, and is available to everyone. We have passed from the condition of the mediaeval period in which land ownership was the basis of social status, guaranteed by an unquestioned hierarchical structure, referred to as The Great Chain of Being, through a process in which financial wealth has superseded landownership. Now we are crossing another threshold into a condition where society will have outgrown the historical structures that legitimated status and identity from the top down, where information will be the primary good, but universally accessible, and social identity and status will be negotiated from the bottom up, as it already is with celebrities. We are undergoing a fundamental change in the way we relate as individuals to the larger social field. In the past identity depended on family relationships and inheritance within a relatively small arena of interaction, beginning with people who were socialized together in kinship groups or



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families, more recently in larger groupings, such as religious confessions, social classes, ethnic communities, or whole national societies. The present was conditioned by the past. The genetic programming we inherited from our primate past appears to have generated two conflicting social drives that are evident in the complexity of modern society. First, we look for order, and we find it in the relationships we have formed over time. Second, we look for new relationships. For most of human history down to the middle of the last century most of us had few opportunities to form new relationships that might endanger the asset value of our established relationships. But as a result of the growth and merging of arenas of interaction over the past generation, none of these processes is any longer adequate to maintain the social stability we might still expect. Despite the continuing functionality of the larger abstract identities, such as ethnicity, religious confession, and citizenship, there are new factors that are independent of them and particularly significant in the process of globalization. The most obvious and tangible derive from geographically indeterminate and unrestricted remote interaction, facilitated by the new social media of the Internet and mobile telephony. There is also another new factor which is less tangible, but potentially the most important. It is the product of the increased participation (active or passive) in public discourse in general that has been facilitated by the growth and merging of all the various modern arenas of interaction, face-to-face and remote, local, national and global. The thought of any individual is more powerful when in dialogue with others. As the numbers of people in interaction with each other increase, not only does human thought become more powerful but general socio-political awareness is enhanced and what it means to be human begins to change in quality. We have paid little attention before now to the qualitative difference between human life in the past, when social interaction for the majority was only face-to-face, and over the past century when most of us have gradually become aware of our position in a much larger arena. How will that quality evolve when the arena in which the typical individual is interactive begins to approach ten billion? The fastest phase of this process is beginning now. This long-term general process of merging arenas and rising social awareness is, however, still uneven, and the unevenness continues to be the source of most of the world’s problems. So long as all our historical arenas of interaction have not merged into a single arena, each arena is on a dif-

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ferent trajectory of change, and at a different stage on that trajectory. Each trajectory is different both in terms of demographic factors (rate of growth, mobility), and of economic potential and cultural tone. The merging of arenas occurs gradually. It begins with the spread of information (media), trade, and financial interaction. The last factor to merge is direct social interaction. But before that happens each party becomes aware of the other in synchronic terms. That is, because of a general concern to preserve the order that protects vested interests, they do not see each other as being at different stages of a convergent process, but rather as advantaged and disadvantaged rivals. All human communities everywhere are approaching global awareness, awareness of life conditions throughout the world. But we see these conditions in terms of present (synchronic) inequalities, rather than as different points on converging historical (diachronic) trajectories of social change. The fact that most of us know little of the history of other parts of the world makes it difficult for us to see the present as process. The fact that we are now probably at the peak rate of change generally means that we are also at the peak of unevenness between arenas, of polarization between the surviving arenas of social interaction that have not yet merged, and of the difference in levels of social awareness between them. Our inadequate understanding of the causes of differing rates of change exacerbates the sense of inequality that results from them. For most of human history we have accepted inequality. Equality is a new idea. Only recently have people generally come to see it as a realizable ideal. However, we have not yet succeeded in establishing a fully egalitarian system of social order. Will globalization finally make that possible? Our adoption of the globalization discourse introduces philosophical problems. Until now we have always made sense of the present through our understanding of the past. But the current rate of change now makes the past an unreliable source of models to explain the present. Adoption of the globalization discourse leads us to try to make sense of the present in terms of what we think globalization is likely to bring in the future. Unfortunately, by defining what is happening in terms of where we think we are heading we are once again distracted from the study of the change around us in the present. This is unfortunate, because in order to understand globalization as a process we need to study current change in its own terms, as it is happening. The adoption of globalization as a subject of academic study signals the arrival of a new research age. We are studying the current looking ahead,



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rather than the recent, looking back, in the light of the past. What is coming will be new to our current understandings. The research methods and explanatory theory we have developed over the past century and a half are also hindering, even inhibiting, our understanding of current change, because they are based on individual disciplinary approaches, whereas the study of globalization requires a holistic approach. Increasing disciplinary specialization sped the advance of science in the 19th and 20th centuries, but now, in the Information Age (cf. Castells 2004), nothing we achieve within the framework of a single academic discipline will help unless it is pursued collaboratively and cooperatively with other disciplinary approaches. We need a new supra-disciplinary research apparatus that is sensitive to change. But all our available methods are disciplinary. Although the need for interdisciplinary research was understood as early as the 1960s, it generated anxiety about the possible loss of disciplinary integrity. This anxiety has begun to diminish under globalization, which has encouraged the merging of research arenas. However, our scientists and their methods are still disciplinary products. Although interdisciplinary collaboration has increased significantly since the 1990s, transdisciplinary training has barely begun. The best we can do at the current stage is to bring together and interrelate the efforts of the full range of relevant disciplines. When did globalization begin? Historically we can say that it was on the cards from the start. What drives it? The only independent variable, the tangible factor without which it would not be possible, is population growth. But increasing numbers of people alone do not necessarily cause globalization. They could continue to cause increasing local and regional conflict, as they often have in the past. For globalization to begin and continuously progress something else is essential, something less tangible and rarely considered: a particular human social inclination. The essential form of human behavior that has driven history in general, and drives modern change, is the expansion and intensification of social interaction that increasing numbers have made possible. As our arenas of interaction have expanded, with the growth of empires, and the growth of cities, despite increasing conflict, social interaction within and beyond them has intensified. What made all our technological innovations possible, from stone tools to electronics and atomic energy, was the progressive increase in the number of minds working together, a process that required not only population growth, but urbanization and the increase in collective learning and innovation that it

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facilitates (cf. Christian 2005). It was the continuing intensification of social interaction—more interactions per unit of time among more people—that enabled us to work together to expand our control of the environment, and of energy, and to develop the means of remote interaction and communication that has raised our ability to innovate to a new level. We must not forget that the accelerating rate of world population growth, which is estimated to have passed one million around 10,000 BC, one billion in 1810, and seven billion in 2012, is now decreasing, and is projected to level off somewhere between nine and twelve billion later in this century. Does that mean that innovation and economic growth will also slow? Probably not, because although we would not have arrived at modernity without population growth, having reached our current globalized condition we may not need continued population growth for further advance. Population movement, in the form of both short- and long-term migration, which has also increased significantly over the past fifty years, parallel with the intensification of remote interaction, can be expected to continue to increase, as innovation and entrepreneurship continue to change the geography of the labor market. The prime mover (although historically dependent on population growth) has been not population growth per se but growth in the intensity of information flows (cf. Castells 2004) resulting from increasing social interaction. Information flows can still continue to grow, because they are no longer limited by geography or any political ability to restrict them. The most important spatial dimension of this accelerating change so far has been the growth and proliferation of cities. We may define cities as settled communities large enough to generate a commercial and a service economy in addition to food production. Since cities began to form in some parts of the world over five thousand years ago, urban populations have grown faster than the overall world population. They reached 20% of the total a hundred years ago. In 2007 they passed the 50% threshold. At current rates they are expected to reach up to 70% by 2050 (Burdett and Sudjic 2010). Urban living has now become the dominant human experience— very different from the rural experience that had been dominant earlier. Smaller, rural communities change more slowly and innovate less. Hence the expanding social gulf between urban and rural communities today, especially in the poorer parts of the world. Not only is urban life more socially intensive than rural life, but cities are increasingly interconnected into a global urban network. The bigger the



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city, the more it functions as a node in an international network of cities. Urbanization is driving globalization, and no location anywhere in the world is any longer beyond the reach of urban institutions. People are flocking to cities, more so in the poorer parts of the world than the wealthier. Accelerating urbanization is causing the expansion of slums, where rural dependence on the local habitat is replaced with a much more complex dependence on expanding social networks. People in the fast-changing parts of one global city are interacting remotely with people in similar parts of other cities. Urbanism is beginning to depend less on spatial density and more on the intensity of interaction irrespective of location. As the possibility of connecting increases, urbanization is now fastest in the parts of the world that have been least interconnected in the past. At the same time, in the more closely interconnected parts of the world it is becoming unnecessary to live in a city in order to enjoy the advantages of full interconnectedness. Urbanism in terms of the intensity of virtual as well as face-to-face interaction is likely to become almost universal. This new level of mobility both into and between urban arenas in a world population of a new order of magnitude will allow us to transcend our current fragmentation into large numbers of independent, often competing, unevenly progressing communities, and merge into a single arena of physical and virtual interaction. How did the rate of change increase to this point? The literature on globalization, which has mushroomed since the mid-1990s, offers various arguments for starting dates, as recent as the World-Wide-Web (in 1993), and the Internet (the late 1960s), or the Berlin Conference (1884–1885), or as far back as the Age of Discovery (beginning in the 15th century) or even earlier. Any suggestion that it was not the result of a Western initiative is rare. Yet even if the origin was due to a Western initiative, why would that initiative have occurred when it did? And why should similar processes have occurred, especially in recent years, in other parts of the world at the time they did? Globalization is a process in which evolution merges with history. Evolutionary processes work through competition. The history of biological evolution is the history of competition within and between species. Each individual seeks advantage over its competitors. Natural selection favors those with the best options, whether in strength, agility, or nous. Is it surprising that eventually, after nearly 3.7 billion years of natural selection, one species should begin to achieve a significant degree of control over its habitat, and

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over other species, and eventually in the last ten thousand years come out on top as the globally dominant species? The factor that more than anything else has distinguished us from all other species, is the gradual but accelerating expansion of the arenas within which we interact with each other. For some fifteen thousand years, our species has been global, the first biological species to extend its distribution throughout the whole land surface of the world. Starting just over four thousand years ago we began to travel the open water surfaces as well. Just a hundred years ago we added the atmosphere. The first milestone in this process was the beginning of sedentarization, facilitated by climate change some ten to twelve thousand years ago, which led to a significant increase in fertility rates and population growth, making it worthwhile to increase food supply by domesticating plants and animals, and cultivating staple foods. Before then, in the course of routine activities we can assume that the average individual would have interacted routinely at most with fifty others, and been aware of perhaps a few hundred more. Since then, humans have generally intensified their relationship with their land, and clustered together in larger and larger numbers. Clustering is an increase not only in numbers but in density, and increasing density generates more frequent interaction among larger and larger numbers of individuals, and a general intensification of social life, making people more directly interdependent and less directly dependent (as individuals) on the resources of their local habitat. Since each individual has a different life experience, more interactions generate a larger and wider variety of impressions and associations, resulting in new ideas for each interactant. New ideas increase the rate of innovation. Gradually some communities in a few select locations, such as parts of Mesopotamia, Egypt and China, developed the socially more intensive quality of towns and cities, which facilitated economic specialization and a greater division of labor. Besides a significant increase in fertility rates, change from a mobile to a stationary daily routine led not only to a landmark change in social organization and the ability to collaborate and invest, but also a reduction in life expectancy due to increased contagion and disease. The next threshold of qualitative change was the ability to separate information from direct interaction, by means of writing. About five thousand years ago, economic transactions began to be recorded in a written form. In the course of the next millennium writing came to be used for



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remote communication and administration, enabling some cities to extend their areas of control. The age of empires had begun. But the association of writing with political power meant not only that anything important should be written and that anything written commanded respect, but also that those who could write had an interest in restricting the spread of literacy in order to maintain their social status. There was no reason for people without power to learn to read or write, while people who acquired power controlled the literate class and could become literate themselves if they wished. In the first millennium, when we passed through what Jaspers (1953) identified as the Axial Age from 800 to 200 BCE, religious texts (scriptures) began to be committed to writing, increasing yet more the value of the written text and skill of writing. Since then, all growth in interconnectedness, in the geographical expansion of direct cultural, political, and economic interaction, has been assisted by increasing sophistication in the technology of remote communication through writing, while literacy spread only slowly. It began to spread faster in the West in the later mediaeval period, and was accelerated by the Reformation in the 16th century, because Protestants wanted to read the Bible and printing had made copies easily available. It was accelerated again by the bureaucratization that came with the Industrial Revolution. After public education was introduced in the 19th century, writing was soon close to becoming universal. But then other means of remote communication emerged. First telegraph, then telephone, followed later by radio, television, and most recently the global Internet, facilitated by digitization, made fully global interaction possible with the result that writing is now taken for granted and has lost its special value. As these means of remote communication multiplied, gradually more and more local arenas of interaction have merged into much larger national, regional and more recently international arenas, and the level of awareness has risen in the general population. The rates of technological innovation and social change have accelerated, and philosophical and scientific activity have increased. The global arena of interaction, envisaged in our use of the term globalization, will bring with it increases in our philosophical, scientific, and technological capabilities that may be beyond our current imagination. There is also opposition to this process: case after case of people willing to fight rather than merge, defending the territorial exclusiveness of exist-

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ing identities, and opposing interaction across the borders between them. But this type of resistance has always lost out in the long term, allowing us to arrive at the current phase of globalization, which now appears unstoppable. With current levels of population and continued growth, we are caught between two alternative trajectories, each of which we can easily trace from the distant past through the present. Either we will come closer together socially, driven by increasing density on the ground, overflowing and transcending the national, ethnic, religious, and other boundaries we have inherited. Or we will actively resist that drive and reinforce the social exclusiveness of our existing cultural identities. The outlook for the first option is unpredictable, because it will create qualitatively new forms of social interaction and experience, with unprecedented opportunities and risks. The outlook for the second is also uncertain, but is likely to exacerbate the animosities, hostilities, and large-scale violent conflicts of the past generation, during which we have already seen complete breakdown of public order (as in the Balkans and central Africa). In the long term, therefore, barring any serious reduction of population that could result from an unforeseen catastrophe, the alternatives are either continuing progress towards globalization (our global species will become one global community) or reaction leading to fragmentation and eventual speciation. Currently it is possible to argue either way. We can envisage continuing globalization, but we are also experiencing the disadvantages of resistance to it in the form of violent conflicts on various scales that are motivated by efforts to hold on to the world as we know it, instead of allowing it to change. Other species, such as ants and cockroaches, have, like us, spread globally, but unlike us they did not develop the capability to travel, interact, and communicate over vast distances, but formed localized breeding communities, and because of long isolation and shorter generations have eventually speciated. The study of globalization is two separate (though complementary) subjects, which are often confused: first, the long process of global distribution and increasing social and geographical interconnectedness, which began over 60,000 years ago, and second, our recent perception that it is happening, our adoption of a globalization discourse, and the way our perception, and (perhaps imperfect) understanding of the process, feeds into our decision-making and adaptation to the changing world around us. This discourse is based on globalization as a positive paradigm. It embodies a general optimism about the future. But it has caused negative reactions.



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Opposition to it was spontaneous. Since it began to take off, every international meeting that might promote it, such as the WTO and the G20, is met with international protests. At the same time, there has been much more open conflict in the world since 1991 than in the previous forty-six years of the Cold War, and the globalization process itself is shadowed by a new problem, the emergence of international terrorism. All that is positive in globalization derives from the accelerating increase in interaction among more and more human minds. All that is negative derives from the unevenness of that same process, and the social boundaries that form in reaction to that unevenness. The future seems to be already here for some of us, within sight for others, but far away for many. Acceleration in the rate of change disrupts vested interests. It breaks the understandings and relationships that provide the order and stability we need. It creates winners and losers—the faster the change, the greater the gains and losses. The potential losers are desperate to maintain the status quo, to hold on to the conditions they know, to retrieve what is already lost, often idealizing what they remember. This reaction underlies most of the major problems of the modern world, which compete with globalization, because the progress of globalization is geographically uneven. Since sedentarization began some ten thousand years ago, rates of settlement growth and accompanying rates of social change have always been uneven. But the degree of social, economic and political unevenness between communities that we see in the world today is unprecedented. In the course of the 20th century a global sense of events percolated through to a larger and larger proportion of the public, from the wealthy to the poor and from the urban to the rural, from the North to the South, as people throughout the world were steadily integrated into expanding urban networks of communication, administration, and development. Gradually, anything beyond the essentially local came to be seen in a larger political and geographical framework. In countries where change began to accelerate later, following the withdrawal of imperial administrations, it has been faster and more disruptive, with the result that some struggle to hold on to the stability of the past, and react with violence against the influence of the future. This increasing interconnectedness has raised the level of social and political awareness. The rising awareness of disadvantage that has come with the current stage of accelerating globalization makes the present decade or so the crucial phase. The further some are left inadequately

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interconnected, the greater their effort to rebel against it and to hold on to the security and stability of the past as they remember it, before the rate of social change appeared to get out of control. The further some get ahead, the greater their eagerness to leave the past behind. The social boundaries that form between these two reactions create globalization’s most serious problem, solutions for which should be a major policy objective. Solving this problem would speed global integration and help us through the current crucial phase of the process. Preparing for a globalized world, therefore, is complex. On the one hand we need to work out how to understand the present without reducing it to models derived from the study of the past. On the other hand we need to study the past carefully in order to understand how we got to where we are today and what underlies the geographical unevenness of social change and interconnectedness in the present. We assume that if globalization is to have significant benefits, these benefits should be visible in our assessment of current trends, and in the direction of current trajectories of change. At the same time, however, the unevenness of globalization in the present is the source of the world’s most difficult problems today. Why are some parts of the world more globalized than others? The standard answer to this question in the literature is that globalization, like modernity in general, began in the West and Western activity is spreading it to the rest of the world. It is spreading unevenly because of the unevenness of Western interests. Although globalization may have become visible in the West before anywhere else, like earlier thresholds of change, such as sedentarization, domestication, urbanism, processes potentially leading eventually to globalization have taken off in a number of different communities in different parts of the world at different times, and are currently complementing what is driven from the West, and beginning to merge with it. Throughout world history, advances in technology have begun in different parts of the world at different times, and it is only since the 17th century at the earliest that the West can claim to have been ahead. Why should that continue? Conditions that led to the recent Western advance may emerge elsewhere. If population growth is the independent variable, and population growth rates are now declining in the West, should we not look carefully at Africa, China and India? If globalization fulfills its promise, before very long from now, still little more than fifteen thousand years since we became a global species, we shall



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have added a social first to the biological first: besides being globally distributed we shall be globally interconnected, one global arena of interaction, one community. It gives us a new perspective on the past as well as the future, on our habitat as well as our political economy, and on the natural as well as the supernatural. The change we are experiencing under globalization is in every dimension of daily life. Much of this volume supports and corroborates earlier work on globalization. We are, however, painting a different picture, because globalization is moving fast, and we are responding to its current stage. Our response derives from a broader disciplinary and professional base than is represented elsewhere. For this reason, because of the accelerating speed with which the situation continues to change, much of what we have to say about the indices, causes and consequences of globalization is new, either in substance or in balance, with different implications for future research and policy. This book presents our current relationship to the past and to the future, and provides data that shows why we are not all at the same stage of progress towards globalization. Despite a general tendency to resist change where the likely outcome is uncertain, the whole of human history can be seen in terms of creeping globalization. Since the stakes are higher now than at any time in the past, resistance in the form of organized violence is greater than ever. So far, however, globalization is continuing, producing one world, one dominant species, one unitary but diverse arena of shared social and intellectual activity, one community. The current volume brings together twenty-four authors from a wide range of disciplines and professions to focus collaboratively on the way the world is changing in the present. This introductory chapter provides the historical context—not modern-historical, but “big-historical”: how we as a species arrived at the current unprecedented rate of change in world-historical terms, and the implications for the future. The following fourteen chapters introduce a selection of approaches from the full range of the modern academic research repertoire and curriculum: social, medical, molecular, and physical anthropology, education, engineering, law, medicine, nursing, political science, sociology, urban studies, and veterinary medicine. Each presents a particular disciplinary or professional response to the research and policy challenges that globalization is presenting. Some chapters report on current or recent work. Each conveys the message that the challenges will be greatest in the coming years because these will be the years of fastest

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change. They are divided into three groups, each organized around a different general question: (i) what is our current social situation and how we did get there? (ii) how is our relationship with our habitat changing and how are we managing the change? and (iii) what can we do to accelerate the evening out of different rates of progress in different arenas? In the first part, headed Assessment, chapters two through five deal not only with the changing scale of social, economic and financial diversity of the world at the beginning of the 21st century, but also the underlying genetic diversity. They explain the current state of unevenness on each of these globalization trajectories. Richard J. Estes from Penn’s School of Social Policy and Practice begins in chapter two with a quantitative social baseline, a comprehensive global summary of recent progress, using an elaborate social indicators approach, which allows some cautious optimism. He documents the unevenness between communities, especially for the socially least developed countries (SLDCs), the countries that are least advanced on the trajectory of globalizing change. He finds that conditions generally over the past fifty years have been improving for most poor people. In particular global awareness has been spreading and rising. Conditions for the most disadvantaged are improving, because they are no longer isolated. They are slowly like the rest of the world beginning to benefit from increased interaction, and the rising awareness that comes with it. Following this social foundation, chapter three introduces the biological dimension of globalization, the relationship between our increasing mobility at the global level and our changing patterns of biological diversity. Theodore Schurr, a molecular anthropologist from Penn’s Department of Anthropology, reconstructs the genetic history of the global distribution of our species, and discusses its significance. Most interestingly he draws attention to the number of different layers of genetic history in the landmass with the longest human history, Africa-Eurasia, which reflect the continual interaction of populations, helping us to understand how Homo sapiens has remained a single species. This chapter also illustrates the significance of difference in time scales for a comprehensive understanding of the globalization process, since genetic processes move at the relatively constant speed of generations, compared with the highly variable and currently increasing speeds of other dimensions of change. In chapter four, Mauro Guillén from Penn’s Wharton School and Sandra L. Suárez from the Department of Political Science at Temple University



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explain the expansion of finance under globalization. They go into detail about why in 2012 we are observing the third act of the crisis that began in 2007, two decades after the vision of global financial opportunities that began with the Big Bang in London in 1986. As the financial arena grew, new opportunities of scale encouraged unprecedented rates of innovation, which resulted in debt increasing beyond the limits of political responsibility. Money has become the primary index of increasing global interconnectedness. But so long as it remains ahead, during the current period of accelerated change, it increases our exposure to the problems of increasing volatility. The last chapter of Part One, chapter five, by Cameron Hu, a recent graduate of Penn’s Department of Near Eastern Languages and Civilizations, shifts our attention to the problem of material design in Dubai—the city without history, that without globalization could not have come to be. It has grown under a regime that distinguishes it from other global cities: while its economics are capitalist, its politics are more difficult to analyze. Part Two deals with problems of habitat. Leaving aside the vast literature that has accumulated in recent decades on deforestation, soil erosion, ozone depletion, and more recently global warming, these chapters look at the way globalization is changing our relationship with our habitat in terms of diet and health. We cannot manage the environment in coming generations without a much better understanding than we currently have about what we are going to require from it, and what are our capabilities for accommodating the way it will continue to change. If we can manage society effectively, we may be able to manage our pressure on our habitat. The most crucial component of our relationship with our global habitat on a daily basis is our choice of food and how we produce, process and prepare it. Janet Monge from Penn’s Anthropology Department and the Penn Museum begins in chapter six by providing an evolutionary perspective on our current problems of under- and over-nutrition on a global level, as illustrated in the escalating statistics for both malnutrition and obesity. In chapter seven, David Galligan and his colleagues at Penn’s School of Veterinary Medicine are concerned with the implications of current trends in the global food market as they relate to meat production. Following on the heels of the demographic transition, we are now passing through the dietary transition: as more and more people move into cities throughout the world and become more affluent, the demand for meat rises at exactly

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the same time as the amount of agriculturally productive land is decreasing. Satisfying the increasing demand for meat increases not only energy demands but also problems of waste disposal and pollution. Rapid urbanization in developing countries is shifting livestock production from traditionally small rural farms to large commercial enterprises that are frequently located in peri-urban areas. Galligan and his team are working on the technologies that will provide more efficient ways to cope with these changes. In chapter eight, Nancy Biller and Neal Nathanson from the Global Health Program in Penn’s School of Medicine set the current global health situation in its world-historical context, with special attention to the way today’s changing economic and cultural factors play into life expectancy, especially in the developing world. They argue that under globalization, it becomes increasingly clear that medicine cannot operate in isolation from the other academic specializations. The next chapter, nine, deals with oral health, which until recently was understood only as dentistry, with very different implications for its significance. Robert J. Collins from Penn’s School of Dental Medicine raises oral health as a medical specialization to the level of full global partnership with general global health. It is interesting that this is a process which has been led by the United Nations as part of the general breaking down of boundaries and re-evaluation of priorities that has come with the growing awareness of globalization. In chapter ten, Marjorie Muecke from Penn’s School of Nursing introduces us to the growing recognition of the deterioration in conditions for women under global urbanization. Gender relations have been the core organizational factor of all societies historically. Globalization and urbanization are disrupting them. In the long run this disruption provides historic opportunities for renegotiation, but during the current period of accelerated change it often puts women at a disadvantage. Most interestingly, Muecke draws our attention to the significance of women’s roles in what she calls the production of health. Finally in this section, in chapter eleven, Adriana Petryna, a medical anthropologist from Penn’s Department of Anthropology, introduces the problems that have emerged in the growth of our efforts to control and cure disease with drugs. Drugs have to be tested before they can be distributed. Finding a clientele that is ready to be exposed to testing and meets the criteria for a valid testing process is in itself difficult, but it also raises new moral problems that are even more difficult to resolve in a global market.



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Part Three turns to action, to a selection of efforts currently in progress designed to put the work of the academy into practice. The last four chapters (12–15) report on projects designed to break down the boundaries that impede the evening out of the globalization process. Chapter twelve sets the scene from the point of view of legal training in the global redistribution of human activity. Law may be the most challenging component of globalization. How can we manage affairs in a global arena of interaction without a global legal system. Progress in the internationalization of legal practice has been slow, and fraught with disagreement, much of which is ideological more than cultural. Mobility and migration continue to increase the native understandings of each individual’s rights. Obligations to others, on which the social order of the past has depended, apply less and less. We need to turn more and more to law. Until now our legal systems have dealt with all such problems nationally. As globalization progresses, legal resolution for problems between people from different national backgrounds is in increasing demand. Sarah Paoletti from Penn’s Law School shows how professional training is keeping up with demand and the way it is changing. First, she addresses the impact of globalization on lawyering, and the ways in which the legal academy has begun to respond to the changes in legal practice necessitated by globalization. She then sets forth the underlying rationale for developing bi-national and transnational clinical collaborations, the logical outgrowth of the rise in international human rights clinical programs, both in the United States and across the globe. In the second section she outlines potential models for such collaborations, drawing on experiences from the human rights and migrant rights movements, as well as the Transnational Legal Clinic which she conducts at the University of Pennsylvania, which operates simultaneously at the local level within the immigrant rich city of Philadelphia, as well as engaging in national and international dialogues on policies and practices related to immigrant and migrant populations. The chapter concludes with an exploration of opportunities for expanding beyond law schools into other disciplines within the academy and proposes the development of multi-disciplinary collaborations that cross borders and cultures aimed at achieving the realization of human rights for all. Global cities such as Philadelphia provide rich and diverse opportunities for examining and developing theories of global cosmopolitanism. Academic institutions situated in global cities should take full advantage of those opportunities: in developing truly collaborative interdis-

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ciplinary and transnational partnerships, we can work to bridge theory and practice in exciting and transformative ways. In chapter thirteen, Huiquan Zhou from Penn’s School of Social Policy and Practice introduces the problems of human commoditization and forced movement that have been increasing under globalization. She finds that in the U.S., where the efforts to prevent this type of injustice are probably among the most advanced, many of the inadequacies of the system tend to result primarily from institutional lag. In chapter fourteen, Alan Ruby from Penn’s Graduate School of Education tells us what we know and what we still need to know about the way globalization is changing education, and how education is responding both to the new problems and to the new opportunities. Education is steeped in the past, perhaps even more than our other primary institutions. Partly for this reason it is currently in crisis, unable to cope, drawn in unproductive directions by vested interests, confused by teachers trained in different social conditions, and the curriculum is drawn from the past instead of designed for the future. The global movement of students is a major engine of future globalization, but the engine needs to be oiled by institutional development. Finally, in chapter fifteen, Joseph Sun and his colleagues from Penn’s School of Engineering and Applied Science cater to the rising demand among young people for practice. They promote service learning in developing countries. Writing from experiences in both long-term community development in Sudan, Chad, Mali, and Honduras and short term projects in Cameroon, China, India, Ghana, and Honduras, they describe a program which is mutually beneficial: providing holistic learning experience for visiting students and progress in sustainable development for the host community. This program is a realization of the University of Pennsylvania’s core academic mission, the Penn Compact, rather than simply an extra-curricular appendage. The program focuses on three areas: community technology centers, water and sanitation projects, and clinical prosthetics and orthotics. It opens up the curriculum to globalization in practical terms. Globalization involves recontextualisation. Each of these chapters and the enterprise they represent means more when brought together with the others within the framework offered in this introductory chapter. The level of detailed analysis would not be possible without disciplinary and professional specialization. But the level of significance is greatly enhanced by



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the larger perspective offered by bringing all these different disciplinary and professional perspectives together in one volume. This is an optimistic book. But the optimism is qualified. It presents globalization as the final evening out of all the social differences that have arisen over the past 15,000 years of Homo sapiens as a global species, without losing the cultural differentiation that contributes to optimum human achievement. However, it focuses on the seriousness of the problems of the current crucial phase of this process, in which the differences are most clearly juxtaposed and opposed, awareness of them is at its highest ever, and resentment and impatience is greatest. The following chapters are an introduction to some of the most important research and policy initiatives needed to deal with this situation, providing not only variety of scientific perspectives but also a considered balance of pessimism and optimism.

REFERENCES Burdett R., and S. Deyan, eds. 2010. The Endless City. London: Phaidon. Castells, M. 2004. The Information Age. Oxford: Blackwell. Christian, D. 2005. Maps of Time: An Introduction to Big History. Berkeley, CA: University of California Press. Elias, N. 1982. The Civilizing Process. Oxford: Blackwell. Gibson, W. 1993. Fresh Air. National Public Radio, August 31, 1993. Jaspers, K. 1953. The Origin and Goal of History. translated by Michael Bullock. New Haven, CT: Yale University Press. Wouters, C. 2007. Informalization: Manners and Emotions since 1890. London: Sage. NOTES 1.1 cf. Oxford English Dictionary.

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2 Development Trends Among the World’s Socially Least Developed Countries (SLDCs): Reasons for Guarded Optimism Richard J. Estes

INTRODUCTION

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ollowing decades of steady social decline many of the world’s socially least developed countries (hereafter SLDCs) are beginning to show evidence of significant progress in meeting at least the basic material and social needs of their growing populations (AfDB 2011, 2013; Collier 2007; ESCAP 2012; UNDP 2011; UNICEF 2012).1 This progress occurred during a period of a worldwide economic recession (2007–2009) and, hence, at a time when most development specialists expected that the social, political, and economic conditions of the SLDCs would worsen rather than improve. This expectation was well-founded given the decades-long declines in development that took place in the majority of SLDCs following the restoration of their independence during the 1960s and 1970s from economically advanced European colonizers (Wikipedia 2013a). Recurrent wars (SIPRI 2013), major violations of human rights and press freedoms (Amnesty International 2012; Freedom House 2012), prolonged natural disasters (IFRC 2013), large disparities in wealth (WB 2012, 2013a, 2013b), an inability to fully exploit their own natural and human resources (WB 2012, 2013c), the near absence of viable civil society organizations (Anheier, Toepler, and List 2010), and widespread corruption on the part of public officials and

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business leaders (Transparency International 2012) contributed to a bleak development prognosis for the SLDCs. Such a prognosis would have held were it not for the timely launching in 2005 of the United Nations’ Millennium Development Campaign (hereafter MDC) which targeted the world’s socially least developed countries for preferential financial aid and technical assistance (UN 2012a, 2012b). This chapter explores the extent to which the world’s SLDCs are beginning to advance their development objectives, especially those associated with the implementation of the MDC and its eight Millennium Development Goals (hereafter MDGs).2 More particularly, the chapter reports the results of a comprehensive survey of the development successes and failures of the world’s 41 SLDCs over the 40-year year period 1970 to 2011. Thus, the chapter: (1) reports the results obtained through application of the author’s previously developed Weighted Index of Social Progress (WISP) to an analysis of worldwide social development trends for the 40-year period 1970–2011; (2) identifies the world’s major development successes and failures, especially those that occurred between 2000 and 2011; (3) explores the nature, extent and severity of the continuing development dilemmas that confront the world’s SLDCs; (4) identifies the sectors within which the greatest SLDC successes and failures are occurring; (5) seeks to explain the sources of the sometimes dramatic changes in SLDC development since the launching of the MDC; and, (6) contains baseline data against which future changes in development for the SLDC can be assessed.

METHODOLOGY The present study is one in a series of analyses of worldwide and regional social development trends (Estes 1988, 1995, 1996, 2004, 2007, 2010, 2012a, 2012b, 2014; Estes and Tiliouine 2014; Estes and Sirgy 2014). The purpose of these studies has been: (1) to identify significant changes in the “adequacy of social provision”3 occurring throughout the world and within specific continental and geo-political regions; and (2) to assess national progress in providing more adequately for the basic social and material needs of the world’s growing population. These reports also are intended to provide policy analysts and development scholars with otherwise difficult to obtain data concerning a wide range of phenomena needed to help accelerate the

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pace of national and international development. This chapter reports a time-series analysis of the social development performances of 160 nations over the 40-year time period 1970–2011. Particular attention is given in the chapter to the recent development performances of the world’s 41 SLDCs at four levels of analysis: (1) at the country-specific level4; (2) at the subregional and (3) regional levels; and (4) at the level of the world-as-a-whole. Data also are reported for countries organized by the United Nations four major socio-economic development level groupings5.

Index of Social Progress (ISP) The primary instrument used in this study is the author’s extensively pre-tested “Index of Social Progress” (Table 2.1). In its present form the ISP consists of 41 social indicators that have been subdivided into 10 subindexes: Education (N=4); Health Status (N=7); Women Status (N=5); Defense Effort (N=1); Economic (N=5); Demographic (N=3); Environmental (N=3); Social Chaos (N=5); Cultural Diversity (N=3); and Welfare Effort (N=5).6 All 41 of the ISP’s indicators have been established to be valid indicators of social development and are used regularly by other policy-focused development scholars (UNDP 2011; WB 2012a, 2012c). Weighted Index of Social Progress (WISP) Owing to the volume of data gathered for the analysis only statistically weighted index (WISP) and subindex (SI) scores are reported in this chapter. The study’s statistical weights were derived through a two-stage principal components and varimax factor analysis in which indicator and subindex scores were analyzed separately for their relative contribution toward explaining the variance associated with changes in social progress over time. Standardized indicator scores (N=41) were multiplied by their respective factor loadings, averaged within their subindex, and the average subindex scores (N=10), in turn, were subjected to a second statistical weighting. The resulting values from this two-stage statistical weighting process formed the basis for computing the composite Weighted Index of Social Progress (WISP) scores as summarized in Table 2.2.7 Statistically unweighted Index of Social Progress (ISP) scores are reported on the author’s previously identified project website for those investigators who may wish to reanalyze the data using their own system of statistical weights.

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Table 2.1 Indicators on the Weighted Index of Social Progress (WISP) by Subindex, 2010 (41 Indicators and 10 Subindexes) Source: Estes (2013a) Subindex Indicators EDUCATION SUBINDEX (N=4) Public Expenditure on Education as Percentage of GDP, 2008-09 (+) Primary School Completion Rate, 2008-09 (+) Secondary School Net Enrolment Rate, 2008-09 (+) Adult Literacy Rate, 2008 (+) HEALTH STATUS SUBINDEX (N=6) Life Expectation at Birth, 2008 (+) Infant Mortality Rate, 2008-09 (-) Under-Five Child Mortality Rate, 2008 (-) Physicians Per 100,000 Population, 2005-08 (+) Percent of Population Undernourished, 2006-08 (-) Public Expenditure on Health as Percentage of Gross Domestic Product, 2008-09 (+) WOMEN STATUS SUBINDEX (N=5) Female Adult Literacy As Percentage of Male Literacy, 2009 (+) Contraceptive Prevalence Use Among Married Women, 2008 (+) Life Time Risk of Maternal Death, 2005 (+) Female Secondary School Enrollment As Percentage of Male Enrolment, 2008 (+) Seats in Parliament Held By Women as Percentage of Total, 2010 (+) DEFENSE EFFORT SUBINDEX (N=1) Military Expenditures As Percentage of GDP, 2009 (-) ECONOMIC SUBINDEX (N=5) Per Capita Gross Domestic Product (as measured by PPP), 2009 (+) Percent Growth in Gross Domestic Product (GDP), 2009 (+) Unemployment Rate, 2006-08 (-) Total External Debt As Percentage of GNI, 2009 (-) GINI Index Score, most recent year 2005-09 (-)

Development Trends Among the World’s Socially Least Developed Countries

Subindex Indicators DEMOGRAPHY SUBINDEX (N=3) Average Annual Rate of Population Growth, 2009 (-) Percent of Population Aged 64 Years, 2009 (+) ENVIRONMENTAL SUBINDEX (N=3) Percentage of Nationally Protected Area, 2004-08 (+) Average Annual Number of Disaster-Related Deaths, 2000-09 (-) Per Capita Metric Tons of Carbon Dioxide Emissions, 2007 (-) SOCIAL CHAOS SUBINDEX (N=6) Strength of Political Rights, 2010 (-) Strength of Civil Liberties, 2010 (-) Number of Internally Displaced Persons Per 100,000 Population, 2009 (-) Number of Externally Displaced Persons Per 100,000 Population, 2009 (-) Estimated Number of Deaths From Armed Conflicts (low estimate), 2006-07 (-) Perceived Corruption Index, 2009 (+) CULTURAL DIVERSITY SUBINDEX (N=3) Largest Percentage of Population Sharing the Same or Similar Racial/Ethnic Origins, 2009 (+) Largest Percentage of Population Sharing the Same or Similar Religious Beliefs, 2009 (+) Largest Share of Population Sharing the Same Mother Tongue, 2009 (+) WELFARE EFFORT SUBINDEX (N=5) Age First National Law—Old Age, Invalidity & Death, 2010 (+) Age First National Law—Sickness & Maternity, 2010 (+) Age First National Law—Work Injury, 2010 (+) Age First National Law—Unemployment, 2010 (+) Age First National Law—Family Allowance, 2010 (+)

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Table 2.2 Statistical Weights Used in Constructing the Weighted Index of Social Progress Source: Estes (2013a).1 WISP2009 = { [(Factor 1) .697)] + [(Factor 2) .162)] + [(Factor 3) .140] } where: Factor 1 = [ (Health .92) + (Education .91) + (Welfare .72) + (Woman .91) + (Social Chaos .84) + (Economic .71) + (Diversity .64) + (Demographic .93) ] Factor 2 = [ (Defense Effort .93) ] Factor 3 = [ (Environmental .98) ] 1

For purposes of comparability across time, the same statistical weights were used in all

five of the study’s time periods.

Data Sources The majority of the data used in the analysis were obtained from the annual reports supplied by individual countries to specialized agencies of the United Nations (UN), the United Nations Development Programme (UNDP 2010, 2011), the World Bank (WB 2013a, 2013b), the Organization for Economic Cooperation and Development (OECD 2012a–d), the International Social Security Association (ISSA 2013), the International Labour Organization (ILO 2012a, 2012b), the International Monetary Fund (IMF 2012a, 2012b, 2013a, 2013b) and other major international data collection and reporting organizations. Data for the Environmental subindex were obtained from the World Resources Institute (WRI 2013) and the United Nations Commission on Sustainable Development (UNCSD 2013). Data for the Social Chaos subindex were obtained from Amnesty International (AI 2012), Freedom House (FH 2012), the International Federation of Red Cross and Red Crescent Societies (IFRC 2013), the Stockholm International Peace and Research Institute (SIPRI 2013) and Transparency International8 (TI 2012). Data for the Cultural Diversity subindex were gathered from the CIA World Factbook (CIA 2013) and from the work of independent scholars in the fields of comparative language, religion and ethnology (Ellingsen 2000). Data sources for the individual demographic, eco-

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nomic, and political indicators reported in chapter’s tables are identified in those tables.

Country Selection The 160 countries selected for inclusion in the study’s larger analysis, including the 41 SLDCs discussed in this chapter, satisfied at least three of the following criteria: (1) a population size approaching at least one million persons in 2010; (2) a reasonable degree of political stability such that timely and reliable data collection was possible; (3) the availability of comprehensive social indicator data; and (4) the country’s inclusion in the author’s earlier studies of national and world development. Countries with missing, inadequate, incomplete, or distorted data on three or more indicators were excluded from the analysis. Table 2.3 identifies the 162 countries included in the present analysis, including the study’s 41 SLDCs (indicated by bold italics). The table organizes these countries by continental and subcontinental groupings and, then, next to each country, is an acronym indicating to which of the study’s four developmental groupings to which the country is assigned by the United Nations, i.e., Developed Market Economies (DMEs, N=34), Commonwealth of Independent States (CISs, N=21), Developing Countries (DCs, N=66) or Least Developed Countries (LDCs, N=41). Levels of Analysis Throughout the chapter data are reported at four levels of analysis: (1) development trends occurring for the world-as-a-whole (N=1); (2) development trends occurring at the at the continental (N=6) and sub-continental levels (N=19); (3) development trends occurring by socioeconomic development grouping (i.e., DMEs, CIS, DCs, LDCs) (N=4); and, (4) development trends occurring within each of the 162 countries, including the 41 SLDCs. These levels of analysis are embedded in each of the chapter’s figures and tables. Time Frame Index and subindex findings are reported separately for each of the study’s five time periods, i.e., 1970, 1980, 1990, 2000, and 2011. This analysis, then, reports a cross-sectional analysis of the “state” of social development for the same set of countries over a 40-year time period.

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Table 2.3 Average WISP Scores by Development Groupings, 1970–2011 (N=160)

AFRICA (N=50) East Africa (N=1 5) Burundi (LDC) Comoros (LDC) Djibouti (LDC) Eritrea (LDC) Ethiopia (LDC) Kenya (DC) Madagascar (LDC) Malawi (LDC) Mauritius (DC) Mozambique (LDC) Rwanda (LDC) Somalia (LDC) Tanzania (LDC) Uganda (LDC) Zambia (LDC)

ASIA(N=45) East Asia (N=7) China (DC) Hong Kong SAR (DME) Japan (DME) Korea, North (DC) Korea, South (DME) Mongolia (DC) Taiwan (DME)

South Central Asia (N=1 3) Afghanistan (LDC) Bangladesh (LDC) Bhutan (LDC) India (DC) Iran (DC) Kazakhstan (CIS) Kyrgyzstan (CIS) Middle Africa (N=7) Nepal (LDC) Pakistan (DC) Angola (LDC) Sri Lanka (DC) Cameroon (DC) Tajikistan (CIS) Central African Rep (LDC) Turkmenistan (CIS) Chad (LDC) Uzbekistan (CIS) Congo, Rep (DC) Congo, Dem Rep (LDC) South East Asia (N=9) Gabon (DC) Cambodia (LDC) North Africa (N=6) Indonesia (DC) Lao.PDR(LDC) Algeria (DC) Malaysia (DC) Egypt, UAR (DC) Myanmar(LDC) Libya (DC) Philippines (DC) Morocco (DC) Sudan (LDC) Singapore (DME) Thailand (DC) Tunisia (DC) Viet Nam (DC) Southern Africa (N=6) West Asia (N=1 6) Botswana (DC) Lesotho (LDC) Armenia (CIS) Azerbaijan (CIS) Namibia (DC) Bahrain (DC) South Africa (DC) Cyprus (DC) Swaziland (DC) Georgia (CIS) Zimbabwe (DC) Iraq (DC) WestAfrica(N=16) Israel (DME) Jordan (DC) Benin (LDC) Kuwait (DC) Burkina-Faso(LDC) Lebanon (DC) Cape Verde (LDC) Oman (DC) Cote d'lvoire (DC) Qatar (DC) Gambia (LDC) Saudi Arabia (DC) Ghana (DC) Guinea-Bissau (LDC) Syria (DC) Turkey (DME) Guinea (LDC) Yemen (LDC) Liberia (LDC) Mali (LDC) Mauritania (LDC) Nigeria (DC) Niger (LDC) Senegal (LDC) Sierra Leone (LDC) Togo (LDC)

LATIN AMERICA (N=26) Caribbean (N=7) Bahamas (DC) Belize (DC) Cuba (DC) Dominican Republic (DC) Haiti (LDC) Jamaica (DC) Trinidad STobago (DC) Central America (N=7) Costa Rica (DC) El Salvador (DC) Guatemala (DC) Honduras (DC) Mexico (DME) Nicaragua (DC) Panama (DC) South America (N=1 2) Argentina (DC) Bolivia (DC) Brazil (DC) Chile (DC) Colombia (DC) Ecuador (DC) Guyana (DC) Paraguay (DC) Peru (DC) Suriname (DC) Uruguay (DC) Venezuela (DC)

NORTH AMERICA (N=2) Canada (DME) United States (DME)

OCEANIA (N=4) Australia-New Zealand (N=2) Australia (DME) New Zealand (DME) Melanesia (N=2) Fiji (DC) Papua-New Guinea (DC)

EUROPE (N=35) East Europe (N-10) Belarus (CIS) Bulgaria (CIS) Czech Republic (DME) Hungary (DME) Moldova (CIS) Poland (DME) Romania (CIS) Russian Federation (CIS) Slovak Republic (DME) Ukraine (CIS) North Europe (N=10) Denmark (DME) Estonia (CIS) Finland (DME) Iceland (DME) Ireland (DME) Latvia (CIS) Lithuania (CIS) Norway (DME) Sweden (DME) United Kingdom (DME) South Europe (N=8) Albania (CIS) Croatia (CIS) Greece (DME) Italy (DME) Macedonia, TFYR (CIS) Portugal (DME) Slovenia (CIS) Spain (DME) West Europe (N=7) Austria (DME) Belgium (DME) France (DME) Germany (DME) Luxembourg (DME) Netherlands (DME) Switzerland (DME)

LEGEND DME: Developed Market Economy (N= 34) CIS: Commonwealth of Independent States (N=21) DC: Developing Countries (N=66) LDC: Least Developed Countries (N=41)

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PART I: WORLD SOCIAL DEVELOPMENT TRENDS Figures 2.1 and 2.2 summarize the study’s major WISP findings for all 162 countries included in the analysis. These data cover the 40-year time period 1970 to 2011 and reflect comparative WISP performances for six continental groupings, i.e., North America (N=2), Australia-New Zealand (N=2), Europe (N=35), Latin America (N=26), Asia (N=45), and Africa (N=50). The WISP scores for these regions averaged 43.6, 43.4, 48.1, 48.5, and 48.7 for 1970, 1980, 1990, 2000, and 2011, respectively.

The Developed Market Economies (DMEs) The world’s most socially developed regions are the 39 economically advanced countries of Australia-New Zealand (N=2), Europe (N=35), and North America (N=2). Referred to collectively as Developed Market Economies (DMEs), these countries had already attained the most favorable scores on the WISP by 1970 and continued to add to them for the next 30 years (Beck, 1998; Estes, 2004). Some improvements continued to accrue for selected DMEs between 2000 and 2011 but, as a group, the DMEs experienced net losses on the WISP averaging -28.2 percent between 2000–2011. These losses are closely associated with: (a) the near-collapse of global financial markets that originated in North America in 2007 (OECD 2014); (b) the actual collapse in 2008 of both a major global investment bank (Lehman Brothers) and a major securities trading firm specializing in subprime mort-

2.1 Average WISP Scores by Continent, 1970–2011 (N=160)

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2.2 Percent Change in Average WISP Scores by Continent, 1970–2011 (N=160)

gages (Bear Stearns); (c) the bursting of the real estate bubbles in North America and Europe; (d) substantial downward pressures on the Euro (€) as the common unit of currency among the 17-member “Eurozone” (Cline and Wolff 2012; Editors 2013; Lapavitsas 2012) and, (e) the imposition by conservative governments in all three DME subregions of regressive policies that undermined the relatively secure social “safety nets” that previously existed in the majority of these countries (UN 2011; USSSA 2012). Despite the high levels of social and economic turbulence that occurred in the DMEs after 2000, and despite their net WISP losses between 2000 and 2011, comparatively small differences currently characterize their development profiles. Indeed, these countries remain far more alike on almost every dimension than different—owing in large measure to the predominately European origins of the countries of North America and AustraliaNew Zealand. Today, and has been the case since the 19 century, the current group of DME countries remain the world’s most socially advanced nations (WB 2013a). This has been the case despite the ebbs and flows that occurred with regard to the changes that took place in socioeconomic patterns within the European DMEs before and after WWI and WWII. Consequently, the historical combined performances of the DMEs on the WISP are in stark contrast to the asymmetrical development patterns reported for other world regions in Figures 2.1 and 2.2.

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Africa The remarkable average WISP gains reported in Figures 2.1 and 2.2 for Africa’s 50 nations between 2000 and 2011 (+114.9 percent), in the main, are accounted for by the continent’s recent ability to exploit to its own advantage the abundant natural resources located in its Northern (primarily oil) and Southern regions (mostly gold, diamonds, and other precious minerals). The region’s countries also are benefitting from large foreign remittances they receive from overseas workers (Anyanwu 2011), from the debt forgiveness program initiated by the International Monetary Fund (IMF 2012a, 2013a), and from increased levels of international development assistance directed to Africa on a preferential basis through the MDC (EU 2013; OECD 2012c; UNDP 2012a, 2012b). Unlike during earlier development decades (Leonard and Straus 2003; Moyo 2009), today, many of Africa’s resource-rich countries are benefiting from the substantial amounts of foreign direct investment that are being made in the continent’s mining, manufacturing, construction, and transportation sectors (AfDB 2013; Ernst and Young 2012). The restoration of peace to large areas of Central and Middle Africa also is contributing to the region’s rapid development—a goal that eluded both the region’s and the world’s political leaders since the restoration of political sovereignty from colonial rule during the middle of the 20th century (CIA 2013). Peace in these countries has made political stability possible and, with this critical advancement, increasing levels of economic and social prosperity (AfDB 2013). This author is especially impressed with the increasing levels of foreign direct investment flowing into many Central African states (Ernst and Young 2012) and well as with the steady rises in the international trade of both primary and partially processed natural resources. Many of these countries also are beginning to experience the return home of educated and highly skilled members of their diaspora living abroad. Peace also has made possible the ability of many African nations to focus on the development of at least rudimentary social safety nets designed to protect economically vulnerable populations from financial exploitation. Central to Africa’s recent development accomplishments has been the implementation of the MDGs and other forms of consistent support from major international development assistance organizations. Unparalleled in its focus and reach, the MDC, with its laser-like focus on deeply impoverished nations located in all regions of the world, has targeted Africa’s poor-

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est and least developed countries for preferential development assistance (UN 2012a, 2012b). Unlike earlier initiatives, the MDC has succeeded in: (a) strengthening the region’s health, education, transportation, and communications infrastructure; (b) fostering the emergence of new intra-regional and international trade partnerships; (c) reducing recurrent inter-ethnic and tribal conflicts; (d) promoting more positive relationships between neighboring countries; and (e) making more transparent the uses to which the large amounts of development assistance being directed to Africa are put. The MDC also has created a working political space that has contributed to the emergence of a wide range of civil society organizations (Anheier, Toepler, and List 2010; UN 2012a, 2012b; TI 2012). Though still in a transition period, many of the region’s governments are beginning to develop secure frameworks for advancing and protecting the basic human rights and press freedoms (AI 2012; FH 2012). Advances in these sectors have been very difficult and many thousands of people died in the course of achieving human rights protections for the country-at-large. Though still fragile, and certainly reversible, these fundamental social gains reported for the African region since 2000 are impressive and, most importantly, they are continuing (AfDB 2013; UNDP 2011).9

Latin America and the Caribbean The absence of significant social development gains for the Latin American and Caribbean region between 2000 and 2011 remains perplexing given the region’s rich natural resources, well developed transportation and communications infrastructure and, in many countries, moderate to high levels of human capital (ECLAC 2012; UNDP 2011; WB 2013a). The reasons that account for the comparatively slow pace of development throughout the region include: (1) a legacy of civil unrest, political instability, and public corruption, which continues to characterize many of the region’s countries (FH 2012; TI 2012); (2) though declining, still high population growth rates (UNPOP 2013); (3) significant gender inequalities (UN-Women 2011); and, (4) the high income disparities that exist between the region’s poor and rich (WB 2013b). On the positive side of development accomplishments, rates of infant and child mortality have declined appreciably throughout Latin America and the Caribbean as have the number of women dying during child birth. Gains in all three of these areas reflect the region’s successes in strengthen-

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ing its medical infrastructure and in making preventive health services more accessible (WHO 2012). Years of average life expectancy have also increased throughout the region and have now reached 74 years, and average increase of 45 years since 1900! Additionally, several of the region’s countries are expected to experience substantial level of economic growth over the near-term: Bolivia, Colombia, Costa Rica, Chile, the Dominican Republic, Ecuador, Mexico, Uruguay, and Venezuela. Panama and Peru are expected to be the top growth performers in the region in 2012, with Asia-like growth rates of 8 and 6 percent respectively (WB 2012). These high rates of economic growth are occurring in an environment of comparatively low unemployment and increasing internal consumption of the region’s varied goods and services. These important economic accomplishments suggest a more optimistic future for the region’s population of 572 million people, especially as Latin American governments promote a more equitable distribution of its expanding fiscal and human resource base. And, in 2012, seven Latin American countries ranked the highest in a Gallup poll of 184 countries with respect to their experiencing the “highest positive emotions” (Clifton 2012)—Panama (No. 1), Paraguay (No. 2), El Salvador (No. 3), Venezuela (No. 4), Guatemala (No. 7), Ecuador (No. 9) and Costa Rica (No. 10). These favorable self-assessments of personal and collective well-being exist among the citizens of other Latin American countries as well despite the lingering, seemingly formidable, challenges that have interfered with past development efforts (ECLAC 2012; Estes 1996).

Asia Considerable 40-year variations also characterize social development patterns in the Asian region. These patterns are most pronounced in China, India, and Indonesia which are home to 2,797 million people or, approximately, 40 percent of the world’s total population. Approximately 65 percent of the world’s absolute poor, including those surviving under the most desperate living conditions, reside in Asia (WB 2013b). The poverty situation is particularly extreme in India, Bangladesh, and in the newly independent successor states of the former Soviet Union of South Central Asia. In all of these countries and subregions, poverty tends to be concentrated in remote rural communities albeit poverty rates in Asia’s major urban centers exceed those of most other world regions. Con-

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versely, absolute poverty in East Asia has been reduced markedly since 1990, especially in China, which, owing to its now decades-long double-digit rates of economic growth, has succeeded in lifting hundreds of millions of its rural population from absolute poverty (Wan 2008; WB 2013b). Rates of infant, child, and maternal mortality also have declined within Asia (WHO 2012) and, at the same time, literacy levels, years of average life expectancy, and levels of per capita income have risen (ESCAP 2012; UNDP 2011). These advances in social development represent major milestones for the region which, in time, is expected to emerge as one of the world’s most influential political and economic centers. Remarkably, Asia is now home to the largest number of the world’s super-rich, a phenomenon which, ironically, is now contributing to a widening income disparity gap between the region’s rich and its poor (Ghani 2010; WB 2012b). Many of the Asia’s impressive gains on the WISP are associated with the end of recurrent internal and intra-regional conflicts (Wikipedia 2013b– c). The ending, or at least the containment, of these conflicts has set the stage for even more dramatic socio-economic accomplishments within the region. Even so, Asia remains one the world’s least peaceful regions as demonstrated by the serious conflicts occurring in Indonesia, Burma, Chechnya, India, Turkey, and Yemen as well as the protracted conflicts occurring in Afghanistan, Iraq, and Pakistan (Fund for Peace 2013). Asia’s recent gains in development are also associated with its successful export-oriented economies which, of some significance, include the outmigration of large numbers of both skilled and unskilled workers, especially that of nurses and other human service care givers (IOM 2013; WB 2013c). The foreign remittances that flow back into the region’s countries as a result of these outmigrations are substantial and contribute significantly to the total GDPs of several countries (UNPOP 2013). Asia’s long-standing cultural pattern of personal and collective savings also adds considerable stability to many of the region’s economies (Horioka and Terada-Hagiwara 2011; Little 2008). High national reserves also have made it possible for countries such as China and Japan to invest in the debt securities of other economically advanced nations which, in turn, has provided a steady source of revenue to these countries as well as more favorable trading terms for debtor and debt-purchasing countries (IMF 2013b; Nelson 2013). On the negative side, however, the majority of Asian countries have seriously under-invested in their social welfare infrastructures at a time when

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fertility rates remain high and the share of their population 60 years of age and older is on the increase (USSSA 2010). Reduced access to preventive health services and the imposition of tuition on all levels of education, including primary school education, have added significant financial pressures on the residents of most East Asian countries which, along with these pressures, also must fully finance child care, increased housing costs, and the loss of secure, life-time, employment (ADB 2012, 2013). The economic stresses experienced by many people living under such conditions has contributed to rises in the suicide rates of Asia’s young and the old alike—even in the region’s more economically advanced countries, i.e., Japan, Korea, and Singapore. Today, WISP scores for the Asian region-as-a-whole (Average= 47.7) closely approximate those for the world-as-a-whole (World M= 48.8, SD= 28.2). The factors that are contributing most to Asia’s rapid development include: (1) predominantly export-led economies; (2) ability to quickly adopt and improve sophisticated electronic and other technologies for use in manufacturing and other industrial processes; (3) ability to quickly export the improved, value added, technologies back to the countries that created the original technologies; (4) increased recognition within the region of the important contribution that can be made by women to Asia’s broad-based socio-economic development; (5) renewed willingness on the part of many Asian countries to suspend centuries-old antipathies toward neighboring states in order to pursue shared subregional economic and social goals; (6) creation of political space that permits the emergence of civil society organizations as partners with government in helping to advance national and regional development; (7) widely shared commitment to full implementation of the eight MDGs; and, (8) progress on the part of some of Asian countries, especially in China, in reducing poverty among large segments of their rural populations. The continuing challenges to development that confront the Asian region include: (1) the unpredictability of global markets for the goods and services produced by the region’s export-led economies; (2) the staggering poverty that continues to exist throughout the region, but especially in China, India, and Indonesia; (3) continuing high rates of fertility in combination with longer average life expectancy; (4) continuing out-migration of many of the region’s talented young people to neighboring countries, to the DMEs, and, now, to the BRICS; and, (5) in most of Asia’s subregions,

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limited opportunities for women to participate fully in policy-shaping and legislative roles. This pattern is especially prominent among the nations of East, South Central, and Southern Asia (ESCAP 2010, 2012).

WISP Findings by Geographic Subregions In addition to measuring the changing state of world social development over time, the WISP also was designed for use in assessing the development performances of each of the world’s six major geographic regions and 19 geographic subregions. Previous publications by the author, for example, include analyses of development trends for Africa (Estes 1995), Asia (Estes 2007), Europe (Estes 2004), and Latin America (Estes 1996). Analyses also were done for clusters of nations that share similar development challenges, i.e., the pre- and post-independence development challenges confronting the successor states of the former Soviet Union, development trends occurring in economies in transition (Estes 2012b) and development challenges confronting countries classified by the United Nations as socially least developed countries (Estes 2010). Other reports focus on the development trends of “failed” and “failing” states (Estes 2012a) and those that exist in the 53 member states of the Organization of Islamic Cooperation (Estes and Tiliouine 2014; Estes and Sirgy 2014). Regional analyses have also been embedded in a wide range of reports that focus on particular sectors of development and on the needs of historically disadvantaged population groups. This enables the examination of the global importance of well-being from a three-dimensional perspective, i.e., through the lenses of time, geographic space, and culture. Figure 2.5 reorganizes the study’s 160 countries into 19 geographic subregions. It rank orders each subregion on the basis of its average WISP performance in 2011 and identifies the number of changes in rank positions that occurred for each subregion between 2000 and 2011. Thus, we are able to both: (1) identify both the most and least socially successful subregions on the basis of their current WISP performances and, (2) assess the nature of the WISP rank position vis-à-vis those of other world subregions. Figure 2.6 also confirms the dynamic nature of the development trends that are occurring in various world regions over time. Especially apparent in this figure is that neither individual nor groups of countries are guaranteed a particular ranking from one time period to the next. Rather, to retain, and hopefully advance, their rank position on the WISP between one develop-

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ment decade and the next, countries—often subregions or groupings of nations that share similar characteristics in common with one another (e.g., the European Union, the group of ASEAN countries)—must continue to make social investments in improving the overall status of their populations. Thus, viewed from this context, the WISP measures both the absolute and relative status of development performance for each country and each subregion over time both in terms of both its own performance at different time intervals and in comparison with the WISP performances of other countries. As country and regional investments in development increases or decline, so too, do their WISP scores and rank position relative to the changes taking place in other countries. As confirmed by the subregional data reported in Figure 2.5 for 2011, the world’s most socially developed subregions are: Western Europe (Rank 1/19, [N=7], Average WISP2011= 67); Australia and New Zealand (Rank 2/19, [N=2], Average WISP2011= 67); Northern Europe (Rank 3/19, [N=10], Average WISP2011= 65); North America (Rank 4/19, [N=2], Average WISP2011= 63); and Southern Europe (Rank 5/19, [N=8], Average WISP2011= 61). The countries included in these subregions are all members of the group of Developed Market Economies (DMEs) and, as such, have consistently outperformed other world subregions since at least 1970. Though the combined population of these subregions is comparatively small as a percentage of the world’s total their consistent representation among the list of most socially developed countries is impressive. This continues to be the case despite their net social losses on the WISP between 2000 and 2011, e.g., North American countries (N=2) experienced an average loss of -8 WISP rank positions between 2000 and 2011 and Australia-New Zealand’s (N=2) average worldwide rank position dropped by -1 between 2000 and 2011. Conversely, the WISP position of the remaining 25 DMEs increased by an average of +1, +4, and +6 rank positions for Western, Northern and Southern Europe, respectively. The world’s socially least developed subregions are: Middle Africa (Rank 19/19, [N=7], Average WISP2011= 32); West Africa (Rank 18/19, [N=15], Average WISP2011= 36); East Africa (Rank 17/19, [N=15], Average WISP2011= 37); Melanesia (Rank 16/19, [N=2], Average WISP2011= 41); and, Southern Africa (Rank 15/19, [N=6], Average WISP2011= 41). Unfortunately, many of the countries included in these subregions consistently have been, and continue to be, among the lowest performing countries on the

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2.3 Average WISP Scores by Development Groupings, 1970–2011 (N=160)

WISP since 1970. An additional positive development pattern reflected in Figure 2.5, however, is the remarkable gains in average WISP rank positions achieved by the six nations of the South African subregion and the average gain of five WISP rank positions recorded for the two countries of the Melanesia subregion. Gains of this magnitude are especially impressive given the generally unfavorable WISP profiles that characterized these subregions during the first 30-years covered by this study. Also, many of the significant

2.4 Percent Change in Average WISP Scores for Development Groupings, 1970– 2011 (N=160)

Development Trends Among the World’s Socially Least Developed Countries

41

gains in development reported for these countries and subregions are the direct result of the successful implementation of the UN’s MDC and the similarly focused bi- and multi-lateral development initiatives of selected countries and private benefactors (EU 2012; OECD 2012c; USAID 2013b). The nine middle performing subregions identified in Figure 2.5 also experienced a combination of positive and negative changes in their WISP rank positions between 2000 and 2011. With the exception of the Eastern European and North African subregions, all of the subregions in this group are located in Asia and Latin America. Several of these subregions consist of countries that are rich in natural resources (especially North Africa and West Asia) and most are enjoying extended periods of peace and relative economic prosperity. Several of the subregions identified in Figure 2.5, including South Central Asia, also are rich in human resources. Even so, unemployment and under-employment patterns in virtually all of these regions are high in comparison with jobless averages reported for the world-as-awhole (ILO 2012a, 2012b). Population growth rates are also high in these subregions (UNPOP 2012) and a number of their countries continued to be governed by autocratic regimes (CIA 2013). Subregional performances on WISP, then, tend to be asymmetrical and to differ dramatically between various regions and subregions. The asymmetrical nature of these patterns is reflected in the data summarized in Figures 2.5 and 2.6 and are even more pronounced when examining the 40-year development profiles of individual countries. The data summarized in these figures also provide a vivid picture of the changing status of subregions against both their own earlier profiles and those of other subregions worldwide.

PART II: A CLOSER EXAMINATION OF DEVELOPMENT TRENDS OCCURRING AMONG SOCIALLY LEAST DEVELOPED COUNTRIES (SLDCS) The SLDCs included in this analysis consist entirely of least developed countries locate in developing Africa (N=32), Asia (N=8), and Latin America (N=1). All 41 of these SLDCs are classified by the United Nations as “least developed countries”, i.e., as “…low income and politically unstable societies that are at risk of social, economic, or political collapse” (UN-OHRLLS 2009). As a group, these nations are characterized by slow to moderate rates of economic growth (WB 2013a), widespread poverty (UNDP 2011; WB

42

Richard J. Estes

2.5 Rank Ordered Average Regional WISP Scores and Percent Changes in WISP, 2000–10/11 (N=19 Regions)

2013b) and, in many cases, they represent countries that have experienced dramatic social losses from one development decade to another (Estes 2014). Their populations also are primarily rural and they have comparatively poor communications networks. Even SLDCs with large agricultural and mineral resources find it difficult to bring these resources to market due to the absence of adequate transportation systems. Recent efforts by the Chinese to help poor African states to develop their mining, transportation and agricultural resources more fully have not always worked to the advantage of the host country (Lyman 2005; Maritz 2013). In general, one can accurately think of many of the lowest performing, land-locked, SLDCs with few natural resources as nations that continue to function on the edge of “social implosion.” The SLDCs also include a special group of least developed countries that are representative of a recently conceptualized “Fifth World” of development which includes such deeply impoverished and politically unstable countries such as Afghanistan, Haiti, Somalia, Sudan, and Zimbabwe. Countries classified as belonging to the fifth world of development already are, or are on the verge of becoming, failed states, i.e., countries that are unable to meet the basic material or security needs of their populations (Fund for Peace 2013). Most are in the midst of protracted civil or intra-regional wars or are experiencing high levels of diversity-related social conflict (Wikipedia 2013b, 2013c). All of these countries have unstable political regimes (CIA

Development Trends Among the World’s Socially Least Developed Countries

43

2013) and few are able to utilize the rich natural and human resources available to them (UNDP 2011). Most of the SLDCs have long histories of corruption in mishandling the large amounts of international development assistance that has been given to them in the past (Glennie 2008; Moyo 2009). Despite the heavy conflict-laden environment in which the countries are functioning, the SLDCs are now the beneficiaries of preferential development assistance through the United Nations’ MDC. Many other international organizations have joined with the United Nations in promoting the goals of the campaign in the SLDCs with the result that the SLDCs now have available to them considerable resources for use in strengthening their social infrastructure (OECD 2012c; USAID 2013a, 2013b). International aid to the SLDCs associated with the MDC is exactly the formula needed to help reverse the decades-long downward development trajectory that has characterized these countries since at least 1970. The long-standing social deterioration that has characterized development trends in the majority of SLDCs poses enormous challenges for both the SLDCs and the larger community of nations (Leonard and Straus 2003; Estes 2014). These challenges have been especially problematic in countries with deeply rooted human rights violations and cross-border conflicts (AI 2012; SIPRI 2013. In many of these situations international peace-keeping forces have been introduced by the United Nations Security Council with the goal of reducing state-sponsored terrorism (e.g., Rwanda, Somalia) or in bringing an end to hostilities between neighboring states (UN Peacekeeping 2013). Emergency assistance also has been needed by many SLDCs in which large numbers of their population either are on the verge of dying from starvation or have been killed, persecuted, or physically displaced by conflicts occurring in their borders, e.g., Democratic Republic of the Congo, Rwanda and Somalia. The financial and social costs of these interventions have been enormous and are continuing to accumulate (OECD 2012a; UNHCR 2012). The socio-political situations of these countries are all the more difficult because of their past misuse of international development assistance provided to them (Glennie 2008; Moyo 2009). Since 2000, however, a different pattern began to emerge with respect to the development priorities of most SLDCs. These new priorities are built on the strengths that are inherent in the SLDCs and focus centrally on advancing the social conditions within which their populations live. These aspirations are reflected in the enthusiasm associated with the implementa-

44

Richard J. Estes

tion of the MDC as well as in the five-year development plans developed by individual SLDCs. Early indications, as evidenced by the data reported in this chapter, are that many SLDCs are beginning to succeed in reversing their past negative development trends. WISP Performances on the WISP By Continental Groupings, 1970–2011 Figure 2.6 reports average WISP scores over a 40-year time period for the SLDCs three major continental groupings, i.e., Africa (N=32), Asia (N=8), and Latin America (N=1). Figure 2.7 reports the percentage change that occurred in SLDC average WISP performances for each of the study’s four development decades, i.e., 1970–1980, 1980–1990, 1990–2000, and 2000–2011. The data summarized in Figures 2.6 and 2.7 reflect several patterns that are of considerable relevance to this analysis: (1) significant development differences existed between the three SLDC continental regions for each of the three initial development decades; (2) these differences were most profound in the low group average WISP scores reported for the 32 African countries; (3) group average WISP scores for the eight Asian SLDC consistently outperformed those of their African counterparts each development decade between 1970 and 2011; and, (4) the one country grouped in the Latin American region, Haiti, outperformed the development performances of both the African and Asian SLDCs until 2011 when their country WISP score dropped to 32.9 vs. a group average of 34.8 for the African SLDCs and a group average of 38.2 for the Asian SLDCs. The dramatic nature of the development changes that occurred for the majority of SLDCs is more apparent in the most recent 10-year WISP data reported in Figure 2.7. The figure summarizes changes in WISP score values for each decade since 1970. Analysis of the figure confirms that substantial changes in WISP levels occurred for the majority of SLDCs between 2000 and 2011, i.e., a group average increase of +242 percent—the highest percentage increase for any group of nations on the WISP! The net change in WISP scores was even greater for the 32 African nations which experienced net 10-year increases on the WISP of +327 percent. Net 10-year gains on the WISP also were impressive for the Asian SLDCs (+118 percent) and for Haiti (+45 percent), albeit those reported for Africa far outpaced those captured for two other continental regions. In a single decade, then, the African SLDCs succeeded in reversing their previous profoundly downward trajectory that characterized their development patterns between 1970 and 2000.

Development Trends Among the World’s Socially Least Developed Countries

45

These gains, as will be discussed later in the chapter, are due to the successful implementation of the United Nations’ MDC and other large scale development assistance efforts initiated between countries on a bi-lateral basis (OECD 2014) or by major nongovernmental entities working at the national or subnational level (Foundation Center 2012). Individual benefactors also have played a major role in helping to finance implementation of selected MDC goals, e.g., the William and Melinda Gates Foundation (Microsoft) in Africa, the Ford and Rockefeller Foundations (automotive and financial giants) in Asia and Latin America, the unparalleled Open Society Initiative of financier George Soros in South Central Asia and the Russian Federation, and a major gift of $3 billion made in general support of the United Nations by CNN-founder Ted Turner. The continental gains reported in Figures 2.6 and 2.7 are unparalleled in development history and, given the substantive focus of the eight MDGs, are expected to be sustained over at least the near-term.

Sub-Regional Changes in WISP Performances, 1970–2011 Four additional figures are provided that disaggregate the continental WISP findings reported above for the SLDCs into nine major continental subregions, i.e., 5 for Africa (Northern, Eastern, Middle, Western and Southern African) and 4 for Asia (Western, South Central, and South East Asia). Separate figures were not prepared for Latin America since the only Latin American SLDC is Haiti for which scores and percentage change in scores are reported in Figures 2.6 and 2.7. As with Figures 2.6 and 2.7, Figures 2.8 through 2.11 report WISP scores for the full 40-year period covered by the analysis. They do, however, make clear that not all subregions within a particular continental grouping of nations, and certainly not across the two continents reported on here, experienced the same levels of WISP improvement during the most recent development decade. What is intriguing about the data presented in Figures 2.8 and 2.9, however, are the substantial 10-year improvements in WISP performances took place in Africa’s Middle (+923 percent), Eastern (+327 percent), and Western (+297 percent) subregions. These subregions have been, and continue to be, among the poorest and least developed subregions on the planet (Figure 2.5) and, therefore, the positive changes reported for them in Figures 2.8 and 2.9 are especially welcomed. These data reported in Tables 2.4 and 2.5 also confirm that rapid advances in social development that are

46

Richard J. Estes

2.6 Average WISP Scores for SLDCs by Continental Region, 1970–2011 (N=41)

possible, even in the most disadvantaged regions, when the world community unites behind a single, ambitious, initiative that seeks to reduce the major impediments to development confronted by poor countries, i.e., high levels of external indebtedness, sluggish economies, underutilization of their natural and human capital resources, ill-health, low literacy levels, joblessness, political instability, and intractable diversity related social conflict. Within these three African subregions considerable progress has occurred, as the magnitude of the impediments to social progress has been reduced. Similarly, the most 10-year significant gains on the WISP for Asia occurred in its Western (+330 percent) and South Central (+206 percent) subregions. Improvements in these regions were long overdue given the comparative rich of natural resources that exist in the West Asia subregion and the regaining of political independence in 1991 from the former Soviet Union by the nations of the South Central region. The social gains observed for these subregions are broadly based across all ten sectors of development measured by the WISP and, as with the rapidly accelerating African states, can be expected to be sustained over at least the near-term. These countries, too, are the direct beneficiaries of the MDC as well as the generous levels of support provided to them through other international development assistance organizations and private benefactors.

Development Trends Among the World’s Socially Least Developed Countries

47

2.7 Percent Change in Average WISP Scores for SLDCs by Continental Region, 1970–2011 (N=41)

COUNTRIES PERFORMANCES ON THE WISP Performances on the WISP for individual SLDCs are reported alphabetically in Table 2.4 for the 10-year period 2000–2011. The table reports country WISP scores for 2000 and 2011 (columns 1 and 2) as well the percentage changes that took place in these scores over the 10-year period (column 3). Table 2.4 also reports the number of changes in WISP rank positions for individual SLDCs for both time periods (column 8) and compares these changes with those attained by all other SLDCs (column 7). Group summary statistics for all the SLDCs-as-a-group are presented in the last several rows of the table which also contain comparative data on the same indicators and time periods for the world-as-a-whole (N=160). Between 2000 and 2011 WISP scores for all the SLDCs-as-a-group increased by an average of +378 percent (SD= +387 percent). These increases raised average scores for the SLDCs from 10.3 (SD= 14.4) in 2000 to 35.4 in 2011 (SD= 7.3). These increases are also reflected in SLDC group average advances in WISP rank position from 139 (SD= 16.7) in 2000 to 135 in 2011 (SD= 20.1). Increases of this magnitude on the WISP are unusual for any group of nations and are suggestive of the positive changes that have occurred in these countries since 2000. Even with their impressive 10-year development accomplishments, however, the group average WISP scores and rank positions of the majority of SLDCs remain substantially lower than those reported for the

48

Richard J. Estes

world-as-a-whole, i.e., the world’s poorest countries remain desperately poor albeit many positive improvements in development are taking place.

2.8 Average WISP Scores for African SLDCs by Geographic Subregion, 1970–2011 (N=32)

2.9 Percent Change in Average WISP Scores for African SLDCs by Geographic Subregion (N=32)11 (N=32)

Development Trends Among the World’s Socially Least Developed Countries

49

Table 2.4 Alphabetical Listing of SLDCs by WISP Scores and Ranks for 2000 & 2011 (N=41) Source: Estes (2013a).

WISP WISP 2000 2011 (Base=163) (Base=162)

% Change in WISP Scores 2000-11

-19.2

17.0

-9.7

25.5

32.4

47.7

47.5

19.4

39.1

12.8

40.1

3.1 3.4

39.6

188.1 362.8

36.2

101.6 212.4 1183.9 957.9

27.7

39.8

43.8

40.4

48.9

20.9

2.5

31.6

1184.3 804.6

-3.8

26.5

22.1

39.0

76.6

-2.3

26.3

1226.0 184.9 291.6 415.5 174.7 802.8 512.1

11.7

33.3

-15.3 -12.1

38.2

12.5

34.4

29.3

-3.8

26.6

5.2

32.1

22.8

32.9

44.5

21.0

42.4

102.3

36.4

40.4

11.1

-5.9

24.3

19.4

41.5

514.0 113.9 408.8 206.1 209.3 754.9

8.5

43.5

12.7

38.9

12.4

38.4

3.9

33.0

35.5

40.6

14.5

22.2

42.6

92.1

18.5

38.6

-10.0 1.2

25.2

12.6

35.2

19.6

42.1

14.1

34.1

6.9 8.2

35.4

1005.1 129.0 108.7 351.3 1366.8 179.4 114.5 141.9 442.9 330.2

22.1

39.3

77.9

206.1 378.3 387.1

-3.9

34.9

19.0

43.6

17.3

37.3

SLDCs (N=41) Afghanistan Angola Bangladesh Benin Bhutan Burkina Faso Burundi Cambodia Cape Verde Cen African Rep Chad Comoros Congo, DR Djibouti Eritrea Ethiopia Gambia Guinea Guinea-Bissau Haiti Laos Lesotho Liberia Madagascar Malawi Mali Mauritania Mozambique Myanmar Nepal Niger Rwanda Senegal Sierra Leone Somalia Sudan Tanzania Togo Uganda Yemen Zambia

WISP WISP 2000 2011 Rank Rank (Base=163) (Base=162) 163 159 114 129 137 150 150 116 99 152 155 123 154 141 162 161 137 155 148 121 127 106 158 129 145 137 141 149 109 123 155 129 129 159 153 137 128 134 147 146 123

162 158 87 128 122 125 139 124 78 152 156 129 157 148 153 134 146 155 151 150 114 119 160 117 109 130 133 149 119 112 143 108 132 159 161 142 115 147 135 141 126

SLDC WISP Rank (Base=41)

41 37 2 15 11 13 22 12 1 32 35 16 36 28 33 20 26 34 31 30 6 9 39 8 4 17 19 29 9 5 25 3 18 38 40 24 7 27 21 23 14

Number Rank Changes 2000-11

1 1 27 1 15 25 11 -8 21 0 •1 -6 •3 -7 9 27 -9 0 -3 -29 13 -13 -2 12 36 7 8 0 -10 11 12 21 -3 0 -8 -5 13 -13 12 5 -3

All SLDCs (N=41) 12.4

37.3

10.3

35.4

14.4

7.3

135.0 134.8

1.0 4.2

Median Average SD

141.4 139.0 16.7

20.1

12.0

12.9

Averages

81.6

81.5

NA

-0.1

21.0 21.0

World (N=162) 48.5

48.7

0.4

50

Richard J. Estes

2.10 Average WISP Scores for Asian SLDCs by Geographic Subregion, 1970–2011 (N=8)

2.11 Percent Change in Average WISP Scores for Asian SLDCs by Geographic Subregion (N=8)

SLDCs with the Most Rapid Positive and Negative Changes in WISP Scores, 2000–2011 Table 2.5 identifies those 28 SLDCs that experienced exceptionally rapid 10-year changes in their WISP rank positions between 2000 and 2011. The table contains the countries that are developing most rapidly as well as those that experienced the most significant social losses between 2000 and 2011. The magnitude of the changes positive and negative changes taking

Development Trends Among the World’s Socially Least Developed Countries

51

place in these countries is in stark contrast to the comparatively slower pace of development taking place in other SLDCs and, indeed, in the majority of world’s developing countries. Special consideration of the development trends occurring in the SLDCs that are experiencing the most significant social gains and losses is warranted for several reasons: (1) until only recently, the majority of these countries have been characterized by recurrent diversity-related social conflict which, in the past, denied them the stable levels of peace required to promote positive development (Wikipedia 2012b, 2012c); (2) most of these countries regained their independence from European colonizing powers only as recently as the mid-1960s; (3) most of SLDCs in which rapid positive and negative development changes are occurring continue to struggle with profound levels of social and economic deprivation (UNDP 2011; WB 2012b); (4) the political systems of the majority of these SLDCs remain unstable (CIA 2013) and, (5) many of these countries are heavily in debt to their former colonizers or to other economically advanced countries (IMF 2012a; OECD 2012c). Table 2.5 divides the most rapidly changing SLDCs into two groups: (1) those SLDCs that experienced 11 or more gains in WISP rank positions between 2000 and 2011 (range = +11 > +36); and (2) those SLDCs that experienced 3 or more losses in WISP rank positions for the same development decade (range = -3 > -29). WISP scores and changes in WISP rank positions between 2000 and 2011 also are reported in the table (columns 2 and 3) as are the country-specific percentage changes in WISP scores (column 4) and the number of WISP rank positions (column 10) for the most recent development decade. As with Tables 2.4, 2.6, and 2.7, Table 2.5 reports summary data for the two groups separately and, again, for the group-as-a-whole. The rank position of the 28 countries within the larger group of 41 SLDCs also is reported (column 9). The majority of rapidly changing SLDCs are located in Africa (N=21), albeit one is located in Latin America (Haiti) and six are in Asia: Bangladesh, Bhutan, Laos, Nepal, Myanmar, and Cambodia. Taken together, the combined population of these 28 countries is in excess of 680 million people, or somewhat less than 10 percent of the world’s total—a population size larger than the combined populations of the European Union (495 million) and the Russian Federation (174 million). The 14 countries with the most favorable changes in WISP rank positions, of which Bangladesh with its population

52 Richard J. Estes Table 2.5 Socially Least Developed Countries (SLDCs) Ranked Ordered by 2011 WISP Scores (N=41) Source: Estes (2013a). NA refers to either “missing” or to data that are “not available” or “not applicable.”

% Change

WISP

WISP

WISP

SLDC

WISP

WISP

WISP

in WISP

1990

2000

2011

WISP

Rank

1990

2000

2011

Scores

SLDCs

Rank

Rank

Rank

Rank

Changes

(Base=124)

(Base=163)

(Base=162)

2000-11

(N=41)

(Base=124)

(Base=163)

(Base=162)

(Base=41)

2000-11

Number

SLDCs With the Most Rapid Gains in WISP Rank Postions, 2000-2011 (N=14)

8.5

13.2 -9.9

-12.1

7.9

3.1

104

47.5

Bangladesh

94

145 114

109 87

4

47.7

2

36 27

38.2

415.5

Ethiopia

124

161

134

20

27

39.6

1183.9

Burkina Faso

113

129.0

Rwanda

150 129

125

43.6

108

13 3

25 21

43.5

32.4

18.9

408.8

Malawi

21.0

19.0

NA

40.4

48.9

20.9

Cape Verde

93 NA

12.8

40.1

212.4

Bhutan

NA

99 137

78 122

1 11

21

NA 14.9

21.0

42.4

102.3

Laos

101

127

114

6

13

14.7

19.6

42.1

114.5

Tanzania

102

128

115

7

23.1

19.4

41.5

113.9

Madagascar

91

129

117

8

13 12

143

3.0

15

34.9

1005.1

Niger

117

12.4

6.9

37.3

442.9

Uganda

107

155 147

135

25 21

12

17.3

22.2

42.6

92.1

Nepal

97

123

112

5

11

17.5

3.4

36.2

957.9

Burundi

95

150

139

22

11

-3.9

14.8

15.9

41.8

170.7

Median

101.5

133.4

116.0

12.8

13.8

41.3

374.8

Average

103.2

135.5

117.0

9.0

14.0

4.0

393.1

SD

10.4

17.1

12

7.5

14.2 18.5

10.6

18.5

8.2

7.9

SLDCs With the Most Rapid Losses in WISP Rank Postions, 2000-2011 (N=14) 28.0

22.8

32.9

44.5

Haiti

83

121

150

30

-29

36.0

36.4

40.4

11.1

Lesotho

79

106

14.1

34.1

141.9

Togo

96

134

119 147

10

17.4

27

-13 -13

36.0

35.5

40.6

14.5

Myanmar

78

109

119

9

-10

NA

12.5

34.4

174.7

Gambia

NA

137

146

26

-9

0.6

1.2

17.3

1366.8

Somalia

119

153

161

40

-8

27.7

39.8

43.8

Cambodia

108

116

124

12

-8

NA

11.7

33.3

184.9

Djibouti

NA

141

148

28

-7

NA

22.1

39.0

76.6

Comoros

NA

123

129

16

-6

12.9

12.6

35.2

179.4

Sudan

105

137

142

24

-5

11.9

-2.3

26.3

1226.0

Congo, DR

103

154

157

36

-3

-1.0

5.2

32.1

512.1

Guinea-Bissau

120

148

151

31

•3

23.7

18.5

38.6

108.7

Senegal

129

132

22.1

39.3

77.9

Zambia

123

126

18 14

-3

27.9

89 84

17.4

16.3

34.8

125.3

Median

96.0

131.9

144.0

25.0

-7.1

18.8

17.1

34.5

297.4

Average

96.7

131.1

139.4

22.9

-8.3

12.7

11.6

6.4

442.1

SD

15.3

13.8

15.2

-3

6.8

9.9

14.2

All SLDCs (N=41)

4.3

14.9

16.3

39.2

135.4

Median

101.0

131.9

127.5

15.0

15.7

15.5

37.9

336.1

Average

100.1

133.3

128.2

16.8

5.1

11.1

12.7

6.3

412.4

SD

13.1

16.1

19.8

10.9

15.4

48.5

48.7

Averages

63.3

81.6

World (N=162) 48.1

0.4

81.5

NA

-0.1

Development Trends Among the World’s Socially Least Developed Countries

53

of 153 million people is the largest, contain 65 percent of the SLDCs experiencing the most rapid changes in WISP rank position. The SLDCs with the most favorable change in WISP rank positions between 2000 and 2011 are: Malawi (Changes in WISP Rank Position= +36), Bangladesh (Changes in WISP Rank Position= +27), Ethiopia (Changes in WISP Rank Position= +27), Burkina Faso (Changes in WISP Rank Position= +25), Rwanda (Changes in WISP Rank Position= +21), Cape Verde (Changes in WISP Rank Position= +21), Bhutan (Changes in WISP Rank Position= +15), Laos (Changes in WISP Rank Position= +13), Tanzania (Changes in WISP Rank Position= +13), Madagascar (Changes in WISP Rank Position= +12), Niger (Changes in WISP Rank Position= +12), Uganda (Changes in WISP Rank Position= +12), Nepal (Changes in WISP Rank Position= +11), Burundi (Changes in WISP Rank Position= +11). These 14 countries achieved an average of +18.6 (SD= 7.9) gains in WISP positions between 2000 and 2011. These gains are especially impressive given the negative trajectory that characterized the majority of these countries between 1970 and 2000 (Figures 2.6, 2.7, 2.8, and 2.9). A number of factors contributed to the high levels of social progress that took place within the group of most rapidly developing SLDCs: (1) the emergence of peace within many of these nations (SIPRI 2013); (2) improved relationships with neighboring states, especially through increased trade and other forms of economic exchange (AfDB 2013; ESCAP 2012; WB 2012c); (3) increased attention to the social dimensions of development but especially in the health, education, and social welfare sectors (ESCAP 2010); (4) participation with the United Nations and other major international development assistance organizations in the implementation of the MDC and its eight MDGs (UN 2012a, 2012b); and, (5) the development of mutually non-exploitative partnerships with former colonizing powers. Each of these factors has been a major driver of development among the SLDCs and they are expected to continue to be major forces for SLDC renewal over at least the near-term. Conversely, the 14 SLDCs that experienced the most significant social losses in WISP rank positions between 2000 and 2011 are: Haiti (Changes in WISP Rank Position= -29), Lesotho (Changes in WISP Rank Position= -13), Togo (Changes in WISP Rank Position= -13), Myanmar (Changes in WISP Rank Position= -10), The Gambia (Changes in WISP Rank Position= -9), Somalia (Changes in WISP Rank Position= -8), Cambodia (Changes in

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WISP Rank Position= -8), Djibouti (Changes in WISP Rank Position= -7), Comoros (Changes in WISP Rank Position= -6), Sudan (Changes in WISP Rank Position= -5), Democratic Republic of the Congo (Changes in WISP Rank Position= -3), Guinea-Bissau (Changes in WISP Rank Position= -3), Senegal (Changes in WISP Rank Position= -3) and, Zambia (Changes in WISP Rank Position= -3). The combined 10-year losses in WISP rank positions for these 14 countries averaged -8.3 (SD= 6.8) and, in the main, are the result of: (1) continued inter-ethnic and tribal conflict (Wikipedia 2013b–c); (2) widespread human rights and press freedom violations (FH 2012); (3) the continued existence of unstable, often corrupt, political regimes that frequently are dominated by ethnic war lords (TI 2012; Wikipedia 2012b, 2012c); (4) an inability of many of these countries to exploit their rich natural resources (WRI 2013); (5) significantly undeveloped communications and transportation infrastructure (WB 2013a, 2013c); (6) low levels of foreign direct investment(s) in many African states (AfDB 2013; Ernst and Young 2012); (7) persistent corruption in the use of international development assistance (Glennie 2008; Moyo 2009); and, (8) substantial underinvestments in their social architecture, including in programs targeted at the poor and other economically vulnerable populations, e.g., children and youth, the elderly, persons with serious disabilities, and so on. The potential for ecotourism in a number of these countries also has been neglected due to the high levels of political instability. Nearly all 14 of SLDCs that experienced rapid declines in their rank positions are classified as “failed” or “failing” states, i.e., countries which, for a variety of reasons, are unable to provide for the most basic social and security needs of their growing populations (Fund for Peace 2013; Estes 2012a). The inability of these countries to provide for the most essential conditions of life leads to considerable internal conflict as well to tensions with neighboring states who receive large numbers of refugees from the failing states. Country failures also lead to enormous humanitarian demands being placed on the international development assistance community—for protection, food, shelter and, in many situations, resettlement in countries located great distances from their own countries. While the numbers of political refugees is on the decline worldwide, today, some 34 million people continue to be “persons of interest” to the Office of the United Nations High Commissioner for Refugees—the vast majority of whom are persons fleeing failed and failing states in search of improved living condi-

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tions (UNHCR 2012). The SLDCs that are under the great social distress are identified in the subindex data reported in Tables 2.6 and 2.7. All 28 of the SLDCs identified above continue to be characterized by slow to modest rates of economic growth, high unemployment, alarming levels of infectious and communicable diseases, and low levels of foreign investment. These difficulties exist within national contexts characterized by high levels of diversity-related social conflict in which hundreds of thousands of people have perished (IFRC 2012; SIPRI 2013). But those SLDCs for which rapid social changes have been reported are beginning to utilize more fully their own natural and human resources as well as the targeted development assistance being provided to them by the international development assistance community. As a result, the majority of rapidly developing SLDCs have made important progress in realizing several of the MDC’s eight goals, particularly those associated with the health, education, and economic sectors. The path of these nations toward more sustainable rates of social progress, however, remains a long one—especially given the decades of social deterioration, high levels of public corruption, and seemingly intractable diversity-related social conflicts vis-à-vis that experienced by either the larger group of Developing Countries (N= 66), the Commonwealth of Independent States (N= 21), or the socially advantaged Developed Market Economies (N= 34). But at least a start toward more accelerated rates of social and economic progress among the world’s poorest countries has begun.

WISP Subindex Performances of the SLDCs SLDC country scores for each the WISP’s ten component subindexes are reported in Table 2.6 which rank orders the SLDCs by their WISP performance in 2011. These scores vary considerably both within countries and between all 41 SLDCs included in the analysis. In all but a few cases, the subindex scores achieved by individual SLDCs are considerably lower than those attained for the world-as-a-whole (for which a statistical average score of 10.0 was set as part of the methodology used in the WISP’s construction). Even so, careful analyses of the patterns of country subindex achievements helps to both identify those WISP sectors in which the most significant changes are taking place. The analysis also aids in the identification of the major drivers of the development changes reported throughout the chapter and, in turn, offers a beginning framework for identifying those sectors which require higher levels of international development assistance.

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The sectors for which the SLDCs attained scores that more or less equaled those reported for the world-as-a-whole occurred on the Environmental (Average = 10.5, SD= 1.3) and Defense Effort (Average = 10.1, SD= 0.6) subindexes. The SLDCs, as a group, also attained subindex scores that approach world average scores on the Education (Average = 9.0, SD= 2.4) and Diversity-Related Social Conflict (Average = 8.9, SD= 2.0) subindexes. All four of these subindexes represent critical areas of social development— two focus directly on human capacity building (education and reducing diversity-related social conflict) and two focus on sets of contextual factors that are necessary to promote human capacity building (environmental protection and reducing levels of public expenditures allocated for military or defense purposes). The scores achieved by the many SLDCs on these subindexes reflect favorably on the decisions that are being made by their political leaders in support of promoting more participatory societies and public institutions. Certainly, these scores reflect policies that redirect scarce resources toward improving the general well-being of the populations of these countries. These decisions also serve as a backdrop for the critical advances that are needed in other development sectors. In stark contrast to the positive results just reported, the SLDCs, as a group, continue to lag seriously behind the world-as-a-whole on the Health (Average= 3.5, SD= 3.0), Women Status (Average= 6.2, SD= 3.1), Welfare Effort (Average= 6.8, SD= 2.6), Population (Average= 7.0, SD= 1.2) and Social Chaos (Average= 7.6, SD= 4.3) subindexes. Steady improvements in each of these sectors of development need to continue if the SLDCs are to achieve at least a minimum standard of well-being for their populations. The need is especially great in the health area which, when combined the gains already achieved on the education subindex, would provide the SLDCs with a healthy and at least minimally educated workforce needed to move the economies of these countries from being primarily agricultural to those which emphasize manufacturing and service—the two sectors that are most characteristic of modern economies. Gains in all three sectors are essential to solving the challenges confronting SLDCs with respect to continuing high rates of fertility, joblessness, and homelessness. The much needed gains in these areas also would contribute to the creation of a range of programs that would provide at least minimal social safety nets for the most economically vulnerable populations of the SLDCs, i.e., the growing numbers of elderly persons, children and youth, persons with severe disabilities, and those who function only

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on the edges of society (the poor and jobless, refugees, cultural minorities). The data summarized in Table 2.7 present an even clearer picture of the state of SLDC development vis-à-vis country performances on the WISP’s subindexes. The table identifies the number of SLDCs that attained one of three score levels on each of the WISP’s ten subindexes: (1) the number of countries that attained a score of 10.0 or higher on the indicated subindex (column 4); (2) the number of countries that attained scores ranging between 8.0 and 9.9 on the indicated subindex (column 3); and (3) the number of countries that attained scores of 7.0 or below on the indicated subindex (column 2). Summary data are reported in the table’s bottom rows that show the actual and percent distribution of the combined subindex performances of all 41 SLDCs. The data reported in Table 2.7 confirm that slightly less than one-third of the SLDCs (31 percent) attained scores on any subindex of 10.0 or more. (These countries are easily identifiable in Table 2.6 for which subindex scores of 10.0 or higher have been printed in bold). Subindex achievements at this level are not remarkable given that a score of 10.0 reflects the average subindex score for the world-as-a-whole which are significantly lower than those reported for more economically advanced countries. These numbers are even less impressive given that 43 percent of the SLDCs achieved subindex scores lower than 7.0 and, as reported in Table 2.6, many of these scores were significantly lower than 6.0. The subindexes with the largest number of countries with scores 7.0 or lower were Health (N=39), Women Status (N=30), and the Demographic (N=30). The number of countries with minimal systems of Social Welfare also was low (N=24) as was the number of countries experiencing high levels of Social Chaos (N=18).

Cartographic Representation of World Social Development Figure 2.12 is a cartographic representation of the development status of all 160 countries included in the present study. Figure 2.12 color codes countries into five development “zones” with Zone 1 representing the most socially developed countries and Zone 5 representing the least socially developed. The map is color coded with those countries with the least favorable WISP scores assigned the darkest colors. Countries identified in white (Zone 1) are those 32 nations with the most favorable WISP score ratings; darker shades represent progressively less developed countries with the least developed represented by the darker shade (Zones 2–5).

Table 2.6 SLDC Subindex Performance Ranked Ordered by WISP Index Score, 2011 (N=41)

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Countries not included in the analysis are color coded in a light shade of green which, in the grayscale rendering of the map, does not convert clearly. Comparable versions of the charts for 1970, 1980, 1990, 2000, and 2010 in full color, however, have been uploaded to the project’s previously referenced website. The most important finding portrayed in Figure 2.12 is the concentration of the lowest WISP scores in Sub-Saharan countries of Central and Middle Africa. Parts of South Central Asia are also located in Zone 5, as are Madagascar and Haiti. All other countries are classified into higher development zones. When examined side by side with comparable cartographic maps for earlier development decades the changes that have taken place in social development worldwide are pronounced and graphically present a vivid picture of the important achievements that have been made in meeting the Table 2.7 Tripartite Distribution of WISP Subindex Scores, 2011 (N=41)

Subindexes

Nuniber of Counti•ies Within R anges Range Range Range Total 7.0 or lower 8.0 - 9.0 10.0 + Countries

Education Subindex

12

Health Subindex

39

1

1

41

Women Status Subindex

30

8

3

41

Defense Effort Subindex

0

13

28

41

Economic Subindex

13

11

17

41

Demographic Subindex

30

10

Environment Subindex

1

13

16

1

41

41

11

29

41

Social Chaos Subindex

18

11

12

41

Diversity Subindex

11

17

13

41

Welfare Effort Subindex

24

10

7

41

Total Percent of Total

178 43.4

105 25.6

127 31.0

410 100.0

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2.12 Distribution of WISP Scores by Country and Development Zone, 2009 (N=160)

basic needs of people over the full 40-year time period of the study. The rendering of complex statistical data graphically is of great use in communicating development changes to audiences that are not accustomed to dealing with long columns of numbers and other statistical representations of changes in development, e.g., the general public as well as the majority of people who hold public office. The use of these charts is especially helpful in communicating complex data simply to persons in decision-making positions bearing on the distribution of international aid and other forms of development assistance.

THE SHIFT TOWARD A MORE POSITIVE SOCIAL FUTURE FOR SOCIALLY LEAST DEVELOPED COUNTRIES The social development trends reported in this chapter run contrary to previously reported findings concerning the nature, pace and extent of social progress taking place within the world’s socially least developed countries (SLDCs). More specifically, the chapter’s findings indicate that substantial social progress has and is continuing to occur within the majority of SLDCs since 2000. Social gains for the SLDCs between 2000 and 2011 were especially pronounced on the Education and Defense Effort subindexes as well

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as on the Environmental and Diversity-Related Social Conflict subindexes. All four of these subindexes achieved scores close to or slightly higher than the average subindex scores reported on for the world-as-a-whole. These gains were especially apparent during the ten-year period 2000 to 2011, i.e., the time period during which the goals of the United Nations’ MDC were being implemented. Though tentative in nature, and certainly still fragile, the development gains reported for the SLDCs at the regional, sub-regional and country levels are, nonetheless, important and they are substantial. They are the result of clearly focused efforts on the part of both the SLDCs themselves and the international community. Thus, a concentrated, even more determined, focus on realization of the MDC’s eight MDGs will help to sustain the important recent gains of the SLDCs over the long-term (Sachs, 2008; Sen, 2009). This sentiment was best expressed by Nobel Peace Laureate and founder of the Grameen Bank movement in Bangladesh, Muhammad Yunus, who, in concluding his volume on Creating a World Without Poverty (2007:233), wrote: All human beings have the inner capacity not only to care for themselves but also to contribute to increasing the well-being of the world as a whole. Some get the chance to explore their potential to some degree. But many never get any opportunity to unwrap this wonderful gift they were born with. They die with their gifts unexplored, and the world is deprived of all they could have done… It is possible to eliminate poverty from our world because it is not natural to human beings—it is artificially imposed on them. Let’s dedicate ourselves to bringing an end to it at the earliest possible date and putting poverty in the museums once and for all. Putting poverty in museums is a realistic ideal toward which many of us can aspire. To do so, though, first requires a commitment. Then commitment requires knowledge. And, finally, knowledge and commitment must be brought together to create praxis, i.e., action fully informed by knowledge such that neither the heart nor the brain alone is in control of the change process. All three dimensions of effective people-centered development are required to bring about the profound changes that needed by the world’s poorest countries. They certainly are needed to engage people themselves

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in the profound change process that leads to the developmental goals of praxis. At the outset of a new century, the need is apparent for new, more dramatic, initiatives that will transform all of the world’s nations into more caring and socially productive societies. Some of these initiatives have been identified in this paper and all emphasize the realization of three goals on nearly all of the world’s leaders agree: (1) the elimination of absolute poverty everywhere; (2) enhanced popular participation at all levels of social organization; and, (3) more equitable sharing of the planet’s abundant resources.

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NOTES 2.1 The SLDCs consist of the world’s poorest and slowest developing countries. The majority of these countries have been identified by the United Nations as “least developed countries” (LDCs) but they also include other low-income and politically unstable societies that are at risk of social, economic or political collapse (UN-OHRLLS 2009). A complete listing of the SLDCs, by continent and sub-continental regions is contained in Table 2.3. 2.2 Launched in 2005, the Millennium Development Campaign (MDC) is organized around the realization of the MDC’s eight Millennium Development Goals (the MDGs) that promote a basic standard of living for people living in the world’s poorest and most socially deprived countries: Goal (1) eradicating extreme poverty and hunger; Goal (2) achieve universal primary education; Goal (3) promote gender equality; Goal (4) reduce infant mortality; Goal (5) improve maternal health; Goal (6) combatting HIV/ AIDS and other diseases; Goal (7) ensure environmental sustainability; and, Goal (8) promoting global partnerships (UN, 2005). Timely reports of global and country progress in achieving these goals are available from the United Nation’s MDC “gateway”: http://www.un.org/millenniumgoals/bkgd.shtml. 2.3 “Adequacy of social provision” refers to the changing capacity of governments to provide for the basic social, material, and other needs of the people living within their borders, e.g., for food, clothing, shelter, and access to at least basic health, education, and social services (Estes, 1988: 199–209). 2.4 Because of the volume of these data, index and subindex scores for individual countries are reported separately on the author’s homepage: http://www.sp2.upenn.edu/ restes/WSS09.html. 2.5 The four socio-economic development groupings used in this analysis are: (1) Developed Market Economies (DMEs) consisting primarily of economically advanced countries (plus selected middle income countries added to the Organizations of Economic Cooperation and Development [OECD] on the basis of their current level of economic development and the rapid pace of that development, e.g., the Czech Republic, Mexico, South Korea, Turkey); (2) the Commonwealth of Independent States (CIS) consisting entirely of successor states to the former Soviet Union (FSU), including the Russian Federation; (3) Developing Countries (DCs) consisting primarily of low, middle and high income countries located in developing Africa, Asia, and Latin America; and (4) Least Developed Countries (LDCs) which, for a variety of historical and socio-political reasons, experience net negative patterns of socio-economic development from one time period to another (UN-OHRLLS 2009). 2.6 For methodological reasons, the ISP’s 41 indicators are divided between positive

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and negative indicators of social progress. On the Education Subindex, for example, higher adult illiteracy rates are negatively associated with social progress whereas gains in primary school enrollment levels are positively associated with overall improvements in development. 2.7 A fuller description of these procedures is summarized in Estes (1988:199–209). 2.8 The Berlin-based think tank Transparency International (TI) issues annual reports focused on corruption worldwide. Although all of these reports focus on public and commercial corruption, each one makes use of a different index: the Corruption Perceptions Index (CPI), the Global Corruption Barometer (GCB), the Bribe Payers Index (BPI), the Global Corruption Report (GCR), country profiles, and working papers on corruption and bribery occurring in individual countries. All of these reports can be obtained from the organization’s home page: http://www.transparency.org/. 2.9 A fuller discussion of development progress occurring within the world’s poorest nations is included in other recent reports prepared by Estes (Estes 2014; Estes and Tiliouine 2014).

3 Human Genetic Diversity in a Global Context Theodore G. Schurr

INTRODUCTION

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hen speaking about globalization in a social science context, one immediately thinks of the circulation of capital, culture, and ideas around the world. This process is leading to changes in social forms, cultural modes, and political and economic mechanisms across the globe. Such changes are linked to the increasing urbanization of the world’s population, which, in turn, brings more people into contact and promotes interactions between them. The range of experiences resulting from this exposure to new people and ideas presents real challenges for understanding events that are happening around us and the meaning of these changes. Globalization today can also be viewed as an extension of population level processes that began many millennia ago. These processes laid the groundwork for later population growth, cultural development, technological change, urbanization, state formation, and epidemiological transitions. Until modern human populations expanded outside Africa and across the globe, beginning some 50,000–70,000 years ago, they has not encountered the new environments, new pathogens, and unfamiliar landscapes that eventually led to new biological and cultural adaptations. They were also not compelled to adjust or modify their social-cultural organization and subsis-

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tence behavior to adapt to these changing conditions. Because these expansions are also generally associated with emerging Upper Paleolithic technologies (Klein 2000; Bar-Yosef 2002; Walter et al. 2000; but see McBrearty and Brooks 2000), it is thought that migration(s) out of Africa was linked to cognitive or behavioral changes that allowed these human groups to make long distance migrations. Favorable climatic conditions at that time may also have facilitated their departure from the African continent (Mellars 2006). This chapter describes the phase of globalization during which modern human populations came to occupy every corner of the globe. More specifically, it outlines the origins and dispersal of modern humans over the past 200,000 years as seen through molecular genetic data. After presenting an overview of the African origin of modern humans, it then discusses the genetic history of specific areas of the world, including Europe, China, Mongolia, and the Americas. This approach fosters a description of the influences on the genetic variation in different populations, including geographic, climatic, cultural and demographic factors. This discussion is also informed by research conducted in the Americas, and research visits to China and Mongolia. In the latter section of this chapter, the historical contact between geographically and biologically distinct peoples over the past several centuries, and the genetic consequence of these interactions is explored.

TRACING HUMAN MIGRATIONS WITH DNA EVIDENCE To provide a scientific context for the discussion of the migration history of modern human populations, a summary of the genetic systems that are typically used to trace population movements across geography and through time will be presented. The two kinds of DNA to be discussed here, mitochondrial DNA (mtDNA) and the non-recombining portion of the Y-chromosome (NRY), have unique properties which make them highly useful for reconstructing the phylogeographic history1 of our species. Both are uniparentally inherited, the mtDNA through maternal lineages and the Y-chromosome through paternal lineages, and both sequentially accumulate mutations through time without the complicating factor of recombination, which would reshuffle the mutational information contained in them (e.g., Wallace, Brown, and Lott 1999; Jobling and Tyler-Smith 2003). Thus, the data from the mtDNA and NRY can be used to identify distinct branches of the human maternal and paternal gene trees, respectively (e.g., Macaulay



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et al. 1999; Kivisild et al. 2002; van Oven and Kayser 2009; Y-Chromosome Consortium 2002; Karafet et al. 2008). Furthermore, the mutational data can be used to date the different branches in these trees, and assess the geographic and temporal contexts in which they arose and spread to different geographic regions (e.g., Metspalu et al. 2004; Shi et al. 2005). Figure 3.1 shows a human mtDNA phylogeny or tree containing a variety of different maternal lineages (haplogroups) observed in populations from around the world. These lineages have been named using a letter nomenclature that reflects the order in which they were discovered and classified (and revised in some cases). They are defined by sets of mutations that are largely unique to their branches and distinguish them from other branches. The root of this tree lies in Africa with L0 mtDNAs, with all other haplogroups having evolved from them (Chen et al. 1995, 2000; Gonder et al.

3.1 A simplified human mitochondrial DNA tree (Modified after Figure 1 in van Oven and Kayser (2008) Hum Mutat 30(2): E386–94; used with permission of John Wiley & Sons, Inc.).

2007; Behar et al. 2008). Some of the derived lineages have their origin in the Near East and Europe (H–K, T–X) (Torroni et al. 1994, 1996, 1998; Richards et al. 2000), India (M2–M4, R9) (Kivisild et al. 2003; Metspalu et al. 2004; Palanichamy et al. 2004), Southeast Asia (B, D–F, R9a) (Ballinger et al. 1992; Torroni et al. 1994; Schurr and Wallace 2002; Macaulay et al. 2005; Hill et al. 2006, 2007), Australia and Papua New Guinea (P, Q, S) (Forster et

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al. 2001; Huoponen et al. 2001; Ingman and Gyllensten 2003), or North-East Asia (A, C, G, Y) (Torroni et al. 1993; Schurr et al. 1999; Derenko et al. 2003). Africa itself has a set of ancient haplogroups (L0–L7) that arose and largely remained in the continent until the past five centuries (Chen et al. 2000; Kivisild et al. 2004; Behar et al. 2008). A fuller description of the distribution of these maternal lineages follows below.

3.2 A simplified Y chromosome parsimony tree. Mutation names are indicated on the branches. The subtrees corresponding to major clades A–T are collapsed in this figure. Haplogroup names are indicated at the tips of the tree. Mutation names are given along the branches; the length of each branch is not proportional to the number of mutations or the age of the mutation. The order of phylogenetically equivalent markers shown on each branch is arbitrary (Figure 2 in Karafet et al. 2008, Genome Res. 18: 830–838; used with permission of Cold Spring Harbor Laboratory Press).



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Similar to the mtDNA tree, the human Y-chromosome phylogeny contains all of the branches of the paternal gene tree that are seen in the world populations (Figure 3.2). Its branches are also defined by mutations occurring in the NRY, and these variants or single nucleotide polymorphisms (SNPs) are nearly all unique in their appearance within the phylogeny (Hammer et al. 1998; Y-Chromosome Consortium 2002; Jobling and TylerSmith 2003; Karafet at al. 2008). Thus, each SNP contains historical information about the evolution of a particular lineage or its sub-branches. By surveying mtDNA and Y-chromosome diversity in human populations, we can identify which branches of these maternal and paternal trees are present within a specific ethnic group or population, or within larger geographic areas. Figure 3.3 presents the distribution of various maternal lineages (mtDNA) in world populations, and Figure 3.4 the distribution of paternal lineages (NRY). The key in the lower center of the images indicates the respective haplogroups that are present in a specific area, and the pie charts indicate their frequencies in those places. As evident from these maps, there are patterns of regional genetic diversity that reflect the deep history of those areas, as well as areas exhibiting great genetic diversity that have been the intersections of human populations for thousands of years,

3.3 Map showing distribution of mtDNA haplogroups around the world (http:// www.scs.illinois.edu/~mcdonald/WorldHaplogroupsMaps.pdf).

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such as Central Asia. The task for the anthropological geneticist is to interpret these patterns of genetic variation in the context of other archeological, climatic, ethnographic, historical, and linguistic evidence.

3.4 Map showing distribution of NRY haplogroups around the world (http://www. scs.illinois.edu/~mcdonald/WorldHaplogroupsMaps.pdf).

MODERN HUMAN MIGRATIONS Having considered the genetic lineages that are used in phylogeographic studies of human populations, the current evidence for the emergence of modern humans and their later expansions across the globe will now be presented.

Africa In recent years, Africa has been the focus of many important studies of human origins and migrations. It has been clear for some time that Africa is highly genetically diverse compared to the rest of the world, perhaps 2–3 times as much, based on data from haploid genomes (Chen et al. 2000; Ingman et al. 2000; Gonder et al. 2007; Behar et al. 2008; Hammer et al. 1998, 2001; Underhill et al. 2000, 2001). It is also indisputably the homeland



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of our species, Homo sapiens, and the source from which modern humans expanded across the globe (Cann, Stoneking, and Wilson 1987; Ingman et al. 2000; Hammer et al. 1998, 2001; Underhill et al. 2000, 2001). Different scenarios have been proposed for the peopling of the African continent. To begin with, the mtDNA and NRY trees are quite old, but appear to differ considerably in their ages. The time to the most recent common ancestor (TMRCA) for the mtDNA phylogeny is at least 175,000 years before present (YBP) (Chen et al. 2000; Gonder et al. 2007; Behar et al. 2008)2. The deepest branch of the maternal phylogeny, L0, is observed in Khoi-San (South Africa) and Ethiopian (East African) populations. It dates to some 125,00–155,000 YBP, while its L0d and L0k branches that are specific to Khoi-San groups being some 90,000 YBP themselves (Chen et al. 2000; Gonder et al. 2007; Behar et al. 2008) (Figure 3.5). Other lineages that evolved later, such as mtDNA haplogroups L1 and L2, are also quite ancient, being at least 100,000 YBP in age. In fact, some of the population-specific maternal lineages in Africa are older than the major Eurasian macrohaplogroups (M and N) that gave rise to all other haplogroups seen outside of Africa (Chen et al. 2000; Gonder et al. 2007; Behar et al. 2008). Most mtDNA studies have suggested an expansion time out of Africa of between 50–60,000 YBP (Quintana-Murci et al. 1999; Ingman et al. 2000; Macaulay et al. 2005), although more recent work now suggests the initial expansion occurred around 70,000 years ago (Rasmussen et al. 2011). Until recently, the NRY tree was dated to no more than 90,000–100,000 YBP (Underhill et al. 2000, 2001; Hammer and Zegura 2002; Kivisild et al. 2002; Semino et al. 2002). In fact, the expansion of modern humans out of Africa had been dated to between 40,000–50,000 YBP using Y-chromosome evidence (Pritchard et al. 1999; Thomson et al. 2000; Underhill et al. 2000). Interestingly, the oldest branches of the paternal phylogeny (A, B) also appear in Khoi-San and Ethiopian populations (Underhill et al. 2000, 2000; Semino et al. 2002) (Figure 3.6). Initial work showed these branches to be more recent in origin than the mtDNA haplogroups, with haplogroup A dating to around 40,000–45,000 YBP, and haplogroup B to 35,000–40,000 YBP (Underhill et al. 2001; Hammer and Zegura 2002). The other common NRY lineage in African populations, haplogroup E, arose between 17,000– 34,000 YBP, and shows considerable substructure in the continent, partly as a result of Bantu expansions several thousand years ago (Underhill et al. 2001; Semino et al. 2002; Cruciani et al. 2004). However, more recent and

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3.5 A simplified human mtDNA phylogeny showing deep African roots. The L0 and L1’5 branches are highlighted in pale and medium grey, respectively. The branches are made up of haplogroups L0–L6 which, in their turn, are divided into clades. Khoisan and non-Khoisan clades are shown in light and dark grey, respectively. Clades involved in the African exodus are shown in the darkest grey color (M, N). A time scale is shown on the left side of the phylogeny. Approximate time periods for the beginning of African Late Stone Age (LSA) modernization, appearance of African LSA sites, and expansion of LSA throughout Africa are shown by increasing colors densities (Reprinted from the American Journal of Human Genetics, Behar et al., The dawn of matrilineal diversity, 82: 1130–1140, 2008, with permission from Elsevier).



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3.6 A phylogenetic tree of the Y-chromosome haplotypes and their percent frequencies in two Ethiopian groups (Oromo and Amhara) and Senegalese compared with the frequencies in the Ethiopians and Khoisan populations previously reported by Underhill et al. (2000). Numbering of mutations is according to Underhill et al. (2001): those examined in the present study are shown in boldface type; those inferred or reported by Underhill et al. (2000) are in italics. Haplotype numbers in the present study are in boldface type; those in italics are from Underhill et al. (2001). Group numbers refer to groups reported by Underhill et al. (2001). The current designations for the major haplogroups present in these populations according to Karafet et al. (2008) are shown in boxes. The frequency values in parentheses correspond to the subclassification of the haplotype defined only by the M89 mutation in the report by Underhill et al. (2000) (Reprinted from the American Journal of Human Genetics, Semimo et al., Ethiopians and Khoisan share the deepest clades of the human Y-chromosome phylogeny, 70: 265–268, 2002, with permission from Elsevier).

extensive analysis of Y-chromosome sequences indicates that the TMRCA of the Y-chromosome is between 120,000 to 156,000 YBP (Poznik et al. 2013). This finding indicates that male lineages did not coalesce significantly more recently than female lineages. Nevertheless, if the previous estimates of TMRCA in NRY lineages are correct, while consistent in confirming a recent African origin for modern humans, the divergent ages of the mtDNA and Y-chromosome lineages raise some other interesting questions. Should the TMRCA of the mtDNA and NRY trees differ substantially, this would suggest that the maternal and paternal ancestors of modern humans might have appeared at different times in the African continent. On the other hand, it may instead point to

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different effective population sizes for females and males in human populations (number of adults of reproductive age who contribute to the next generation), or perhaps selection on the Y-chromosome. Any one of these factors would affect the coalescence time estimates for these paternal lineages ( Jorde et al. 2000; Underhill et al. 2000). The phylogenetic diversity of the mtDNA and NRY may also reflect demographic or socio-cultural processes in human populations. For example, an analysis of mtDNA and NRY variation in hunter-gatherer and farming populations in Africa revealed substantial differences in female and male migration rate and/or effective size between the two kinds of societies, as well as the effect of polygyny and patrilocality on patterns of genetic diversity in these populations (Destro-Bisol et al. 2004). A comparable reduction in NRY diversity within human populations has also been observed in other regions of the world where patrilocality is commonly practiced, such as Central Asia (Chaix et al. 2004) and Turkey (Gokcumen et al. 2011). Thus, patterns of genetic diversity in human populations reflect not only the phylogeographic history of these groups, but also the forms of social organization and subsistence practices that they have used for hundreds and thousands of years.

Out of Africa Judging from archeological evidence, modern humans began expanding out of Africa some 50,000–70,000 YBP (Klein 2000; Mellars 2006). This expansion process may have entailed more than one migration out of the African continent during this period of time (Underhill et al. 2000, 2001; Karafet et al. 2001; Metspalu et al. 2004). The earliest migration appears to have moved through the Arabian Peninsula or the Sinai region into southwest Asia (Quintana-Murci et al. 2001, 2004; Al-Zahery et al. 2003; Kivisild et al. 2004; Cerny et al. 2008; Abu-Amero et al. 2009; Rasmussen et al. 2011). From this region, modern humans moved through India, Southeast Asia, and Australasia, reaching these locations by 50,000 YBP (Kivisild et al. 2002; Yao et al. 2002; Basu et al. 2003; Ingman and Gyllensten 2003; Metspalu et al. 2004; Palanichamy et al. 2004; Macaulay et al 2005; Thangaraj et al. 2005). Another wave of humans appears to have expanded through the Near East into Europe and North Africa (Richards et al. 2000; Olivieri et al. 2007), and a later one may have moved through Central Asia into Northeast Asia (Karafet et al. 2001; Quintana-Murci et al. 2004; Zhang et al. 2007). Figure 3.7 shows a portion of this expansion process and the diversification



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3.7 A map of Eurasia and northeastern Africa depicting the peopling of Eurasia as inferred from the extant mtDNA phylogeny. The bold black arrow indicates the possible “coastal” route of colonization of Eurasia by anatomically modern humans (ca. 60,000–80,000 ybp). This “Southern Coastal Route” is suggested by the phylogeography of mtDNA haplogroup M, the virtual absence of which in the Near East and Southwest Asia undermines the likelihood of the initial colonization of Eurasia taking a route north around the Red Sea. The initial split between West and East Eurasian mtDNAs is postulated between the Indus Valley and Southwest Asia. Spheres depict expansion zones where, after the initial (coastal) peopling of the continent, local branches of the mtDNA tree (haplogroups given in the spheres) arose (ca. 40,000 – 60,000 ybp), and from where they where further carried into the interior of the continent (thinner black arrows). Admixture between the expansion zones has been surprisingly limited ever since (Figure 5 from Metspalu et al. 2004, BMC Genet. 5:26).

the major branches of the mtDNA tree that occurred as humans moved out of Africa into other regions of the world. Africa, itself, saw considerable population movements after the major expansions out of this continent. There is good evidence for at least two expansions back into Africa (Kivisild et al. 1999; Cruciani et al. 2002, 2004; Olivieri et al. 2007), including one by Semitic speakers into East Africa. Populations from Africa also continued to influence groups from Europe, the Middle East, and Arabian Peninsula (Rando et al. 1998; Bosch et al. 2001;

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Richards et al. 2003; Cerny et al. 2008). In addition, population movements within Africa influenced the structure and diversity of groups living there (e.g., Cerny et al. 2009). In particular, the Bantu expansions had a major impact on the genetic make-up of populations from sub-Saharan Africa, bringing lineages such mtDNA haplogroup L3e and NRY haplogroup E2a into these regions (Bandelt et al. 2001; Pereira et al. 2001; Salas et al. 2002; Underhill et al. 2001; Semino et al. 2002). Thus, Africa has been not only the source area from which several major expansions of modern human groups took place, but also a region that has experienced its own internal migrations and population interactions for tens of thousands of years. On a global scale, we can observe patterns of mtDNA and NRY diversification that reflect the process of human migration and divergence resulting from isolation by distance. This process has help to shape the distinct regional patterns of mtDNA and NRY diversity that have emerged since human populations colonized previously unoccupied regions (e.g., Australia, PNG, Americas, Oceania) (Hammer et al. 1998; Jorde et al. 2000; Templeton et al. 2002; Underhill et al. 2001). We can also see regions of great diversity in terms of haplogroup composition that have resulted from extensive interactions of human groups for thousands of years. Central Asia is one such zone of interaction, and has seen numerous movements of nomadic tribes and populations, as well as been a primary route for trade for over several millennia (Comas et al. 1998, 2004; Wells et al. 2001; Zerjal et al. 2002; QuintanaMurci et al. 2004; Thornton and Schurr 2004; Gokcumen et al. 2008; Dulik et al. 2011). As a consequence, its populations exhibit a great diversity of genetic lineages that have originated in both West and East Eurasia. The initial expansions and movements around globe established the ancient patterns of genetic diversification that largely exist today. These patterns have since been altered by both prehistoric and historic population movements, by genetic drift in isolated populations, and by the significant demographic growth of human populations in the past few thousand years. The genetic variation in both the mtDNA and Y-chromosome reflects this long record of human population dynamics in different parts of the world.

REGIONAL MIGRATION HISTORIES Having provided a global perspective on human dispersal patterns, the migration history of several regions of the world will now be outlined.



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These regions include Europe, China, Mongolia, and the Americas. Exploring data from these areas illuminates the patterns of genetic variation arising from prehistoric population movements, and also identifies the recent historical events that have led to changes in these patterns. The impact of recent historic processes linked to globalization on genetic variation on these regions will also be addressed.

Europe Based on archeological data, modern humans entered Europe around 40,000–45,000 YBP. Figure 3.8 shows the rapid spread of the Aurignacian culture from the Near East into the European continent that occurred within several thousand years. It appears that these colonizing groups initially brought mtDNA haplogroup U and NRY haplogroup F with them to this region, with mtDNA haplogroups HV and I and NRY haplogroups I, K and R arriving, or evolving in situ, between 20,000–30,000 YBP (Richards et al. 2000; Underhill et al. 2000). However, others have argued that demographic expansions from East Eurasia to Europe through migrations occurring in the last 60,000 years may have given rise to many lineages seen in Europe today (Chaix et al. 2008). In any case, the genetic make-up of European populations was largely established by the time of the last glacial maximum (LGM) around 20,000 YBP. During the LGM (22,000–14,000 YBP), much of the northern portion of Europe was covered in ice (Figure 3.9). The glaciation of these northern regions shaped patterns of human settlement for thousands of years to come. It forced human populations to move south into several refugia (Iberia, Italian peninsula, Balkans) where conditions were more hospitable, and caused the mixing of genetic lineages present in these groups for thousands of years (Forster 2004). Much of modern day Europe was not fully re-occupied until after 10,000 YBP, when the glaciers had fully receded. Another consequence of the inhabitation of these refugia is that new haplogroups emerged during the LGM period. This process is seen quite clearly in the distribution of mtDNA haplogroups H and V. Both of them show a strong western European focus and evidence of human re-expansion out of the Iberian Peninsula (Torroni et al. 2001; Achilli et al. 2004) (Figure 3.10). As a result, haplogroup V is now more frequent in populations located far outside of its source area (i.e., Saami in Finland; Meinilä et al. 2001; Tambets et al. 2004) than in it. These observations also emphasize

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3.8 A map of Eurasia and northeastern Africa depicting the peopling of Eurasia as inferred from the extant mtDNA phylogeny. The bold black arrow indicates the possible “coastal” route of colonization of Eurasia by anatomically modern humans (ca. 60,000–80,000 ybp). This “Southern Coastal Route” is suggested by the phylogeography of mtDNA haplogroup M, the virtual absence of which in the Near East and Southwest Asia undermines the likelihood of the initial colonization of Eurasia taking a route north around the Red Sea. The initial split between West and East Eurasian mtDNAs is postulated between the Indus Valley and Southwest Asia. Spheres depict expansion zones where, after the initial (coastal) peopling of the continent, local branches of the mtDNA tree (haplogroups given in the spheres) arose (ca. 40,000 – 60,000 ybp), and from where they where further carried into the interior of the continent (thinner black arrows). Admixture between the expansion zones has been surprisingly limited ever since (Figure 5 from Metspalu et al. 2004, BMC Genet. 5:26).

the crucial role that climate change has played in shaping the distribution and movement of human populations for many millennia. The post-LGM expansion is just one of the major population movements that have influenced the pattern of genetic variation in Europe. The first occurred with the initial settlement of this region by modern humans around 40,000 YBP, while a second demic expansion involved Near Eastern farmers beginning 10,000 YBP (Richards et al. 1996, 1998, 2000; Rosser et al.



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3.9 A view of Europe during the last glacial maximum 20,000 years ago (modified after www.metatech.org/07/ice_age_global_warming.html).

2000; Tambets et al. 2000; Cinnioglu et al. 2004). The latter resulted in the diffusion of mtDNA and NRY haplogroups into Western Europe from the southeast, probably emanating from Anatolia (e.g., mtDNA haplogroup J, NRY haplogroup J-M172). However, the Neolithic expansion only contributed some 10–25% of the genetic lineages now seen in European populations (Richards et al. 1996, 1998, 2000; Rosser et al. 2000; Al-Zahery et al. 2003). In fact, based on ancient DNA data, the basic pattern of western European mtDNA diversity appears to have been established by only the Bronze Age (Ricaut et al. 2012). Recent movements of human groups have also influenced the genetic make-up of European populations, bringing new genetic lineages into, or

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3.10 Spatial frequency distribution of mtDNA haplogroup H based on population analysis (Reprinted from the American Journal of Human Genetics, Achilli et al., The molecular dissection of mtDNA haplogroup H confirms that the Franco-Cantabrian glacial refuge was a major source for the European gene pool, 75: 910–918, 2004, with permission from Elsevier).

altering frequencies of genetic lineages in, a particular region. For example, based on NRY data, researchers have noted the genetic influence of the expansion of the Franconian and Ottoman Empires on European populations (Roewer et al. 2005), and the influence of European crusaders on Lebanese populations (Zalloua et al. 2008). Similarly, the Norse and Gaelic sources of the founders of Iceland have now been well established (Helgason et al. 2000a, b), and the expansion of Roma (gypsy) populations across Europe has traced back to India using genetic evidence (Kalaydjieva, Gresham, and Calafell 2001; Iovita and Schurr 2004; Morar et al. 2004). The most recent manifestation of this pattern is the current immigration of non-European populations into Europe during the last century, with these groups coming from Africa, Turkey, South Asia, the Middle East and the Caribbean, among other source areas (e.g., Ben-David 2009). Thus, while never entirely homogeneous, Europe’s future genetic make-up will likely be quite different from that which existed even a few centuries ago.



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China The People’s Republic of China (China) is a vast country with a diverse population, particularly outside of the major region of Han Chinese dominance. Minority populations live largely around the periphery of the country, including Tibet to the West and Xinjiang to the northwest. These minority groups represent dozens of different language groups (e.g. Austro-Asiatic, Hmong-Mien, Daic, Austronesian, Turkic, Tungusic), whereas the majority of the people in modern nation state speak Tibeto-Burman languages (Ramsey 1987; Lewis 2009) (Figure 3.11). Their interactions with the Chinese state have not been unproblematic for minority populations, either in prehistory or the modern era (Harrell 1996; Hansen 1999; Lipman 2000; Sperling 2004). This diversity of ethnic groups in modern China reflects the early settlement of East Asia, and the subsequent expansion of different populations within and into this region over the past 50,000 years. Both mtDNA and NRY data indicate an early occupation of this region, possibly as part of the initial modern human expansion across the globe (Chu et al. 1998; Kivisild et al. 2002; Yao et al. 2002; Kong et al. 2003; Metspalu et al. 2004; Macaulay et al. 2005; Zhang et al. 2007) or perhaps as a secondary expansion following the early occupation of East Asia and Australasia (Rasmussen et al. 2011). Among the more ancient lineages to arrive or arise there include mtDNA lineages A, B, D, F, M7, M8/C/Z, and N9 (Torroni et al. 1993, 1994; Schurr et al. 1999; Kivisild et al. 2002; Yao et al. 2002; Tanaka et al. 2004; Macaulay et al. 2005), and NRY haplogroups C, D, and O (Ding et al. 1998; Su et al. 1999; Kim et al. 2000; Qian et al. 2000; Underhill et al. 2000; Shi et al. 2005). It also appears that the initial occupation of East Asia proceeded from the south to the north regions of East Asia (Chu et al. 1998; Su et al. 1999; Shi et al. 2005; Zhang et al. 2007), with some lineages being brought into the region from Central Asia (Karafet et al. 2001). The mtDNA data further reveal some specific maternal lineages that have arisen in East Asia and become common in Han Chinese and other northeast Asian populations. For example, haplogroup M7 is seen through East Asia, and its daughter branches, M7a, M7b, M7c, are differentially distributed in China, Japan, and Korea, respectively (Kivisild et al. 2002). In particular, M7a and M7b2, which are specific for Japanese and Korean populations, may represent a (pre-) Jomon contribution to the modern mtDNA pool of Japan (Kivisild et al. 2002; Tanaka et al. 2004). Similarly, NRY hap-

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3.11 Ethno-linguistic groups in the People’s Republic of China ~1983 (modified after http://en.wikipedia.org/wiki/File:Ethnolinguistic_map_of_China_1983.jpg).

logroup D is found only in northeast Asia in Tibetan, Mongolian, Korean, Japanese, and northern Han Chinese, and along with NRY haplogroup C are the only paternal lineages present in the Ainu of Hokkaido, the descendants of the Ainu (Tajima et al. 2004; Tanaka et al. 2004). These data imply that NRY haplogroup D represents a separate and ancient expansion of people from Central Asia into this region (Su et al. 2000; Qian et al. 2000; Karafet et al. 2001; Underhill et al. 2001). Based on NRY data, the distribution of paternal haplogroup O3-M122 in Southeast and East Asia also reveals major expansion of East Asian throughout region, after its initial colonization. This lineage probably arose in Southeast Asia some 25,000–30,000 years ago, and then spread northward from this source area (Shi et al. 2005) (Figure 3.12). This lineage subsequently gave rise to several other sublineages in East Asia, some of which are associated with the emergence of Sino-Tibetan populations 10,000 years ago, and the later settlement of the Himalayan region (Qian et al. 2000;



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Su et al. 2000; Wen et al. 2004; Shi et al. 2005). Overall, these genetic data provide an in-depth view of the ancient settlement of East Asia and the expansions of human populations that took place once they had settled there. Yet, in Xinjiang in the northwestern periphery of modern day China, it was populations from the west that first settled this region some 4,000 YBP (Mair and Mallory 2000; Thornton and Schurr 2004). Archeological evidence obtained from burials in deserts of the Tarim Basin in the Uighur Autonomous region have revealed that the people interred in them do not resemble contemporary people of the region, or modern Han Chinese. Instead, they appear more West Eurasian in their facial features, stature, hair color and other physical traits (Francalacci 1998; Mair and Mallory 2000). This finding provoked a strong reaction from the Chinese government, which had asserted that these cultures and peoples came from East Asia

3.12 The frequency distribution of the O3-M122 haplotypes in East Asian and other continental populations (Reprinted from American Journal of Human Genetics, Shi et al., Y-chromosome evidence of southern origin of the East Asian-specific haplogroup O3-M122, 77: 408–419, 2005, with permission from Elsevier).

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(Wong 2008). However, recent genetic evidence clearly points to an early West Eurasian presence in Xinjiang and later interactions with Han Chinese (Cui et al. 2010; Kim et al. 2010; Zhang et al. 2010). The exact source of these Tarim Basin populations remains somewhat unclear. A reevaluation of craniometric data from the region has suggested that they represent a population of unknown origin that arrived there in the early Bronze Age (Hemphill and Mallory 2004). In this view, around 3200 YBP, the Tarim Basin population experienced significant gene flow from highland populations of the Pamirs and Ferghana Valley, possibly including groups known as the Saka who served as ‘middlemen’ facilitating contacts between East (Tarim Basin, China) and West (Bactria, Uzbekistan) along the area encompassing the Silk Road (Hemphill and Mallory 2004). Regardless of where these people originated, they were the first to settle this region. Han Chinese arrived later around 2,000 YBP with dynastic expansions. Since 1500 B.C.E., a succession of Chinese dynasties arose, starting with the Shang dynasty, although only the Han dynasty expanded beyond the core area of Chinese culture (Yellow and Yangtze Rivers) into the northwest around 200 B.C.E. (Lewis 2007). Over time, this region was absorbed into the Han sphere of control. As noted above, the Silk Road also ran through this region, including the Taklamakan Desert, with caravans moving east and west using the oases of the desert as stopping points along the journey. The Chinese capitalized on this road for trade with West and within Central Asia for many centuries. It also served as a conduit for the exchange of goods, ideas and technology from both East and West, and played a key role in the transformations in the cultural, economic, and political life of societies situated both within the Central Eurasian heartland and on its periphery (Whitfield 2001; Kuzmina and Mair 2007; Beckwith 2009). The patterns of genetic diversity seen in populations from Eurasia reflect this flow of goods and people across the region. These interactions have produced a gradient of maternal and paternal genetic lineages extending from west to east. There are mostly West Eurasian lineages in West Asia and East Eurasian lineages in East Asia, while both types are found in the connecting Central Asian region, which represents a mixing zone (Comas et al., 1998, 2004; Zerjal et al. 2003; Quintana-Murci et al. 2004; Yao et al. 2004; Gokcumen et al. 2008; Heyer et al. 2009; Dulik et al. 2011). Contemporary Uyghurs, who claim to descend from the Tarim



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Basin peoples, exhibit a mixture of East and West Eurasian maternal lineages. The exact combination of lineages varies depending on the region in which their populations live, but they generally have a predominance of East Eurasian mtDNA haplogroups (Comas et al. 2004; Gokcumen et al. 2008; Li et al. 2009). In this regard, genetic data have recently been recovered from individuals interred in the Xiaohe cemetery from the Tarim Basin. Interestingly, they were shown to have both East Eurasian and West Eurasian mtDNA lineages (C, H, K) but only West Eurasian NRY lineages (R1a1a) (Li et al. 2010). Thus, like modern Uyghurs, the Xiaohe people were a genetically admixed population, and one that had occupied the Tarim Basin since the early Bronze Age. Collectively, these data generally support the assertion of Uyghurs that they are the descendants of the original Tarim Basin people. These findings have not influenced current government policy in Xinjiang, as the imposition of Chinese rule and push towards the assimilation of Uyghurs into Chinese culture has led to ethnic unrest there (Hennock 2008). Muslim Uyghurs lack powers of self-governance within the Chinese state, and are increasingly viewed as threats to national security because of their religious practices3. Xinjiang is also important to the Chinese government because it contains valuable natural resources such as gas (Christoffersen 2006; The China Daily.com 2006) and historically served as a military buffer against Russian expansion (Millward 2007; Mackerras and Clarke 2009)4. These divergent views of the region have led to political conflicts between the autochthonous Uyghur population and the expanding Han Chinese5 that are not likely to be resolved in the immediate future.

Mongolia The formation of the current population in Mongolia followed a complex process that involved the mixing of ethnically different peoples (Schurr and Pipes 2010). Mongolians have also traditionally organized themselves into a fluid and flexible system of confederations, tribes, clans, and families (Spuler 1971, 1989, 1994; Saunders 2001; Morgan 2007). This dynamic population history is of great interest because it has shaped the patterns of genetic diversity observed in modern Mongolian populations. Analysis of mtDNA variation in Mongol populations from Xinjiang, Mongolia, and Inner Mongolia has provided insights into their maternal genetic ancestry (Kong et al. 2003; Yao et al. 2004; Gokcumen et al. 2008).

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These studies have shown that the mtDNA haplogroup distribution in Mongolians consists of mostly East Eurasian lineages (A, B, C, D, F, G, M7, M8, M9, N9a, Y, Z), with a low to modest frequency (4–20%) of West Eurasian lineages (H, J, T, U, and W). Most of the East Eurasian haplogroups are also observed in indigenous Siberian and Northeast Asian populations (Torroni et al. 1993, 1994; Schurr et al. 1999; Derbeneva et al. 2002a, b; Derenko et al. 2002, 2003, 2004; Pakendorf et al. 2003; Schurr and Wallace 2003; Starikovskaya et al. 2005; Gokcumen et al. 2008), while M7 haplotypes are much more common in Chinese, Japanese, and Korean populations (Yao et al. 2002; Kivisild et al. 2002; Tanaka et al. 2004; Lee at al. 2006). In addition, haplogroups B and F are commonly seen in East and Southeast Asian populations as well as Tibetans (Ballinger et al. 1992; Torroni et al. 1994; Melton et al. 1995; Qian et al. 2001; Schurr and Wallace 2002; Yao et al. 2002; Kong et al. 2003; Tanaka et al. 2004; Macaulay et al. 2005), but represent a small proportion of the mtDNAs in Mongolians. By contrast, the West Eurasian haplogroups are much more common in populations inhabiting regions to the west of Mongolia (Comas et al. 1998, 2004; Quintana-Murci et al. 2004; Gokcumen et al. 2008). All of these maternal lineages probably originated in Central or West Asia (Torroni et al. 1996, 1998; Macaulay et al. 1999; Richards et al. 2000; Capelli et al. 2003) prior to their being brought to East Asia by ancient steppe populations some 5,000 years ago (Renfrew 2002; Thornton and Schurr 2004; Anthony 2007). Studies of Y-chromosome variation in Mongolians have also identified a variety of different paternal haplogroups that arose in either East or West Eurasia (Wells et al. 2001; Zerjal et al. 2002, 2003). Mongolians have haplotypes from primarily haplogroups C and K (~70%), along with low to moderate frequencies of other haplogroups present in Central/East Asia (D, N3, O3, R1a1), and low frequencies of paternal lineages more commonly seen in populations from the Caucasus and West Asia ( J, L, R1a) (Wells et al. 2001; Zerjal et al. 2002; Al-Zahery et al. 2003; Regueiro et al. 2006). These West Eurasian lineages were likely brought to the region by nomadic steppe populations that moved into East Asia from the west (Renfrew 2002; Thornton and Schurr 2004; Anthony 2007). This pattern of Y-chromosome diversity is generally consistent with the findings of other studies of Central and East Asian populations (Tajima et al. 2002; Katoh et al. 2005a; Xue et al. 2006; Dulik et al. 2011).



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Of greater interest for more recent Mongolian history is a subbranch of the NRY haplogroup C called C3c. C3c is unusual in having a large central type and short derived branches extending from it. This star-like pattern indicated that C3c had recently arisen through a founder event, and then was spread fairly rapidly across the area in which it is now found. Because the founder haplotype occurred at moderate frequencies in populations living across a broad region of Central and East Asia, it likely arose there. Furthermore, estimates of the age of the C3c sublineage suggested that it originated more than 1,000 YBP, probably in what is now modern Mongolia (Zerjal et al. 2003). Because of the concentration of C3c within the boundaries of the original Mongol empire, this sublineage has been linked to expansion of the Mongol Empire. Under this scenario, Chingghis Khan (ca. 1162–1227 C.E.) and his male relatives disseminated the sublineage throughout this region, both through military conquest and by cementing political alliances though spousal exchanges of women (Saunders 2001; Morgan 2007). As a consequence, some sixteen million men living in Central and East Asia now carry the haplotypes belonging to C3c (Zerjal et al. 2002, 2003), including populations in Pakistan (e.g., the Hazaras; Qamar et al. 2002) and Russia (Kalmyks; Nasidze et al. 2005) (Figure 3.13). Today, Mongolia is rapidly undergoing a major modernization phase. Fueled by support from Japan, South Korea, and other East Asian countries, it is significantly investing in its urban and transportation infrastructure, and expanding its exploration of natural resources (Bardarch and Zilinskas 2002). At the same time, it continues to valorize its imperial and archeological past and use images and ideas from the Xiongnu and Mongol Empire to construct a national narrative (Wang 2000). These trends are seen in the structures present in Ulaanbaatar, the capital city. A statue of Chinggis Khan now presides in the middle of the façade of the modern Mongolian Parliament in Ulaanbaatar, having become a national icon for the country (Figure 3.14). The modern nation of Mongolia is reclaiming this warrior as its major founder, despite the excesses and brutality that he and his male relatives exacted on the populations that they conquered. Another statue positioned in the square in front of this building commemorates Sükhbaatar, a local hero who liberated Mongolia from Chinese occupation and a White Russian army (Onon 1976). Political heroes of the past millennium are displayed at the seat of Mongolian state power.

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3.13 Distribution of Y-chromosome haplogroup C3c associated with Genghis Khan and his male relatives. Populations are shown as circles with an area proportional to sample size; star-cluster chromosomes are indicated by dark gray sectors. The shaded area represents the extent of Genghis Khan’s empire at the time of his death (Morgan 1986) (Reprinted from the American Journal of Human Genetics, Zerjal et al., The genetic legacy of the Mongols, 72:717–721, 2003, with permission from Elsevier).

As noted above, Mongolian prehistory plays an important role in the national origins narrative. There is great interest in the Xiongnu Empire, by both Mongolian and foreign archeologists, because this culture is viewed as representing the emergence of modern Mongolian culture and subsistence patterns (Keyser-Tracqui et al. 2006; Wright et al. 2009). Reflecting later cultural influences, there are also a number of Buddhist monasteries in Ulanbaatar, including the Gandan (Gandantegchinlen Khiid) Monastery, which houses a 26-meter high 20-ton gilded statue of Migjid Janraisig (Avalokitesvara), one of largest in East Asia (Figure 3.15), which attests to the Buddhist influence on Mongolian culture ( Jerryson 2007). Thus, Mongolia’s past is directly interwoven with its present, both in terms of the genetic legacy of its forbearers and the cultural legacy of the empires and religions (including communism) that have shaped its present day social and political system.

Americas Molecular genetic studies of Siberian and Native American populations indicate that ancestral Native Americans originated in south-central Siberia and entered the New World between 20,000 and 15,000 YBP, after thousands of years of isolation in Beringia (Schurr 2004; Schurr and Sherry



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3.14 Genghis Khan statue in front of the Mongolian Parliament in Ulaanbaatar (Photo by T. G. Schurr).

3.15 The gilded statue of Migjid Janraisig (Avalokitesvara) in the Gandan (Gandantegchinlen Khiid) Monastery, Ulaanbaatar, Mongolia (Photo by T. G. Schurr).

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2004; Achilli et al. 2008; Kitchen et al. 2008; Bonatto et al. 2008; Fagundes et al. 2008). These early immigrants probably followed a coastal route into the New World, where they expanded into all continental regions (Kemp et al. 2007; Tamm et al. 2007). A second expansion, possibly coming from the same area of Siberia, may have entered the Americas, and genetically influenced North American populations. This is seen by the presence of mtDNA haplogroup X2a and NRY haplogroup C in this region (Karafet et al. 2001; Lell et al. 2002; Reidla et al. 2003; Zegura et al. 2004; Malhi et al. 2008; Perego et al. 2009). The ancestral Beringian populations ultimately moved into northern North America after the LGM and, over the course of the next 10,000 years, gave rise to Aleuts, Yupik and Inupiaq Eskimos, and Na-Dene Indians, the diverse peoples of the circumarctic region (Starikovskaya et al. 1998; Schurr et al. 1999; Rubicz et al. 2003; Helgason et al. 2006; Zlojutro et al. 2006) (Figure 3.16). The prehistory of the Americas continues to be explored through genetic studies. However, a significant chapter of indigenous American history has occurred in the last five centuries, due to contact with people of European descent. The entry of Europeans into the New World brought about a number of significant changes for Native American populations. Warfare and epidemic disease killed huge numbers of individuals from various tribal populations, sometimes leading to the extinction of particular ethnic groups (e.g., Snow and Lamphear 1988; Schultz 2000). This demographic decline led to some reduction in the genetic diversity of these populations, as well as the formation of new populations from the remnants of tribes affected by Europeans contact (Thornton and Marsh-Thornton 1981; Ubelaker 1988). Perhaps the first location where European contact occurred is Greenland, where the local Inuit bear evidence of interactions with the Vikings some 1000 years ago (and perhaps also the Danes who settled there centuries later). In addition to settling Iceland, the Vikings also journeyed to the west, reaching Greenland and northeastern North America. Although they were unable to permanently settle this region, they left a genetic impact in the Greenland Inuit populations. These populations now exhibit almost entirely indigenous mtDNA lineages (E, F*, R1), but only 40% indigenous Y-chromosome lineages (C, Q), due to Viking/Norse admixture (Bosch et al. 2003; Helgason et al. 2006) (Figure 3.17). Similar research in the Northwest Territories of Canada has begun to illuminate the history of the Dene and Inuvialuit peoples who live in the



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3.16 A schematic illustration of maternal gene flow in and out of Beringia. The colors of the arrows correspond to approximate timing of the events and are decoded in the colored time-bar. The initial peopling of Beringia (depicted in light yellow) was followed by a standstill after which the ancestors of the Native Americans spread swiftly all over the New World while some of the Beringian maternal lineages–C1aspread westwards. More recent (shown in green) genetic exchange is manifested by back-migration of A2a into Siberia and the spread of D2a into northeastern America that post-dated the initial peopling of the New World (Taken from Tamm E, Kivisild T, Reidla M, Metspalu M, Smith DG, et al. (2007) Beringian Standstill and Spread of Native American Founders. PLoS ONE 2(9): e829. doi:10.1371/journal. pone.0000829).

Western Arctic. Genetic studies using mtDNA and Y-chromosome data are helping to reconstruct the histories of these groups, as well as elucidate the peopling of the circumarctic region and the Inuit expansion across the

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3.17 Y-chromosome haplogroups found in Inuit and Danes. The binary markers typed and haplogroups assayed are indicated on a rooted maximum parsimony tree, based on that published by the Y Chromosome Consortium (2002). The haplogroup frequencies in Inuit and Danish Y-chromosomes are shown as filled circles, which are proportional to haplogroup frequency (small unfilled circles unobserved haplogroups). Haplogroup nomenclature follows the conventions of the Y Chromosome Consortium 2002 (Springer and Human Genetics (2003), “High level of male-biased Scandinavian admixture in Greenlandic Inuit shown by Y-chromosomal analysis”, Bosch et al., Figure 2, is given to the publication in which the material was originally published with kind permission from Springer Science and Business Media).

Arctic. The results of these studies will help to elucidate the movement of Dene peoples across the subarctic, and also illuminate the expansions of Inuit groups (Dorset, Sadlermuit, Thule) across the Arctic over the past several thousand years. Like other First Nations, these populations were also significantly affected by European contact. The emerging fur trade and entry of the Hudson Bay Company during the 18th through 20th centuries had profound



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impact on the social organization and subsistence economy of Aboriginal communities in this region (Ray 1974; Lytwyn 1986; Yerbury 1986; Gough 1997; Raffan 2007). They also suffered significantly from infectious diseases, to which they lacked exposure, with a 1928 influenza epidemic killing an estimated 10 to 15% of the Aboriginal population of the Northwest Territories (Helm 2000). Policies imposed by the Canadian government also presented significant hardships for Aboriginal peoples. These policies disrupted their traditional nomadic lifestyle, caused the removal of Aboriginal children to residential schools where they laregely lost their indigenous culture and language (Miller 1986; Milloy 1999; Indian and Northern Affairs Canada 2010), and disenfranchised Aboriginal peoples from their traditional lands. However, many of these issues are being now addressed through economic development, legal action, and cultural initiatives. First Nations have negotiated land claims settlements (e.g., Tlicho Land Claims and Self-Government Act 2006), received formal apologies (cbc.ca 2008), and The Common Experience Payment (CEP) as part of the 2007 Indian Residential Schools Settlement Agreement (Indian and Northern Affairs Canada 2010). In addition, they have been elected as representatives in provincial and federal governments, and led cultural revitalizations efforts across the north (e.g., Inuvialuit Cultural Resource Centre 2007). Thus, the history of First Nations in this region reflects their efforts to adapt to and work within a new global economic system that was being imposed upon them by European colonists, while also maintaining their own cultural traditions. Due to their reliance on traditional subsistence practices, both Dene and Inuvialuit are actively involved in harvesting a portion of the animal populations that live in the region for subsistence needs. However, in the late 19th century, caribou herds had disappeared from this region, and, by the 1930s, knowledge of maintaining caribou (reindeer) herds was largely lost. These herds were decimated by disease and hunting, and by encroachment on their breeding and grazing grounds. Thus, between 1935 and 1964, a number of Saami families from Norway were invited to the Northwest Territories to train men from Inuvialuit, Alaskan Inupiat, Coronation Gulf Inuit, and Gwich’in communities in reindeer herding techniques (Hart 2001). This effort was intended to establish locally owned and self-sustaining herds that would provide meat to communities that were experiencing shortages before and during that time. Although the herding industry ultimately failed, in part due to government policies on herd management

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(Hart 2001), some of the Saami stayed in the region and married into Inuvialuit families. Thus, today, some ethnically Inuvialuit individuals now bear the mtDNA and NRY lineages of another Arctic people whose origin is an entire continent away (Dulik et al. 2012; Vilar et al. 2014; Schurr et al., unpublished data). A similar picture of tribal history and interaction with Europeans is seen in southeast Alaska. This is Tlingit and Haida country, which is noted culturally for its totem poles, house fronts, and beautifully carved hats and masks, as well as elaborate canoes (Emmons 1991; MacDonald and Huyda 1994). Here, too, research into the history of Tlingit populations is employing DNA studies to clarify the settlement and clan house histories. As with other studies of this kind, the DNA results are being compared with oral history, archeology, ethnographic data, and other evidence to better understand implications of genetic data (e.g., Schurr et al. 2012). Like other parts of the north, these indigenous groups encountered and interacted with Europeans for several centuries. These foreigners included Russians, Spanish, English, and French, and eventually Americans, many of whom had come to this region to hunt fur-bearing animals (Dolin 2010). After the contact period, in the 19th century, the whaling industry brought men from different European nations, as well as places as far away as Fuji and Cape Verde, to the Americas to work on the ships (Tonnessen and Johnsen 1982; Bockstoce 1986; Karttunen 2005; Zhadanov et al. 2010). Some of these men married into indigenous communities or had relationships with women from them, contributing West Eurasian, African, and Polynesian NRY lineages to local populations. The modern fishing economy also led companies to bring in foreign cheap labor from distant lands to work in local salmon canneries. In the early 20th century, these people included Filipino salmon processing workers in Alaska, who were known as the “Alaskeros”. They worked in Alaska during the summer and then moved south to work the “farm factories” of California and eastern Washington in other seasons (Cordova 1983; Friday 1994). After arriving in Alaska, some of the Alaskeros married into Tlingit communities. As a result, the Tlingit now exhibit mostly Native American genetic lineages reflecting their aboriginal past, along with having a minority of lineages originating in European and Southeast Asian populations (Schurr et al. 2012). These historical events have produced a certain hybridity among Ab-



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original peoples of the north. It is mostly biological in nature, as Tlingit groups continue to practice their cultural traditions, and seek ways to reinvigorate their language and ritual. However, the influence of modernization is also unmistakable. This push toward greater integration into the global economic system is reflected by different Tlingit groups considering how to develop tourism in the region, both in terms of ecological tours and cruise liner stops, in order to sustain their communities.

CONCLUDING REMARKS As the preceding discussion attests, patterns of human genetic variation observed today reflect both ancient and historic processes of globalization. In many places around the world—Europe, China, Mongolia, the Americas—genetic studies have revealed complex population histories that have been shaped by thousands of years of human activity. To understand those histories, we can use molecular tools to excavate the layers of genetic evidence that will reveal them. At the same time, we must also examine the DNA data in the context of evidence from archeology, demography, ethnography, history, and linguistics to develop the most complete understanding of the genetic patterns that are observed. It should also be emphasized here that local patterns of genetic variation have changed with contact between peoples from around the world over the past 500 years. The fur trade, slavery, plantation-based agriculture, whaling, commercial fishing and mining industries have brought people from the far corners of the world into new settings, resulting in the mixing of languages, genes, and cultures in these locations. However, this erosion of local genetic patterns in different parts of the world has occurred only recently, leaving those established in prehistory largely intact. Yet, these prehistoric patterns themselves also reflect population movements and interactions that have occurred ever since the emergence and expansion of modern human populations across the globe. Thus, most regions of the world have a multi-layered genetic history that reflects thousands of years of migration, settlement, and population interactions, such as the expansion of Central Asian steppe empires and emergence of Chinese dynastic kingdoms. The question facing us now is how long these patterns will persist in the face of increasing urbanization, growing population densities and global travel.

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4 The Global Financial and Economic Crisis: A Drama in Three Acts Mauro F. Guillén and Sandra L. Suárez

INTRODUCTION

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he global financial and economic crisis that started in 2007 is a rather unique event. It was triggered by the implosion of the U.S. real estate market, whose effects were magnified by the securitization of mortgages and other financial assets, and by the high degree of leverage of financial companies. The crisis spread very quickly to other developed and developing markets through a variety of channels, including finance, trade, and the breakdown of trust and confidence more generally. As a result of its global reach, the crisis has meant the loss of tens of millions of jobs worldwide, trillions of dollars in financial wealth, and the disappearance of some of the most storied financial institutions. The swiftness and gravity of the crisis has also elicited a massive government response in the forms of liquidity injections, bailouts, and economic stimulus efforts of a scale not seen since the 1930s. It is also a crisis that has reopened a series of important intellectual debates, especially those between Keynesians and monetarists, and those between the believers in the so-called efficient market hypothesis and those who propose to approach economic phenomena from a behavioral perspective (Cassidy 2010).

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The crisis is also unique because of its manifold political edges. No account of the crisis would be complete without examining the politics of financial regulation, or lack thereof, and the ways in which politics shaped the choice of government actions to contain and overcome its effects. In this chapter, we consider evidence from several economies around the world to illustrate the extent to which politics played a role in the years preceding the crisis, the response to the crisis, and the possible reconfiguration of the political economy of global capitalism as a result of the crisis.

ACT I: THE FINANCIAL CRISIS IN THE UNITED STATES, 2007–2008 On February 7, 2007, one of the world’s largest banks, HSBC, announced losses related to U.S. subprime mortgage loans. A couple of months later, on April 3, New Century Financial, a subprime specialist, filed for Chapter 11 bankruptcy. In June, Bear Stearns told an incredulous financial community that two of its hedge funds suffered large losses related to subprime mortgages. Other Wall Street standard-bearers also started reeling from bad investments, including Merrill Lynch, JPMorgan Chase, Citigroup, and Goldman Sachs. Before the end of August the problems had spread to some French and German banks, and prompted the Federal Reserve and the European Central Bank to pump liquidity into the banking system and to reconsider their interest-rate policies. These were only the beginnings of a truly global financial and economic crisis that marked the end of one of the greatest financial expansions in history. The recession in the U.S. officially started in December 2007. By mid2009, the crisis had brought to their knees major bank and non-bank financial institutions, causing several to collapse, and led to a severe economic contraction, plummeting trade, rising unemployment, and price deflation. The crisis quickly acquired global proportions after hitting Western and Eastern Europe, Japan, Latin America, the rest of Asia, and parts of Africa. The chain of interrelated trends and events leading to the crisis in the United States is complex. At the core lay the problem of asset price inflation, especially in the stock and housing markets, coupled with the belief that prices would go up indefinitely. With the benefit of hindsight, we know that the bubbles were largely the result of unusually low interest rates between 2001 and 2006. The Federal Reserve could have curbed asset-price in-



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flation. After all, central banks enjoy independence from the political power precisely so that such excesses are avoided (Polillo and Guillén 2005). The Fed’s attention, however, was focused on sustaining the economic recovery. It ignored other signs of economic stress and risky behavior by financial institutions. In particular, Chairman Alan Greenspan was not as technocratic and independent as everyone assumed. In fact, he had behaved in a rather charismatic way since the early 2000s, becoming a larger public figure than the venerable institution he chaired. Most importantly, it appears that he preferred to downplay the first signs of trouble so as to avoid raising interest rates during the months leading to the 2004 presidential election, in a reversal of his policy stand in 1992, when he was accused of undermining George H. W. Bush’s reelection chances. Loose monetary policy was, in many ways, a first important background factor leading to the crisis. A second contributing factor had to do with recent developments in emerging economies, especially China. During the 1990s, emerging economies had witnessed or experienced firsthand what could happen to them in the event of a currency or a sovereign debt crisis, or both. Between 1997 and 1999 several East Asian economies, Brazil, and Russia fell like dominos to the pressures of short-term currency speculators and capital outflows. The International Monetary Fund (IMF) stepped in to provide liquidity, but with accompanying special demands and limitations, including wide-ranging institutional reforms. These “conditionality” clauses became the source of major debates among economists and produced a backlash in emerging economies against the coercive practices of the IMF. In many cases, the policies and reforms mandated by the IMF proved counterproductive (Guillén 2001:190–197; Henisz, Zelner, and Guillén 2005; Stiglitz 2002). China, in particular, took good note of the situation. It embarked on a frenetic policy of amassing foreign reserves and investing them in securities issued by foreign governments, especially the United States. According to IMF (2009b) data, during 2008 China accounted for 24 percent of all capital exports in the world, and the United States for 43 percent of all capital imports. Other big exporters included Germany (nearly 13 percent), Japan (9), Saudi Arabia (8), and Russia (6). After the United States, the largest recipients of capital were Spain (10 percent of the world’s total), Italy (5), and Greece (3). Thus, the world of international capital flows had become polarized between the exporters and the importers, with China and the United States playing the leading roles, respectively. Massive inflows of cheap money from abroad

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helped keep interest rates low in the U.S., thus fuelling the twin asset–price bubbles in the securities and housing markets. One way to reduce the imbalances between the U.S. and China would be for the latter to allow its currency to float, something that Beijing continues to resist since it would reduce the competitiveness of its exports. The crisis, however, would not have reached such massive proportions without the peculiar, and to a large extent unprecedented, developments taking place in the financial sector. Financial institutions, both bank and nonbank, felt strong pressures to meet growth and profit expectations in order to prop up their share price. This aspect in and of itself was not unique to financial services. Corporations across the board were under intense pressure to increase performance, especially at a time when shareholder wealth maximization dominated debates about corporate governance (Davis 2009; Fligstein 1990; O’Sullivan 2000). Low interest rates, however, affected financial and non-financial companies in sharply different ways. A manufacturing firm usually benefits from low rates because it can more cheaply fund its needs for working and fixed capital, and because its customers also see their credit possibilities improve. By contrast, low rates tend to constrain the ability of banks and other financial institutions to make a profit, because when rates are low, spreads are minuscule. And yet, financial industry profits grew during the 2000s from representing no more than 20 percent of all U.S. corporate profits to more than 40 percent. During 2007, on the eve of the crisis, 41 percent of all corporate profits were accounted for by the financial services industry, at a time when it represented about 15 percent of economic activity, as measured by gross value added. These massive profits could not possibly have come from interest rate spreads. Rather, they came from leverage and from fees and commissions collected through the design and sale of new financial products. While non-financial corporations and the government barely increased their leverage, households and, especially, financial institutions did so at a staggering rate. According to the IMF (2009a), by the end of 2007 financial institutions had trebled their leverage when compared to the late 1990s. At the center of the quest to generate shareholder wealth in financial services through leverage and new financial products were a series of perverse incentives. Bonuses were perhaps the most blatant, especially when they were tied to revenue growth and not profits, or when the financial company could generate fees and commissions but not be responsible



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for the risk attached to the products. Concerning top management, stock grants were especially pernicious, as they would perversely reinforce risky behavior so as to meet Wall Street’s expectations. Whether they were selling their products to private investors or purchasing their own products with borrowed money, financial institutions were playing with “other people’s money” furthering the divide between risk and responsibility. Competition for the best traders also proved problematic because they were showered with incentives based on short-term performance, which invited risky behavior as well. Moreover, when compensated in stock, executives and traders borrowed against it in order to maintain a lavish lifestyle. Their own leveraged finances as individuals added to the desire to meet revenue and profit expectations. Moral hazards are another oft-mentioned cause of the crisis. There is some evidence indicating that after the Savings and Loans government bailout in the late 1980s—the largest since the Great Depression—the CEOs of financial institutions came to the realization that the government would not let them collapse. This sense of being ultimately backed up by the taxpayer was probably reinforced by the 1998 bailout of Long Term Capital Management. The government did not finance the bailout of LTCM, but orchestrated it, reinforcing the belief that financial institutions would be protected if they ran into trouble. The actions of the government thus contributed to the intensification of the risky behavior that it should have sought to discourage. Ignorance or irresponsibility regarding the costs of risky behavior afflicted not only financial institutions but individual citizens as well. Just like financial institutions, U.S. consumers lured by lower interest rates and the belief that housing prices would never drop became highly leveraged. When the economy is healthy, borrowing allows individuals to share in the relative prosperity and boost their consumption, but it also makes households more vulnerable to changes in interest rates and disposable incomes. In turn, increases in mortgage delinquency and foreclosures further contributed to the losses of financial institutions. Since the 1980s, household debt as a percentage of disposable income increased to over 100 percent in many developed countries. By 2005, household leverage was 159 percent in U.K, 135 in the U.S., 141 in Ireland, and 107 in Spain and Germany. Leveraged households, however, do not always pose a potential problem. During the 1980s and 90s, the majority of household debt was held by higher-in-

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come families with the means to pay it down. The pressure for profits and the relaxation of financing rules, however, allowed credit to be extended to households with a much smaller capacity to pay it back, especially if interest rates on the loans reset to higher levels (Girouard, Kennedy, and Andre 2006). Initially, the concept of debt securitization and the slicing of mortgages was thought to shield financial institutions from the risk of extending credit to subprime borrowers. But as debt securitization became more popular, the risk actually became more concentrated within U.S. banks. We now know that most holders of securitized debt were highly leveraged financial institutions. Finally, the financial crisis of 2007–2009 has brought to the surface the massive information asymmetries among the various actors involved in the activities of complex financial institutions, including top executives, traders, directors, shareholders, bondholders, raters, insurers, regulators, and so on. Clearly, employees were not telling top executives every detail of their doings, as the bizarre episode of renegade trader Jérôme Kerviel at the French bank Société Générale illustrated. Top executives, whether out of ignorance or not, failed to give directors a clear picture of the situation. Shareholders and bondholders were in the dark, in part because raters and insurers were saying that everything was fine. And even as rating agencies began issuing downgrades and subprime delinquencies started to spike, the IMF (2007:10) reported that financial institutions were “sufficiently capitalized, diversified and profitable to absorb direct losses.” Regulators, for reasons to be analyzed later, were even more in the dark due to their lack of resources and the fragmentation of the regulatory structure.

The Road to Financial Innovation Innovation lies at the heart of the capitalist economy. Financial innovations, however, are peculiar because it is very difficult to protect them from imitation by competitors. Financial institutions quickly learned that innovations such as derivatives could be the source of sustainable profits if new products or structures were constantly designed, new types of underlying assets became available as raw material, technology or expertise barriers could be created, mass production was possible, and at least some of them could be taken off the books in order to maximize the use of the available capital base. The pressure to innovate and engage in increasingly



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risky behavior in order to secure above average returns was also used as justification for the exuberant bonuses, which could no longer be earned by selling the idea of a “mere” 10% return on investment. The pursuit of above-average returns for investors resulted in greater risk-taking through financial innovation. The early successes of JP Morgan and Goldman Sachs in derivatives innovation attracted myriad imitators, including commercial and investment banks, and insurance companies, both domestic and foreign. A key issue in this respect was that the imitators often misunderstood the risks and the limits of the innovations (Tett 2009). The most important innovation in securitization was collateralized debt obligations (CDOs). In essence, you would put a large number of incomegenerating assets such as bonds, mortgages or other types of debt into a pool and then issue securities for sale to investors. CDOs could also be made from other CDOs, and they were called CDOs squared. Yet another type was synthetic CDOs, made from credit derivatives. The issues with CDOs and other securitizations were three-fold. First, originators cared about volume, not quality. Second, in order to calculate the risk you would need to have historical data on how the underlying assets performed over several business cycles. This was certainly possible with bonds issued by major corporations, but not with residential mortgages, simply because there had never been a truly devastating mortgage crisis in the past and the quality of many of the new borrowers was not known, at least not to every financial institution or division within these institutions. In general, default probabilities for CDOs were grossly underestimated. Also, increasingly complex and unreliable computer models had to be used in order to calculate default probabilities when the underlying assets were sliced and diced multiple times. And third, in order to maximize profits, originators needed to mass produce the securities, move assets off balance to free up capital, and obtain the highest possible rating for a given return level. Among other tactics, they engaged in “ratings arbitrage,” whereby originators exploited loopholes in the rating agencies’ computer models (Tett 2009). Credit derivatives were the other important financial innovation, and the one that brought AIG down, at a cost of $180 billion to taxpayers. In the classic credit default swap (CDS), the buyer makes a periodic payment and receives a payoff from the seller if an underlying debt instrument such as a loan or bond defaults. CDSs have certain peculiarities that are important to note. First, the buyer need not own the underlying instrument. Second, the

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seller need be neither a regulated insurer nor have set aside enough capital to cover potential losses. Third, the seller often misunderstood the risk inherent to the underlying instrument. And fourth, the buyer might be fooled by a false sense of security and take on more risk, thus exacerbating moral hazard. The mounting pile of mortgage debt from the credit expansion of the 2000s provided excellent raw material for derivatives. Subprime loans were especially attractive to originators because of their high interest rates; all they needed to do was persuade the rating agencies and the investors that the slicing and dicing reduced the risk while preserving the return. Moreover, CDOs and CDSs were over-the-counter instruments, meaning that there was no central clearinghouse or market. The result was a lack of transparency concerning the risk-return profile of the innovative products.

The Politics of Deregulation The rapidly changing regulatory landscape of the 1990s and 2000s contributed to the financial meltdown by allowing—even encouraging—the system to become more complex and tightly coupled. The overall trend since the 1980s was one of removal of obstacles to the free unfolding of market forces and to the introduction of sophisticated financial innovations, under the assumption that markets could self-regulate. In 1986, Margaret Thatcher set into motion a major revolution in financial services with the so-called London Big Bang. This reform should be seen in the context of a package of “neo-liberal” reforms (Fourcade-Gourinchas and Babb 2002). Fixed trading commissions were eliminated, electronic trading introduced, and the cozy club of City insiders was effectively dismantled. Over the next two decades, London regained its long-gone status as a global financial center, attracting the likes of JP Morgan, Lehman and AIG. The fact that regulatory oversight was less stringent in London made it a magnet for U.S. financial institutions as a location in which to experiment with new financial products. Meanwhile, regulatory developments in the U.S. were creating a more fertile ground for financial innovation and risk taking, and making the financial system both more complex and more tightly coupled. In the early 1990s, regulators and Congress considered several initiatives and bills to monitor and oversee the expanding universe of derivatives. Intense industry lobbying caused these initiatives to be shelved. In 1996 the Fed made the astonishing decision to allow financial institutions to reduce required reserves if they used credit derivatives to curb risks. Perhaps the most prominent



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piece of legislation from the 1990s was the Financial Services Modernization Act of 1999, which repealed the even more famous Glass-Steagall Act of 1933 and amended the Bank Holding Company Act of 1954 to permit commercial banks to enter the securities and insurance business and viceversa. Then Treasury Secretary Lawrence Summers explained that “at the end of the 20th century we will at last be replacing an archaic set of restrictions [on financial activity] with a legislative foundation for a 21st century financial system.” He asserted that the legislation “would provide significant benefits to the national economy” (as quoted in Labaton 1999). There are many factors that contributed to the dismantling of the Depression-era regulations, among them, international competition, the ideological convergence of the Republican and Democratic parties, and changes in the market place resulting in a convergence of interests among commercial banks, securities firms and insurance companies. For many years after the Great Depression, American commercial banks operated differently from European banks. Since the early 1980s, financial interests argued that Glass-Steagall should be repealed to enable American banks to enter the securities business. Though initially the argument emphasized the banks’ loss of business to other domestic financial institutions, eventually U.S. banks argued that they could not compete with Japanese banks, which had become among the largest in the world and were able to operate securities firms in the U.S. Then in 1986, Margaret Thatcher’s decision to revolutionize the financial services sector with the so-called London Big Bang put additional international competitive pressure on U.S. policymakers. In 1987, the Reagan Administration announced that Treasury had concluded that American banks should be allowed to merge with other financial institutions if they were going to be able to compete in the international arena (Nash 1987). In 1989 the Bush White House was also explicit in that international competition was a motivating factor for advocating a regulatory change. The argument made at this time was not that U.S. banks could not compete with British banks, but that the City of London had taken over New York City as the financial capital of the world (Choi, Park, and Tschoegl 2002). These competitive pressures coincided with the ideological convergence of the Republican and Democratic parties on a deregulation agenda. The repeal of Glass-Steagall and amendments to the Bank Holding Company Act occurred with a Republican Congress and a Democratic President. Democrats in Congress had opposed the integration of banking,

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securities, and insurance businesses in the mid 1980s, but would eventually reverse their position and follow the lead of the Clinton administration. In 1992, Bill Clinton captured the White House after 12 years of Republican administrations by claiming to be the leader of a new Democratic party, one that would embrace private sector growth vs. government sector growth. Clinton’s margin of victory over the other contenders for the Democratic Party nomination had allowed him to set a more pro-business agenda than the one advocated by the more traditionally liberal Democratic constituencies (Borrelli 2001). The Clinton administration supported financial deregulation from the outset. Then, when in the 1994 mid-term elections the Republican Party won a majority position in both the House and Senate, the stage was set for a major overhaul of the depression-era regulations long advocated by the large commercial banks. The evolution of business interests with regards to the dismantling of the depression-era regulations was the result of important changes in the financial markets. During the 1960s and early 1970s, large commercial banks had very little interest in expanding into other areas of finance because they were able to make money from interest-free or low interest deposits, safe government securities and commercial loans. By the mid 1970s, their profitability started to erode in part because bank customers began to look for more profitable investments such as mutual funds and money market accounts, and borrowers were able to secure loans from other sources such as commercial paper and junk bonds (Wilmarth 2002). From the point of view of the banks, the fact that their customers were no longer using their services meant that their territory was being invaded by securities firms. Thus, commercial banks complained to Washington that the playing field should be leveled and they should be permitted to enter the securities business. Commercial banks did take advantage of the removal of restrictions to intrastate and interstate mergers and bank operations and responded to the reduced profits by acquiring competitors. During the 1980s and 1990s, there was a big wave of commercial bank consolidations. After literally thousands of mergers, what emerged was a completely transformed banking sector dominated by large banks. There was significant consolidation in Europe as well. U.S. and European banks took advantage of financial deregulation in the U.K. and also acquired a number of investment banks (Wilmarth 2009). Lobbying, and the corresponding campaign contributions, by commercial banks did not let up. Their efforts were thwarted by the securities and insur-



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ance industries, which did not want competition from commercial banks. Legislators were also wary of allowing federally insured commercial banks to merge with other financial firms whose profitability was more volatile. Eventually, the securities industries decided to end their longstanding opposition to the repeal of Glass-Steagall. In the exchange, securities firms wanted to be allowed to expand into commercial banking and have access to the Fed’s emergency borrowing. Commercial banks wanted entry in the insurance industry as well and continued to pressure congress for across the board integration of financial services. By the mid 1990s, however, the insurance industry was making waves in a way suggesting that they also wanted Congress to permit them entry into commercial banking. Theirs was also a defensive move in reaction to the 1996 the Supreme Court ruling that permitted national banks to sell insurance in towns of 5,000 or fewer residents. In July 1997, State Farm Mutual Automobile and Casualty Insurance, at the time the largest property and casualty insurance company in the U.S., announced that it had filed an application with the Office of Thrift Supervision to form a commercial banking subsidiary (New York Times 1997). A few months later, the Travelers Group, which was also amongst the largest U.S. commercial and property insurers and which also owned Smith Barney, a brokerage firm, announced its acquisition of Salomon Brothers, an investment house. By all accounts, Travelers had wanted to merge with a large commercial bank but knew that regulators would likely block the acquisition; it decided to shop for an investment firm instead. When Travelers failed in its efforts to acquire Goldman Sachs, it opted for Salomon Brothers. Reflecting the trend towards the consolidation of financial services, the New York Times remarked that “after combining with Salomon Inc., Travelers will rival the likes of Merrill Lynch & Company, the American Express Company and Citicorp, as well as the biggest financial companies in Europe and Japan” (Truell 1997). State Farm’s decision to enter the banking industry and the Travelers Group’s being public about its desire to merge with a large bank illustrates how the interests of insurance firms had changed. Along with securities firms, insurance companies would now pressure Congress to legislate a repeal of Glass Steagall and the Banking Act to enable them entry into the commercial banking and securities business. In 1998, Citicorp announced that it was merging with Travelers, creating the world’s largest financial services company, one combining commercial banking, securities, and insurance services. The announced merger

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was a complete turnaround; the Chairman of Citibank had been known for his dislike of the securities business. However, it was the Chairman of Travelers who first approached Citibank. The new entity now known as Citigroup, along with other large commercial banks, securities firms and insurance companies, would become a major supporter of a legislative overhaul of the depression-era regulations because without it federal regulators would have no choice but to force it to break up within two to five years. The passage of the Financial Modernization Act of 1999 thus signaled the end of an era when the fear that financial entities could become “too big to fail” had kept financial deregulators at bay. The removal of restrictions per se did not necessarily have to spell trouble. After all, many countries around the world allowed integrated and diversified financial firms to operate. Unlike in other countries, however, the U.S. regulatory structure was not overhauled in order to guarantee the stability of this radically changed financial system. This was the key mistake made by the Clinton administration, later compounded by the lack of oversight during the Bush years. Commercial banks continued to be supervised by the Federal Reserve, the Office of the Comptroller of the Currency, the FDIC, and individual states. Securities firms were primarily under the watch of the Securities and Exchange Commission (SEC). Insurance companies were regulated by individual states and by the Department of Labor. After 1999, a diversified financial services company was allowed to choose the regulator for each of its businesses, leading to a situation in which no single government body had a 360-degree view of the entire portfolio of each company and the associated systemic interactions. The Commodity Futures Modernization Act of 2000 also added to the problem by treating swaps as distinct from futures or securities. This essentially meant that neither the SEC nor the Commodity Futures Trading Commission (which is overseen by the U.S. Congress Agriculture committee and was explicitly barred by Congress from regulating the over-the-counter derivatives market shortly after Long-Term Capital Management’s bailout) could supervise these new, and potentially lethal, financial products. Industry lobbying was very effective at obtaining a favorable ruling on the part of the SEC concerning leverage ratios. In 2004 the agency voted to raise them. Not surprisingly, Lehman, Bear Stearns, and Morgan Stanley increased their asset-to-equity ratios above 3,000 percent, and Merrill Lynch and Goldman Sachs to above 2,500 percent.



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The case of AIG, by far the largest and most costly bailout to date, illustrates the effects of deregulation and fragmented supervision. Before the end of 1999, the ink on the Modernization Act still fresh, AIG acquired the status of thrift holding company, when the Office of Thrift Supervision (OTS) approved its application to charter AIG Bank. It also received approval to buy a small savings and loan bank in Delaware. The OTS had been created in the wake of the savings and loan crisis to replace the Federal Home Loan Bank Board, and had virtually no expertise in credit derivatives. Still, AIG’s infamous financial products division (based in London), as well as the thrifts at General Motors, General Electric, and some divisions of Lehman Brothers, Merrill Lynch, and Morgan Stanley came under the supervision of the OTS, primarily because these firms chose it as the regulator. After lobbying European regulators, the OTS was conferred equivalency for supervising AIG between 2004 and 2007, which meant that it was the only agency supervising the company’s London operation and its growing portfolio of derivatives, which eventually reached 1.5 trillion dollars (Gerth 2008). In early 2007 the Government Accountability Office (GAO) issued a bruising report documenting the lack of expertise at several of the regulatory agencies, including OTS, when it came to supervising derivative products (GAO 2007). On 3 March 2009, Ben Bernanke summarized the situation at a Senate hearing when he stated that AIG “exploited a huge gap in the regulatory system” and that “there was no oversight of the [AIG] Financial Products division” (Gerth 2008). AIG could not be allowed to fail, however, because its credit-default swaps were used to insure the mortgage-backed holdings of FDIC-insured commercial banks as well as of other financial institutions. Among AIG counterparties that were perceived as “too big to fail” and received 100 cents on the dollar on their insured mortgage-backed securities were U.S. companies such as Goldman Sachs, Merrill Lynch, Bank of America, Citigroup, and Wachovia, but also many European banks such as Société Générale, Deutsch Bank, UBS, and The Royal Bank of Scotland.

ACT II: GLOBAL CONTAGION, 2008–2009 The problems in the U.S. spread quickly around the world due to the tight interconnections among economies and financial systems. In fact, during the 1980s and 90s, the global economy had become more complex

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and interconnected. The global economic and financial system became much more complex during the 1990s and 2000s for two reasons. First, there was a pronounced increase in the number and size of multinational firms and their subsidiaries. This important change meant that more decisions about investments and job creation were being made by transnational actors. While in 1980 the cumulative stock of foreign investment by multinational firms amounted to 6.7 percent of global GDP, by 2007 the figure had risen to 27.9 percent (UNCTAD 2009). Second, the growth of global imbalances stemming from the rise of the United States as the consumer of last resort, and China as the leading exporter of capital, meant that U.S. securities, both public and private, were purchased by investors from around the world and showed up on the balance sheets of banks in Asia and Europe (IMF 2009b). According to the Bank for International Settlements, crossborder banking external assets stood at 54.0 percent of global GDP in 2005, up from 13.7 percent in 1980. At the same time the global economic and financial system was becoming more complex, it was also turning more interconnected, for two reasons. First, all sorts of companies, not just multinational ones, engaged in restructuring, outsourcing, and off-shoring as ways to reduce costs and increase operational flexibility (Gereffi 2005). The value chain of product development-production-distribution was broken down into its various constituent activities and located in different parts of the world in a breathtaking quest for lower costs. As a consequence, more intricate patterns of cross-border trade, not only in finished goods but especially in intermediate inputs, subassemblies, and services, meant that problems or disruptions in one part of the global trading system would affect other parts almost instantaneously. The increasing prevalence of just-in-time supply chains also contributed to the sharp increase in the degree of tight coupling because they eliminated the buffer or cushion afforded by inventories of intermediate inputs and finished goods. The liberalization of trade in services and of capital flows during the 1990s was the second factor behind the tight coupling of the global economic and financial system. Trade negotiations during the early 1990s yielded an unprecedented commitment to free trade in services and the creation of the World Trade Organization (WTO) in 1995. China’s entry into the WTO in 2001 represented a key milestone in the integration and tight coupling of the global trading system. The liberalization of cross-



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border capital flows was an even more important process, including trading of foreign stocks and bonds, borrowing in foreign currencies, listing shares abroad, and currency trading (Abdelal 2007; Davis 2009). For instance, capital flows amounted to about 21 percent of global GDP in 2007 up from 6 percent in 1996 (Blanchard and Milesi-Ferretti 2009). While in 1980 daily currency exchange turnover amounted to about 0.7 percent of global GDP during the entire year, as of April 2007 it had increased more than nine-fold to 6.6 percent according to the Bank for International Settlements. The greater ease and volume of cross-border capital flows had the consequence of constraining policymakers’ ability to influence market developments, especially during times of crisis. Governments lost autonomy as market participants could move money from one country to another at dizzying speed. Given this background of increasing complexity and interconnectedness in the global economic and financial system, it is no surprise that one of the key characteristics of the crisis has been its rapid spread around the world in terms of reduced economic growth and rising unemployment. Except for the Great Depression of the 1930s, previous financial crises had been regional in scope, affecting just a few countries (Glick and Rose 1999). For instance, the economic and monetary crises of the early 1970s affected the most developed economies in the world, but not the developing world. In 1992, a new episode of monetary turmoil unfolded in Western Europe alone. In late 1994, the Mexican crises spread to other emerging and developing countries, but not to the developed world. In 1997, the so-called Asian Flu diffused throughout East Asia and parts of Latin America like wildfire, but spared other parts of the world, except for South Africa and two or three Eastern European countries. Thus, as of 2007, the possibility of a truly global economic and financial crisis was not something that most people were entertaining, even after the first signs of serious trouble became readily apparent. The crisis of 2007–2009 was different primarily because of the very different ways in which it spread globally (Reinhardt and Rogoff 2009). In most countries, the causal chain leading to financial and economic problems did not primarily involve a direct impact from U.S. toxic financial products, although some banks in Germany and Switzerland reported heavy subprime losses as early as August and October 2007, respectively. In the United Kingdom and Ireland, the causal chain started, as in the U.S., with the bursting

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of the domestic real estate bubble infecting the financial sector and in turn bringing about a severe economic recession. In a second group of countries, the problems started in the financial sector and then spilled over into the non-financial, real economy. In the dramatic case of Iceland, the problems originated in bad financial investments and cross-border arbitrage bets. In Switzerland, bad financial investments by UBS and other banks (and falling trade volumes) hit the real economy hard. In most Eastern European countries, growth was based on foreign borrowing, which largely evaporated as a result of the global financial turmoil. The ensuing credit contraction brought these economies to a standstill. Persistent currency depreciations made matters worse in Hungary, Poland, and the Czech Republic. Meanwhile, countries with fixed exchange rates (Bulgaria, the Baltics) ran the risk of a sudden devaluation. A third causal chain started with a drastic fall in construction and real estate activity that infected the real economy, and could potentially affect the financial sector as has happened in Spain and Dubai. Construction had been a major engine of economic growth and employment in both countries. The quick reversal of fortune in that sector spilled over into the real economy very fast, causing growth to slow down and unemployment to soar. These countries also suffered from lower tourist arrivals and, in Dubai’s case, reduced global trade. Depending on how long and deep the recession proves to be, the financial systems of these countries could be severely affected. A fourth chain involved the decline in trade and its devastating effects on industrial production and employment in export-oriented economies such as China, Mexico, Japan, Germany, and, as noted above, Switzerland. The smaller, export-oriented Eastern European countries also suffered from the decline in trade. Finally, exporters of commodities were hurt by the sudden drop in prices, including Russia and several Middle Eastern, South American and African countries, as well as Canada and Australia. These causal chains indicate that the crisis diffused from the U.S. to export-oriented economies through the trade channel, especially in a situation in which proportionally speaking more trade is destroyed as GDP growth slows down as a result of the off-shoring of so many business functions and intermediate goods. A second group of countries experienced economic difficulties when their domestic construction, real-estate, and/or financial sectors got into trouble. Very few countries have been directly and signifi-



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cantly affected by U.S. toxic financial products. As the IMF recently noted, “the United States is grappling with the financial core of the crisis” (IMF 2009b:63). The complexity and tight coupling of the global economy and financial markets facilitated the spread of the crisis.

Politics, Ideology, and the Responses to the Financial Crisis Government officials and central bankers responded with different degrees of urgency to the crisis, due not only to the lags in its spread around the world, but also because of the different ways in which each country entered the crisis, political preferences and ideologies, and the power of interest groups. Most of the early policy responses had to do with a strategy of containment, especially in terms of interest rate reductions, emergency liquidity support, and enhanced guarantees for bank deposits. These measures sought to provide the buffers and cushions that the tightly coupled financial system lacked. Other more extreme measures, like a suspension of the convertibility of bank deposits and regulatory capital forbearance, were avoided for their politically costly or even counterproductive effects, although they had been used in other recent banking crises around the world (Laeven and Valencia 2008). Policymakers then turned to resolution strategies. The repertoire of potential measures included workout programs of bad loans, government insurance of bad debt, the transfer of bad debts to a government asset management company (a “bad bank”), sales of financial institutions to new owners, government intervention and recapitalization of banks, and bank liquidations (Laeven and Valencia 2008). In the two large countries with the most severely damaged financial systems—the U.S. and the U.K.—the government and the central bank followed different approaches. In the U.K., the government moved swiftly to nationalize the first victim (Northern Rock) in February of 2008, and other smaller institutions, including Bradford & Bingley, and effect major recapitalizations through state ownership of the country’s major banks, such as Lloyds and Royal Bank of Scotland. By contrast, U.S. policymakers engaged in a haphazard series of actions, in part driven by the pressures from the banks themselves, and by the difficulty of selling to the Congress and the public massive government intervention in the financial sector. Thus, during the crucial year of 2008, U.S. policymakers implemented a breathtaking variety of responses (Stewart 2009): in March they orches-

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trated the takeover of Bear Stearns by JP Morgan; in July regulators seized IndyMac; in September mortgage giants Freddie Mac and Fannie Mae were brought under government conservatorship; in September Lehman Brothers was let go bankrupt, in a decision that sent the markets into a tailspin; shortly thereafter, a lifeline was established for AIG, Bank of America took over Merrill Lynch, JP Morgan acquired Washington Mutual, and Citigroup was slated to purchase Wachovia, although Wells Fargo finally got the prize a month later; in early October Congress passed a $700 billion Troubled Assets Relief Program (TARP), subsequently used to recapitalize Citibank ($25 billion), JP Morgan Chase (25), Bank of America (20), Wells Fargo (20), and, after converting themselves into bank holding companies, Goldman Sachs (10) and Morgan Stanley (10); in November AIG became practically owned by the government while Citigroup received a lifeline potentially worth $306 billion and a further capital injection of $20 billion, leaving the government with a one-third equity stake; and in December GM and Chrysler received approval for bailout funds of up to $18 billion. The Obama Administration, for its part, passed through Congress a stimulus packet worth $787 billion and a modified Troubled Asset Relief Program (known as TARP II), whose implementation had not yet started as of late 2009. Meanwhile, the largest banks went out of their way to return bailout money in order to free themselves from government impositions, especially those having to do with executive compensation. Given the Fed’s policy of offering free funds to the banks upon request and the government’s implicit guarantee of banking activities as the lender of last resort, it is not surprising that banks could make profits during the second half of 2009, even though they had not unloaded the toxic assets that brought them down in the fall of 2008. Other countries have not had to deal with massive problems in the financial sector, but with a major economic downturn or the potential for one. As a result, they have not engaged in major financial bailouts and reengineering, but in fiscal stimulus to prop up the real economy. A noteworthy case is China, which approved a vast stimulus packet worth 5.5 percent of GDP in 2009 and 6.5 percent in 2010, three times larger than the U.S. stimulus. India also announced a similarly large packet. In both cases, up to 90 percent of the money will be spent on physical infrastructure projects, whereas in the U.S. only 10 percent will, with the rest going into tax credits for families, education, science and technology, renewable energy, Medicaid, un-



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employment benefits, and healthcare information technologies. Clearly, the political process—rather than the counter-cyclical impact of the spending— shaped the allocation of funds. Europe appears to be divided, also for ideological and political reasons. The U.K. approved a fiscal stimulus as big as the U.S.’s relative to the size of the economy, and France has implemented an infrastructure program, but Germany had been much more reluctant to spend its way out of the recession For historical and ideological reasons, the Germans felt they could live with high unemployment but wanted to avoid inflation at all costs, while the French had the reverse preferences. Yet, after first attempting to survive the crisis with a limited stimulus package in 2008, earning Chancellor Merkel the nickname of “Frau Nein,” the German government announced a much larger second package ($63 billion) in early 2009. Meanwhile, researchers at the IMF demonstrated that a coordinated global stimulus would be somewhat more effective at turning the global economy around than individual efforts by different countries, in large measure because the spending from any stimulus packet leaks or spills over into other countries due to trade and other interconnections (Freedman et al. 2009).

ACT III: THE SOVEREIGN DEBT CRISES OF 2010 ONWARDS The liquidity injections, financial bailouts, and economic stimulus efforts implemented by governments around the world succeeded at containing the crisis. Several economies declared by early 2010 the end of the recession. In particular, Brazil, Russia, India, and, especially China, reported robust GDP growth figures, and the United States emerged out of the recession by the second quarter. Smaller economies like Turkey, Malaysia, South Korea, Taiwan, Thailand, Egypt, and Peru, among others, also grew vigorously in the final months of 2009. The measures adopted to confront the crisis, however, resulted in a rapid deterioration of public finances. By 2010, the sovereign debt burden of the G7 countries as a percentage of GDP grew to 115 percent, up from 70 percent just before the crisis, thus reaching a level not seen since 1950 (IMF 2010b:4). While unemployment continued to lag, the macroeconomic landscape had improved considerably by mid 2010 in the world’s major economies, with the notable exception of Western Europe in general and the Eurozone in particular, where Act II of the crisis unfolded. The core problem in the

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Eurozone was relatively simple to describe. After ten years of a seemingly successful implementation of Economic and Monetary Union (EMU), the 17-country single currency area came under speculative attack beginning in December 2009. At the time, the euro was trading slightly above 1.5 U.S. dollars, with the record having been set at nearly 1.6 in July of 2008. By May 2010, the euro plunged to 1.27, though still well above the historical minimum of 0.84 in October 2000. Although the euro had sustained even sharper declines earlier during the crisis, especially in the second half of 2008, the situation in early 2010 was different because speculation was focused on the so-called peripheral member countries, also referred to as the PIIGS, namely, Portugal, Ireland, Italy, Greece and Spain. In fact, the IMF had already called attention to this group of countries, dryly noting that “financial market participants are increasingly focusing on fiscal stability issues among advanced economies” (IMF 2010a:4). Confidence in the euro was undermined by speculation in the markets that these countries would eventually default on their large government debt burden. The recession reduced tax revenue at the same time that boosted expenditures on unemployment benefits, bringing the budget deficit to levels as high as 12 percent of GDP. The risk premiums for sovereign debt skyrocketed in the European western and southern periphery. Greece and Ireland had to be bailed out in 2010, and Portugal in 2011.

The Politics of the Sovereign Debt Crisis The euro crisis that started in 2010 had more to do with politics than with economic realities. Greece was certainly in bad shape economically and financially. The markets and other European countries lost all confidence in its ability to clean house after it became known that the government had lied about the true size of the government deficit. Greece also had the largest debt burden of all peripheral euro countries, at over 120 percent of GDP, followed by Italy’s 110. The Greek economy had seen its competitiveness eroded due to high taxes, wages, and other types of costs, which had risen well in excess of productivity gains during the subsidy-fueled economic boom of the late 1990s and early 2000s. Greek political institutions—parties, government agencies, and the like—failed miserably to galvanize support for a shift in economic policymaking so as to help the country pursue a more sustainable path to economic growth, one not dependent on foreign capital and subsidy inflows, and on the creation of new government jobs.



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The major Eurozone economies—especially Germany and France— and the European Union itself hesitated for weeks as to how to cope with the rapidly unfolding Greek sovereign crisis, in part because of domestic political considerations, namely, the reluctance of taxpayers to bail out a country they perceived as a free-rider. This feeling was particularly acute in Germany, where sitting conservative Chancellor Angela Merkel waited until a key regional election in early May 2010 to push hard for the creation of a massive one-trillion dollar fund to assist eurozone countries with sovereign debt problems, of which about 12 to 16 percent was expected to be allocated to Greece over the following three years. At Germany’s insistence, both the European Union countries and the IMF contributed to the fund. Markets calmed down in the wake of the more unified and decisive approach to the sovereign debt crisis signaled by the establishment of the fund. In November of 2010 the EU agreed to a €85 bail-out program for Ireland and in May of 2011 to a €78 rescue package for Portugal. During the month of August of 2011, after months of speculative attacks on peripheral European government bonds, the European Central Bank took the unprecedented step of buying Italian and Spanish bonds in order to calm the markets, a measure that the Federal Reserve had adopted earlier during the crisis. It was also a question of whether budget deficits would become a major problem in the other two heavily indebted economies, the United Kingdom and the United States, which were also running budget deficits of 13 and 11 percent of GDP, respectively, and had accumulated debts in excess of 60 percent of GDP, and also faced large trade deficits (Bergstren 2009). The European sovereign debt crisis is complex primarily because European banks own much of the bad debt of peripheral countries. For instance, as of the summer of 2010 German banks carried on their balance sheets €74.3 billion worth of Greek, Spanish, Portuguese, and Irish government bonds, equivalent to 48 percent of their highest-quality capital, the so-called tier 1. French banks owned €25.5 billion or 14 percent of their tier 1 capital (Blundell-Wignall and Slovik 2010). This situation essentially presented policymakers and politicians with two options. The first would be to bail out peripheral countries if they become unable to refinance their debts. The second would be to restructure peripheral debt in such a way that bondholders take a hit, thus making it necessary to bail out some of the banks with the highest exposure, especially the German banks, the Greek banks

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(whose holdings of Greek debt equal 226 percent of their tier 1 capital), and the Portuguese banks (69 percent). If Spanish government debt were to be restructured, Spanish banks would also be pushed down the precipice because of their huge exposure, equivalent to 113 percent of their tier 1 capital. In the event that Italian government bonds lost value, the exposure of German banks would double and that of French banks nearly triple. The capital of Italian banks would be virtually wiped out (Blundell-Wignall and Slovik 2010). Thus, the debate in Europe in the fall of 2011 was more about whether to use taxpayer funds to rescue countries or to bail out the banks. One analysis projected that those with the greatest problems would be Royal Bank of Scotland, Deutsche Bank, Société Générale, UniCredit, Groupe BPCE, Commerzbank, and Bankia. In addition, the Franco-Belgian banking giant Dexia was nationalized in October of 2011 (Adler 2012; Lewis 2014).

Fiscal Austerity and Economic Growth Another important aspect of the third phase of the crisis is the tradeoff between fiscal austerity and economic reform (Blyth 2013; Gorton 2012). Unfortunately, since the end of 2010 governments in Europe and North America simultaneously sought to reduce their deficits mostly by cutting expenditures. In a situation in which beggar-thy-neighbor, export-oriented growth was difficult if not impossible and domestic consumer demand anemic, government austerity reduced GDP growth in most Western economies. The IMF’s Global Financial Stability Report published in April of 2010 emphasized the need for fiscal adjustment, but in ways that would be politically sustainable: To address sovereign risks, credible medium-term fiscal consolidation plans that command public support are needed. This is the most daunting challenge facing governments in the near term. Consolidation plans should be made transparent, and contingency measures should be in place if the degradation of public finances is greater than expected. Better fiscal frameworks and growth enhancing structural reforms will help ground public confidence that the fiscal consolidation process is consistent with long-term growth. (IMF 2010b:xii.) By October of 2011, many economists predicted that a double-dip recession was in the making and would soon be corroborated by GDP statistics.



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In August 2011, the newly installed IMF Managing Director Christine Lagarde put it delicately: Shaping a Goldilocks fiscal consolidation is all about timing. What is needed is a dual focus on medium-term consolidation and short-term support for growth and jobs. That may sound contradictory, but the two are mutually reinforcing. Decisions on future consolidation, tackling the issues that will bring sustained fiscal improvement, create space in the near term for policies that support growth and jobs. (Lagarde 2011) The IMF correctly diagnosed the problem as one of excessive debt on the balance sheets of households, non-financial corporations, financial institutions, and governments. Until deleveraging takes place, it will be hard for banks to resume lending, for investors to feel at ease, for consumers to spend, and for governments not to feel under the gun of the bond vigilantes. Each of these factors will contribute to slower growth, persistently high unemployment, and likely social unrest. At a time of high leverage, however, austerity by itself may aggravate the problem, as a growing chorus of economists has pointed out (Krugman 2013), especially if all countries in Europe pursue them simultaneously. The IMF has warned about unwanted effects of one-size-fits-all austerity, although it oftentimes has contradicted itself in actual policy: This suggests that for many countries, deficit reduction would ideally be deferred to the future, when its output costs would likely be lower…Monetary policy should remain accommodative for the foreseeable future, and structural policies to promote growth should also be pursued. The composition of fiscal adjustment could also be tilted to mitigate its adverse impact on the most vulnerable. (IMF 2013:37) In early 2013 the Eurozone officially went into a feared double-dip recession. While economic growth in the northern surplus economies was nothing to rave about, unemployment was relatively low. By comparison, the southern economies were deeply into recession, and joblessness surpassed 20 percent in several countries. Austerity measures failed to either rein in the public deficit or spur economic growth.

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Spontaneous Protest Movements In early 2011 the world witnessed the Arab Spring, a series of spontaneous protest movements across the Arab-speaking world that started in Tunisia and Egypt, where long-standing authoritarian regimes were toppled. The Libyan government proved more difficult to dislodge, and fighting between protesters and the security forces continued in Yemen and Syria through the fall of 2011. Lack of economic opportunity for the young in a part of the world in which over 40 percent of the population is under the age of 25 was a major background factor. The revolts triumphed when external pressure and the withdrawal of the army’s support for the incumbent dictator made regime continuity impossible. It is still unclear, however, whether the Arab Spring will result in a transition to democracy or not. Spontaneous protests against economic injustice, corporate greed and runaway financial institutions also took place in developed countries. They started in the United Kingdom in early 2011 and turned violent in August. Peaceful protest movements occurred in Spain starting in May (the so-called indignados), Israel in July, and the United States in September (“Occupy Wall Street”). In October a global “Day of Rage” was observed around the world. It is still too early to gauge the impact that these protests might have on policymaking or elections, or if a fourth phase of the crisis may be dawning as the focus of attention shifts from the halls of political power to the streets.

CONCLUDING THOUGHTS: GLOBALIZATION AND THE CRISIS While it is perhaps too early to draw any definitive conclusions about the causes of the crisis, the effectiveness of the policy solutions to contain and resolve it, and the best ways to prevent a similar meltdown in the future, it is perfectly possible to make solid arguments about the role that global forces played in its unfolding. As far as the implosion of U.S. financial markets in 2007 and 2008 is concerned, there are two paramount global factors that played a decisive role. First, the loose monetary policy that paved the way to the bubbles in the markets for stock and for housing was made possible by the massive accumulation of trade surpluses and savings in emerging economies, especially China. Second, financial deregulation in the U.S. was driven by a combination of economic and political changes, in part fueled by London’s earlier deregulation drive and its implications for New York’s



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supremacy as the world’s leading financial center. The way in which the crisis spread from the U.S. to other countries around the world in 2008 and 2009 is another way in which global processes were at play. U.S. problems diffused like wildfire through financial and trade circuits. One could also argue that plummeting confidence in financial markets and institutions provided the right kind of context in which even countries with relatively strong banks suffered the consequences. The rapidly evolving sovereign debt meltdown that started in 2010 provides yet another example of globalization at work. Starting with problems in relatively small and peripheral economies in Europe, sovereign debt concerns rattled the markets and posed a fresh challenge to the incipient economic recovery in various parts of the world. The financial and economic crisis has thus reminded us about the increasingly interconnected nature of the global system. It is reasonable to argue that, while the world has historically seen other periods of intense economic and financial integration, the crisis has put on the agenda the need for reexamining certain aspects of economic and financial globalization and the urgency of building a strong framework of collaboration among governments to prevent crises from spiraling out of control. Globalization has not only made us keenly aware of planetary interdependencies, but also brought about a system of interconnected markets in which confidence is essential but easily undermined.

REFERENCES Abdelal, R. 2007. Capital Rules: The Construction of Global Finance. Cambridge: Harvard University Press. Adler, J. 2012. Raging Bulls: How Wall Street Got Addicted to Light-Speed Trading. Wired, http://www.wired.com/2012/08/ff_wallstreet_trading/all/, accessed June 22, 2014. Bergstren, F.C. 2009. The Dollar and the Deficits: How Washington Can Prevent the Next Crisis. Foreign Affairs (November–December 2009):20–38. Blanchard, O., and G.M. Milesi-Ferretti. 2009. Global Imbalances: In Midstream? IMF Staff Position Note SPN/09/29, December 22. Blundell-Wignall, A., and P. Slovik. 2010. The EU Stress Test and Sovereign Debt Exposures. OECD Working Papers on Finance, Insurance and Private Pensions, No. 4, OECD Financial Affairs Division, Paris: Organisation for Economic Coopera-

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tion and Development. Blyth, M. 2013. Austerity: The History of a Dangerous Idea. Oxford: Oxford University Press. Borrelli, S.A. 2001. Finding the Third Way: Bill Clinton, the DLC, and the Democratic Platform of 1992. The Journal of Policy History 13:429–462. Cassidy, J. 2010. After the Blowup: Laissez-Faire Economists Do Some Soul-Searching—and Finger-Pointing. The New Yorker January 11:28–33. Choi, S.R., D. Park and A. Tschoegl. 2002. Banks and the World’s Major Banking Centers. Working paper, Financial Institutions Center, The Wharton School: Philadelphia. Davis, G.F. 2009. Managed by the Markets: How Finance Re-Shaped America. New York: Oxford University Press. Fligstein, N. 1990. The Transformation of Corporate Control. Cambridge, MA.: Harvard University Press. Fourcade-Gourinchas, M, and S.L. Babb. 2002. The Rebirth of the Liberal Creed: Paths to Neoliberalism in Four Countries. American Journal of Sociology 108:533–579. Freedman, C., et al. 2009. The Case for a Global Fiscal Stimulus. IMF Staff Position Note 09/03, issued March 6. GAO. 2007. Financial Market Regulation: Agencies Engaged in Consolidated Supervision Can Strengthen Performance Measurement and Collaboration. Government Accountability Office, report number GAO-07-154, released March 15, 2007. Washington, DC. Gereffi, G. 2005. The Global Economy: Organization, Governance, and Development. In Handbook of Economic Sociology, ed. N.J. Smelser and R. Swedberg, pp. 160–182. Princeton, NJ: Princeton University Press. Gerth, J. 2008. Was AIG Watchdog Not Up To The Job? November 10. www.propublica.org Girouard N, M. Kennedy, and C. Andre. 2006. Has The Rise in Debt Made Households More Vulnerable? OECD Economics Department Working Paper no. 535, Paris: Organisation for Economic Cooperation and Development. Glick, R., and A.K. Rose. 1999. Contagion and Trade. Why are Currency Crises Regional? Journal of International Money and Finance 18:603–617. Gorton, G. 2012. Misunderstanding Financial Crises. Oxford: Oxford University Press. Guillén, M.F. 2001. The Limits of Convergence. Princeton, NJ: Princeton University Press. Henisz, W.J., B.A. Zelner, and M.F. Guillén. 2005. Market-Oriented Infrastructure Reforms, 1977–1999. American Sociological Review 70:871–897.



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IMF. 2013. Fiscal Monitor: Fiscal Adjustment in an Uncertain World (April). Washington, DC: International Monetary Fund. ———. 2010a. Global Financial Stability Report: Market Update ( January). Washington, DC: International Monetary Fund. ———. 2010b. Global Financial Stability Report: Meeting New Challenges to Stability and Building a Safer System (April). Washington, DC: International Monetary Fund. ———. 2009a. Financial Stability Report. Washington, DC: International Monetary Fund. ———. 2009b. World Economic Outlook. Washington, DC: International Monetary Fund. ———. 2007. Financial Stability Report. Washington, DC: International Monetary Fund. Krugman, P. 2013. How the Case of Austerity has Crumbled. New York Review of Books June 6. Labaton, S. 1999. A New Financial Era. The New York Times October 23, section A, p. 1. Laeven, L., and F. Valencia. 2008. Systemic Banking Crises: A New Database. IMF Working Paper 08/224. Washington, DC: International Monetary Fund. Lagarde, C. 2011. Don’t Let Fiscal Brakes Stall Global Recovery. Financial Times August 15. Lewis, M. 2014. Flash Boys: A Wall Street Revolt. New York: W.W. Norton. Nash, N. 1987. Treasury Now Favors the Creation of Huge Banks. The New York Times June 7. O’Sullivan, M. 2000. Contests for Corporate Control: Corporate Governance and Economic Performance in the United States and Germany. Oxford: Oxford University Press. Polillo, S., and M.F. Guillén. 2005. Globalization Pressures and the State: The Global Spread of Central Bank Independence. American Journal of Sociology 110:1764– 1802. Reinhardt, C.M., and K.S. Rogoff. 2009. This Time is Different: Eight Centuries of Financial Folly. Princeton, NJ: Princeton University Press. Salmon, F. 2009. Recipe for Disaster: The Formula that Killed Wall Street. Wired Magazine 23 February 2009. Stewart, J.B. 2009. Eight Days: The Battle to Save the American Financial System. The New Yorker September 21:58–81. Stiglitz, J.E. 2002. Globalization and its Discontents. New York: Norton. Suárez, S. 2000. Does Business Learn? Taxes, Uncertainty and Political Strategies. Ann Arbor: The University of Michigan Press. Tett, G. 2009. Fool’s Gold: How the Bold Dream of a Small Tribe at J.P. Morgan Was Cor-

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rupted by Wall Street Greed and Unleashed a Catastrophe. New York: Free Press. The Economist. 2011. High-Frequency Trading: Rise of the Machines. The Economist July 30. The New York Times. 1997. State Farm Plans Banking Subsidiary The New York Times July 1. Truell, P. 1997. A Wall Street Behemoth. The New York Times September 25. UNCTAD. 2009. World Investment Report. New York: United Nations Conference on Trade and Development. Wilmarth, A.E. 2002. The Transformation of the U.S. Financial Services Industry, 1975–2000. University of Illinois Law Review:2002. Available at SSRN: http://ssrn. com/abstract=315345 _____. 2009. The Dark Side of Universal Banking: Financial Conglomerates and the Origins of the Subprime Financial Crisis. University of Illinois Law Review 41:963– 1050.

5 “Where Everything Is Political” Architecture Against Politics in Global Dubai1 Cameron Hu

“Infrastructure is no longer a more or less delayed response to a more or less urgent need but a strategic weapon, a prediction: Harbor X is not enlarged to serve a hinterland of frantic consumers but to kill/reduce the chances that Harbor Y will survive the 21st century. On a single island, southern Metropolis Z, still in its infancy, is ‘given’ a new subway system to make established metropolis W in the north look clumsy, congested, and ancient. Life in V is smoothed to make life in U eventually unbearable.” —Rem Koolhaas 1998:1264

I.

T

he eastern coast of the Arabian Peninsula is in rapid metamorphosis. Since the onset of the new millennium dredging ships, cranes, bulldozers, and excavators have augmented its continuous line with terraforms, artificial islands, and peninsulas of sand harvested from the sea floor. Cast in the shape of flora and geographical figures, the terraforms reproduce their namesakes on a massive scale. Dubai’s Palm Jumeirah, a residential complex in the approximate shape of a palm tree, occupies some 25 square kilometers off the city’s shoreline. The World, a private archipelago configured after a map of the globe, covers nearly 54 square kilometers, and a second, incomplete Palm island will encompass almost 104 square kilo-

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5.1 The World and Palm Jumeirah (photograph by the crew of International Space Station Expedition 22, used under CC BY-SA 3.0 and available at http://commons. wikimedia.org/wiki/File:Artificial_Archipelagos,_Dubai,_United_Arab_Emirates_ ISS022-E-024940_lrg.jpg).

meters. Computer projections of the latter show it encircled with verses of poetry by Dubai’s Monarch Mohammed bin Rashid al Maktoum, and the second of its four lines—to be inscribed with a long chain of boardwalks and stilt houses—will read in Arabic, “It takes a man of vision to write on water.” These constructions are the predominant icons of contemporary Dubai, and, insofar as their likenesses have been circulated through magazine pages, laptop screens, and billboards, the terraforms are at the fore of the world’s mental images of the city and of the Arabian Gulf states in general. Yet it is worth noting that for such global visibility, the city’s terraforms are also in a sense invisible. On the ground, Dubai’s denizens can see only unremarkable mounds of sand and concrete emerging from the tide. The World and Palm islands require a rare vantage: the images of palms and continents can only be witnessed from far above. More than their expense, scale, or bold design, it is likely this orientation toward verticality that first registers Dubai’s novelty in the history of the



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urban environment. The 19th and 20th centuries witnessed the ascent of an opposite mode of architectural vision. The urban modernities of Paris and New York invented the life of the street and sidewalk, and so tacitly acclaimed the horizontal in urban experience. Baudelaire’s flaneur observed the modern city by aimless passage through the city, and late into the century Michel De Certeau still defended the primacy of ground- or street-level optics in his meditations on everyday life: “The ordinary practitioners of the city live ‘down below,’ below the thresholds at which visibility begins. They walk—an elementary form of this experience of the city; they are walkers” (1984:93). Dubai’s terraforms, however, direct their signification not to the pedestrian or flaneur but to visual modes that have little to do with physical presence—to the aerial photograph and the satellite image. It is this condition that affords a glimpse of some emergent qualities of architecture in an era of globalization. It reveals architecture’s increasingly spectacular function in the twenty-first century. The terraforms rise to the challenge of a mediasaturated world. They are designed with photography and digital rendering and dissemination in mind, and serve as a global broadcast of their own accomplishment. Advertising almost nothing of their lived experience, and directed away from the occupants of their physical location, the terraforms quickly call to mind Guy Debord’s observation that “mere representation” increasingly supplants “all that was once directly lived” (1994:12). Yet more significant is that these architectural spectacles can only exist in the context of the globe as a visualizable entirety, of the world-as-picture. The satellite image immediately and permanently maps the city’s icons into the geopolitical cartography of borders and territory, into the visual representational field of international strategy—and there architecture immediately enters into a system of global relation, comparison, and contention.

II. Dubai is 100 miles southwest of the Strait of Hormuz, the narrow channel that cleaves the Arabian Peninsula from Iran and through which so much petroleum passes into the Indian Ocean and world; a site that 19th century military tacticians and 20th century energy strategists alike identified warily as a “chokepoint.” A city-state of one and a half million, Dubai is also the largest of the United Arab Emirates. In the last decade it has become inter-

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nationally notorious for its explosive urban growth, for a rapid proliferation of anomalous and hyperbolic forms for which the term “building” is often unsatisfactory. Present-day Dubai assembles immense man-made islands and land reclamations, indoor ski runs, the world’s tallest skyscrapers, underwater hotels, life-sized replicas of the ancient and modern wonders of the world, and a host of whole, self-contained cities: industrial and logistical free zones, “Internet Cities,” “Media Cities,” and “Golf Cities.” The architectural boom lends itself to quantification. Dubai, it is often repeated, employs a fifth or quarter of the world’s construction cranes (Bagaeen 2007:176), and is the world’s second-largest building site after Shanghai (which claims a population roughly ten times that of Dubai [Davis 2006:49]). The boom responds to and provokes exponential population growth—between 1995 and 2005 the number of Dubai’s inhabitants more than doubled—and this growth, driven almost entirely by immigration, dismisses traditional notions of nation or citizen. Of the current population, at most 20 percent and as few as 4 percent of Dubai’s residents are citizens of the United Arab Emirates (Davidson 2008:190). The overwhelming majority are expatriates, guest workers from Europe, the Middle East, and South Asia. The international press has remained transfixed by the city’s expansion, relentlessly documenting Dubai’s “phenomenal growth” (Matly and Dillon 2007:9), “astonishing ascent” (Kotkin 2008), and “bling-bedecked Cinderella story” (Sherwood 2006) with panoramic photographs of cranes and construction sites. The proliferation of such ecstatic reports is exemplary of the city’s power to captivate public discourse; and indeed, Dubai has been subject both to unrestrained enthusiasm and venomous critique. The Australian critic Germaine Greer condemned Dubai’s architecture in general as “beyond crass”(2009) and declared the Burj Dubai—Dubai’s, and the world’s, tallest tower—“outrageously megalomaniacal, and defiantly worldly, a new Tower of Babel.”2 Greer did so, however, in the pages of London’s Guardian, a newspaper that previously nominated Dubai as a plausible capital for the 21st century (White 2008). Opinions of Dubai take such dystopian and utopian turns, but they tend toward uniformity in their insistence that the city is center and symptom of some current epoch, no matter how one prefers to periodize. An image of the city’s Sheikh Zayed Road graces the cover of a book entitled Evil Paradises: Dreamworlds of Neoliberalism (Davis 2007), while a Beirut journal has acclaimed Dubai the great Arab city of the contemporary era, the logical



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5.2 Dubai From Above (photograph by Nino Verde, used under CC BY-SA 3.0 and available at http://commons.wikimedia.org/wiki/File:Dubai_aerial_view.jpg).

heir to a position once occupied by Baghdad, Damascus, Cairo, and Beirut itself (Abdullah 2006). Elsewhere, the architecture pages of the New York Times have deemed Dubai the era’s “center for urban experimentation” (Ourosoff 2008), much as the prominent Dutch designer Rem Koolhaas ominously declared it the world’s “last chance” to “start over” (Koolhaas 2007:9). The proliferation of hyperbole underscores the city’s decided significance to observers of the contemporary city: often Dubai seems to manifest the global urban condition, or perhaps its future, in extremity. This essay takes up the geopolitical weight of that extremity. Following Dubai’s exaggerated urban forms—among them its terraforms, skyscrapers, and self-contained cities and economic zones—it presents a case study in the expanded social life and political efficacy of architecture in an era of globalization. The process of globalization, and in particular the proliferation of new media technologies and the increasingly rapid movement of populations, is widely taken to challenge the stability of traditional spatial relations. Architecture is more or less reducible to the work of fixing spatial relations, and so it should therefore appear a rather feeble force in globalized politics and society. Yet Dubai’s emergent urban forms actually suggest

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the opposite. Indeed, the city-state’s architecture persists and even swells as a primary political implement in its global relations. The following pages attend to the surprising salience of architecture’s basic powers—to organize regimes of time and space—in the ordering of the city-state’s geopolitics. Architecture, I will argue, enacts Dubai’s much-proclaimed regime of “apoliticality” and exception from a region otherwise declared to be exceedingly “political.”

III. “Buildings stabilize social life,” writes the sociologist Thomas Gieryn. “They give structure to social institutions, durability to social networks, persistence to behavior patterns” (2002:35). Delineating modes of spatial relation, of motion and stasis, of community and isolation, concrete and steel fix social formations.3 Pierre Bordieu’s well-known analysis of the Kabyle house argued that styles of domestic architecture enforced elements of the Kabyle social world; some years later, Gieryn’s own work finds that the architectural arrangement of a biotechnology research facility routinizes and normalizes research practices and institutional arrangements. It is not unreasonable, then, to conjecture that an architecture of such global ambitions as Dubai’s megaprojects might work to organize social relations at a global scale. Indeed, this essay follows the recent publication of several studies on the function of architecture and “spatial products” as instruments of geopolitical maneuver. While it is common to discuss architecture and politics as practices animated by a common zeitgeist and, therefore, at any moment entangled, recent works by Keller Easterling (2005), Eyal Weizman (2007), and others point to a closer relationship between the two, in which architecture is increasingly a medium through which states might manage and manufacture geopolitical situations. Contemporary Dubai presents one such direct line between state and built space: architecture, taken broadly, appears as one of the state’s primary tools in the organization of its international relations. What Dubaians, according to Michael Matly and Laura Dillon, have deemed the “major milestones” in Dubai’s development are industrial infrastructures recognizable as precursors to today’s architectural megaprojects. In 1961 Sheikh Rashid bin Said al Maktoum (1912–1990), the Vice President and Prime Minister of the UAE, and Dubai’s Emir, initiated multiple dredgings of Dubai Creek. The shallow saltwater channel, which cuts



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5.3 Jebel Ali Port (photograph by Imre Solt, used under CC BY-SA 3.0 and available at http://commons.wikimedia.org/wiki/File:Jebel_Ali_Port_1_Imresolt.jpg).

through the center of the city, was deepened so that large vessels could pass through it regardless of the tide. A second milestone was likewise a colossal reorganization of space and environment, the construction in 1975 of the world’s largest harbor, Jebel Ali Port. Fifty-two square kilometers in area, it became the largest port in the Middle East and, according to Matly and Dillon, “ranked alongside the Great Wall of China and the Hoover Dam as the only three man-made objects that could be seen from space” (2007:2). Jebel Ali Port was soon enveloped by the Jebel Ali Free Zone, a vast business and manufacturing zone free of restrictions on currency, ownership, and without income taxes or import and export duties. Dubai Creek and Jebel Ali Port anticipate the tropes of Dubai’s contemporary architectural condition: the large-scale transformation of natural environments, appeals to aerial vision, micro-cities defined by discrete political logics. That they represent the “milestones” in the city-state’s late transformation suggests that politics and economics in Dubai’s modern era have always been thoroughly architectural. Indeed, its geopolitical positioning and economic growth have long been conducted through varieties of architectural practice. Moreover, Jebel Ali and the dredging of the Dubai Creek are widely understood in terms of the personal strategy of Sheikh Rashid bin Said al

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Maktoum (Davidson 2008:139), and monarchic prescience persists as the explanation for Dubai’s contemporary urban phantasmagoria. Numerous accounts depict the current monarch, Sheikh Mohammed bin Rashid al Maktoum, as a “visionary Crown Prince” known for his “energy, drive, and total belief in what he is trying to achieve”—“the man who many say is responsible for the exceptional success that Dubai has been experiencing (Sampler and Eigner 2003:ix). A 2007 report by CBS’ Sixty Minutes was no less hagiographic, reporting that the city is “all the vision of one man” (Kroft 2007). One need not adopt this language to demonstrate the heavy hand of the monarchy in the built environment. The ruling family of Dubai owns its entire land area, and is therefore implicated in all allocations of space. State and real estate are practically inseparable, and as Mike Davis notes, Dubai’s political sphere therefore “has been officially collapsed into the managerial” (2007:61). Emaar and Nakheel, the property development groups responsible for Dubai’s radical spatial products (the “World” and “Palm Islands,” Burj Dubai, and others) are primarily state owned (Bagaeen 2007:178) and their managers have served simultaneously as government ministers. Mohamed Ali Allabar, Director of Dubai’s Department of Economic Development, is also Emaar’s chairman; Sultan Ahmed Suleyam, is head of both Dubai’s Ports, Customs and Freezone Corporation, as well as Nakheel. The conjoining of private industry and government is best exemplified, however, in Maktoum, who often refers to himself as the “CEO of Dubai” (Kanna 2010:106). Thus, in a city-state where built spaces are conceived as the engines of modernization, and in the absence of any distinction between the organs of the state and Dubai’s major real estate and development entities, urban form appears as an obvious political implement and expression of sovereign will. Yet, it is difficult to isolate the political ideals that animate Dubai’s megaprojects. Among the acclamations of contemporary Dubai, so common before its present financial difficulties, one finds frequent celebration of a confusing national spirit. It has been suggested in a variety of publications, both regional and international, that the city-state’s unique virtue is its “apolitical” disposition. Dubai presents “an apolitical system of economic success and stability” according to 1000 Numbers and Reasons Why Dubai (Beirut Information and Studies Center 2008:25); elsewhere, in the pages of Newsweek, the reader encounters a more or less identical description. “In a



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region where everything is political, Dubai’s greatest distinction—and the secret of its prosperity—is that it is almost utterly apolitical” (Molavi 2007). Yet for the term’s easy use, the significance of “apoliticality” is not immediately evident. It may strike some readers as an impossible state of affairs, contradictory at least to common-sense notions of the political. What could it mean for a thoroughly political entity—in this case, a constitutional monarchy—to disavow those properties and processes implicit in its very existence? The explanatory tools of brochures and newsmagazines do not, of course, aspire to political theory. Nonetheless, reference to a more formal attempt to characterize the essence of the “political” will draw its opposite into relief, and Carl Schmitt’s long essay on The Concept of the Political (1996) is useful here. Its first sentence registers the same sentiment with which one might object to apoliticality as an impossible condition—“The concept of the state,” he writes, “presupposes the concept of the political” (p. 19)—but especially interesting are those modes of conceiving of the political sphere that that Schmitt proceeds to identify. He acknowledges at least two styles of thought: the first takes politics as a category of activity distinct from and antithetical to the discrete realms of economy, religion, morality, and science; a second, Schmitt’s thesis, imagines politics as an ever-present capacity for violent enmity, for a distinction between friend and enemy that can arise in any domain and which is the singular responsibility of the state. This distinction clarifies the meaning of any appeal to apoliticality. In invoking the apolitical as a real condition, one denies a model of ever-present politics in favor of an imagined sphere of properly political activity separate from economics and religion, and entirely repressible. It is precisely this model that is conjured to describe contemporary Dubai—“an apolitical system of economic success”—and indeed, in the Beirut journal Al-Mustaqbal Al-Arabi, the Emirati political scientist Abdul Khaliq Abdullah explains Dubai’s growth in terms of this partition: as the result of a deliberate choice between the antithetical worlds of politics and economics. He writes, “The business of Dubai is business…there is no place for political concerns or controversies in Dubai” (2006:70). Here, business necessarily precludes politics, which, as in Schmitt’s conception, is irreducibly a question of contention and “controversy.” The author recalls historical precedents for this partition: Rashid bin Said al Maktoum dealt primarily with “economic men” rather than falling under the influence of

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“political people,” and his decisions “were not political, but commercial, with the intent of transforming Dubai into a commercial city and nothing else” (2006:70). Yet for its established past, apoliticality bears special significance amidst the contemporary world order. According to the aforementioned Newsweek report, it is a consequence of apoliticality that “Here [in Dubai], globalization’s triumph has almost been complete” (Molavi 2007) and in the same fashion Abdullah insists that Dubai “is driven to the fullest extent toward globalization” (2006:60). Such statements describe an alignment of the purified economic sphere and the work of globalization—they suggest that being apolitical consists in an elected compatibility with processes of global capitalism. Significantly, both are simultaneously descriptions of exception from a region rendered impenetrable to capital by varieties of contentious politics. Dubai is apolitical and globalized in a region “hostile to the world and to the contemporary age” (Abdullah 2006:60), or, to recall Newsweek’s formulation—a region “where everything is political.” Distinguished from Schmitt’s articulation of politics and linked to notions about globalization and regional “hostility,” a rough outline of the apolitical is now visible. In sum, to be apolitical as such is to aim for a maximal position in the networks of global capitalism. It is to purify the economic, to dismiss some category of properly political activity, to jettison trappings that would manifest “hostility” and interfere in Dubai’s compatibility with the international marketplace. Two contemporary portraits further contextualize the apolitical condition and Dubai’s emergent urban forms. Theories of the present abound, yet Jean and John Comaroff ’s characterization of capitalism at the turn of the millennium—the moment at which Dubai’s expansion began—is especially resonant. Their essay “Millennial Capitalism: First Thoughts on a Second Coming” (2000) captures the apolitical much as it appears in Dubai. “Neoliberal capitalism, in its millennial moment portends the death of politics by hiding its own ideological underpinnings in the dictates of economic efficiency, in the fetishism of the free market, in the inexorable ‘needs’ of business”(2000:322).7 The “death of politics” is a trope of capitalism at the turn of the millennium, and it draws from the apocalyptic tone of so many famed “end of history” hypotheses that appeared at the close of the 1980s, announcing capitalism’s triumph and “the unabashed victory of economic and political liberalism” (Fukuyama 1989:3). In the wake of this



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supposed death of politics and ideology—and as in Abdullah’s opposition of politics to globalization—“the political” comes to describe all that which contests the apparent hegemony of global capitalism, and the practice of global capitalism itself is established as the “apolitical.” “Politics” as such is the stigmata of history’s losers—of those who are late to reach its terminus. If “Millennial Capitalism” describes a regime of temporal experience, Michael Hardt and Antonio Negri’s Empire (2000) is of similar interest for its description of spatial practices at the close of the millennium. Despite its widely discussed shortcomings, Empire is at least useful for its diagnosis of the spatial aspirations of global capitalism. Borrowing from Deleuze and Guattari’s A Thousand Plateaus (1987), Hardt and Negri argue that the globalized market place demands “a smooth space of uncoded and deterritorialized flows” (2000:333). In contrast to the world system of 19th and 20th century imperialism, which enforced rigid territorial boundaries and “strict notions of inside and outside that effectively blocked the free flow of capital, labor, and goods” (2000:332) they argue that the contemporary political economy dreams of the withering—the smoothing—of political boundaries in order to facilitate such flows. If “flow” has emerged as the dominant metaphor for the cultural, political, and economic practices that arise within late capitalist globalization, then “smooth space” describes their ideal infrastructure. Thus, there exist two tacit descriptions of the apolitical at the millennium, one temporal, the other spatial, and these correspond to architecture’s capacities to narrate historical time in the course of idiomatic claims of identity, and to organize space through its physical structure. The following pages take up this correspondence. What is the “apolitical” in architectural practice? How does architecture call the apolitical into being? A small number of pervasive architectural features—the narration of a “city from zero” and “beyond history,” and the ubiquity of enclosure and selfcontainment as a spatial models for urban growth—increasingly stage and stabilize the perceived absence of politics.

IV. Denying its own ideological character, the apolitical maintains a likewise antagonistic relationship to narratives of historical continuity. Geopolitical life often requires the articulation of a historical sensibility. Arab

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nationalism requires a conception of common Arabic history. Marxism, a long-duree movement of technology and labor. In declaring itself without politics, Dubai necessarily dismisses those historical narratives that would imply the political as such. Yet just as the declamation of political ideology belies itself by registering a specific form of political ideology, so too does the declamation of historical narratives constitute a variety of historical narrative. Here, I follow Fredric Jameson’s recommendation to “search out the concealed ideological narratives at work in all seemingly non‐narrative concepts, particularly when they are directed against narratives themselves” (2002:6). What kinds of political histories and mythologies arise to buttress Dubai’s apolitical logic, and how are they articulated in the built environment? In February 2009 I attended Dubai’s International Property Show (IPS), an annual exposition of the city’s projected real estate and architectural developments. Promotional photographs from previous years forecasted an atmosphere like that of a stock exchange floor: a cosmopolitan crowd of frenzied, suited men jockeying for position before flat screen televisions, which displayed three-dimensional renderings of hypothetical projects— buildings, communities, and whole imagined cities. Yet by February, the worldwide recession had just reached Dubai, and the atmosphere of ecstatic capitalism was noticeably absent. Rumors spread of rampant debt and project cancellations, and the venue, Dubai’s International Exhibition Centre, was nearly vacant. Many of those construction projects defined by their incredible scale and cost appeared more impossible still without throngs of fevered investors. Among these now-jeopardized schemes was the IPS’s major exhibitor, Falcon City of Wonders. A mammoth gated community visible from the air as a two-dimensional falcon, it is organized around full-scale (and often oversized) replicas of various “wonders” of the world, which will serve as functional shopping malls, office parks, and amusement parks. The development proposes anachronism as a full-time lifestyle; if it is completed one will be able to jog on the Great Wall of China, shop at the hanging gardens of Babylon, and rent office space in the Great Pyramids of Giza. I spent a half-hour alone in the exhibit’s temporary movie theater, watching its promotional video on loop. More than a description or pitch for the development, the animated feature presented a suggestive fictional narrative of the project’s—and indeed, Dubai’s—origins. The video begins



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with sunrise over windswept dunes. A small Bedouin party appears in the distance, and a British-accented voiceover narrates dramatically: “One day a boy went into the desert, with nothing but his precious falcon, and his precious dreams. And as he released the falcon, the boy whispered, ‘Only my dreams soar as high as you do. Give my dreams your wings, and help them to fly.’ ” The falcon flies to the Pyramids of Giza, the Leaning Tower of Pisa, and other such monuments, extracting the essence or charisma of each structure (which the production visualizes as a kind of dark blue lightning). Completing its collections at the Eiffel Tower, the falcon returns to Dubai, where sand dunes have been suddenly replaced with skyscrapers and eight‐lane superhighways. The accumulated charisma is tossed down into the desert outskirts of Dubai, and the Falcon City of Wonders appears fully formed from beneath a cloud of dust. Description of investment opportunities follows; we might skip to the final frame in which the slogan “Beyond History” appears alone on a black backdrop. Indeed, the question of Dubai’s position in or out of perceived historical time is not a mere academic invention. The video may refer in particular to Falcon City of Wonders, but it effectively assembles a composite history of Dubai. Its plot reiterates much of the discourse in circulation about the city: that the contemporary city appears instantaneously, ex nihilo. The video begins with serene shots of empty desert, and moments later we are confronted with the jagged, spaceage skyscrapers of Skeikh Zayed road. The viewer is relieved of any sense of intermediate stages, of historical time, and indeed, this speed of transformation is a crucial figure in Dubai’s mythopoetics. Dubai is widely styled as an “instant city” (Ourosoff 2008) that appears overnight, replacing a “sleepy, pearl-diving village” with a “modern metropolis” (Shadid 2006). Writers of various genres have obsessed over the appearance of “an astonishingly modern city nearly from scratch in a mere 15 years” (Bagaeen 2007:173), and this is not the mere fixation of foreign observers. A billboard outside of Dubai’s World Trade Center—the venue of the International Property Show—offered a concise pictorial summary of the same (non)narrative of compressed time. Superimposing the visage of Mohammad bin Rashid al Maktoum over a photograph of the skyscrapers of Sheikh Zayed Road, the image’s caption exalted instantaneity as a national ethic: “We do not wait for events in order to produce them.” Such advertisements go so far as to exalt the instantaneous as a national ethic.

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5.4 Dubai’s Sheikh Zayed Road (photograph by Fabio Acchili, used under CC BY 2.0 and available at https://www.flickr.com/photos/travelourplanet/7997582352).

One could attempt to verify such figurations—go to the archives in order to discern whether Dubai is really so instant—but to do so misses a crucial aspect of the city, indeed, of the global city in general. Architecture in Dubai does more than remake space—it initiates a circulation of images and representations of which the “instant city” epitomizes. As the anthropologist Ahmed Kanna writes, Dubai exists in triplicate: “the city, the representation, and the experience” (2006:2). Instead of pursuing the reality of representations that often eclipse their referents, we might turn to their utility. How does the “instant city” as such abet apolitical statecraft? The narrative of the instant city relies on preformed historical stages embodied in video and billboard’s empty desert, and the jagged, futuristic skyline that replaces it without warning. The former is the symbolized primitive of distant memory, the state of nature; the latter is the facade of fully realized modernity.4 “Modernity” is of course an empty signifier, nebulous, contested, and shifting, but so many stories of the instant city isolate modernity as something material—something that one can literally



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build. Dubai appears to claw through historical time with steel girders and cranes. If it seems counterintuitive that a polity can literally build its way into a stage of historical time, such confusion only lays bare the manner in which the idea of modernity masks an essentially spatial character with reference to historical time. The very notion of modernity, as Timothy Mitchell writes, employs “an understanding of history in which there is only one unfolding of time, the history of the West, in reference to which all other histories must establish their significance and receive their meaning” (2000:7). In this way, differences cut across space—among them differences that might obtain in the urban fabrics of Western Europe and the Arab world—come to describe disparate temporal stages in modernity’s single trajectory. Of course, the European achievement of modernity is largely attributable to the economic relationships it maintained and maintains with its peripheries, Karl Marx, among others, identified colonialism as “the rosy dawn of the era of capitalist production”(1946:775), so it seems less likely that the West proceeds ahead of its peripheries than that their different “stages” of development are always synchronic and interdependent. Nevertheless, difference from the West is inevitably “reposition[ed] within the West’s universal and singular history” (Mitchell 2000:8) and such irregularity is rephrased as stages of under-development in the universal march toward a single modernity. We can doubt this mashing together of space and time, especially in a globalized world that complicates all such “center‐periphery models,” (Appadurai 1996:36) but the narrative has considerable power even in those spaces that it relegates to end of historical time. Paired with the lingering threat of colonial violence both military and economic, universal historical time, and modernity are normative. They encourage assimilationist desires. “Never mind,” writes Jameson, “that all the viable nation-states in the world today have long-since been ‘modern’ in every sense…what is encouraged is the illusion that the West has something no one else possesses—but which they ought to desire for themselves. That mysterious something can then be baptized modernity” (2002:8). We might say, if crudely, that becoming modern is simply—and against all of the term’s temporal claims—to appear increasingly like the West, and that the discourse of modernity places the non-West in elementary historical positions from which they must aspire to “develop,” “modernize,” “civilize,” and so on.

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Acclamations of Dubai’s instant urban modernity respond to that call, but they do so paradoxically. Subscription to a universal historical script is apparent in the ecstasy with which Dubai’s status as a modern and global city is proclaimed, and yet in transforming so quickly from pre- to posthistory—from the mythologized desert to the sudden megacity—Dubai effaces the appearance of visible striving. It materializes all at once with a mastery of the European idioms of urbanity. It exists either in the mode of modernity, or it does not exist at all. Dubai immediately enters historical time “only at the point of its disappearance” (Mitchell 2000:5), when the non-Western absents itself.

V. Rem Koolhaas is perhaps the most prominent architect of the late 20th and early 21st centuries and his firm, OMA, is well known for works like Seattle’s Central Library, Beijing’s CCTV Building, and the Netherlands’ embassy in Berlin. It is also celebrated for the production of analytical compendiums like S, M, L, XL (Koolhaas, Mau, and Werlemann 1998) and Mutations (2001), in which Koolhaas and collaborators diagnose the state of the contemporary city amidst the transformations wrought by late capitalism and globalization. “Generic City,” published in S, M, L, XL, is perhaps Koolhaas’ most influential essay. He demands in it an emancipation of the city from the “straitjacket” of identity and history, “a global liberation movement: ‘down with character!’ ”(Koolhaas 2001:1248). His literary style tends toward the ironic, but he is rehearsing a well-known stance on the exhaustion of historical identities as a resource from which contemporary architects and urbanists might draw. “The fact that human growth is exponential,” he writes, “implies that the past will at some point become too “small” to be inhabited and shared by those alive. We ourselves exhaust it… Identity conceived as this form of sharing the past is a losing proposition…the stronger identity, the more it imprisons, the more it resists expansion, interpretation, renewal, contradiction.” (ibid.). Koolhaas’ announcement is resonant with both the anti-historical mythology of the instant city, as well as the very idea of Falcon City of Wonders. Indeed, Koolhaas (2001) anticipates many of the peculiarities of modern Dubai: “The street is dead,” he writes. Against the street, against the claims of identity—against an architecture that



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draws “from physical substance, from the historical, from context, from the real”—Koolhaas acclaims the emergence of generic cities, which, “like the contemporary airport,” are “all the same.” In recent years Koolhaas has turned his critical attentions to the Middle East, curating an exhibit entitled “The Gulf ” at the 2006 Venice Architecture Biennial, and “Dubai Next: Face of 21st Century Culture” at the Vitra Design Museum in Weil am Rhein, Germany in 2008. These projects culminated in Al Manakh, a 500 page survey of Dubai and the Gulf States composed of short essays and theses, interviews, digital snapshots, maps, aerial photographs, and info-graphics on population and economy. Titled to conjure both the English “almanac” and an Arabic word for “climate,” the publication of Al Manakh perhaps registers the arrival in full of what is called the “Dubai Effect,” a widespread fascination with the city compatible with its own sensational architectural forms. Though Koolhaas had long since announced the end of the city as we know it, his introductory essay to Al Manakh goes further than “Generic City” in its fatalist approach to the contemporary urban condition. “We live in an era of completions, not new beginnings,” he begins in “Last Chance?”. “The World is running out of places where it can start over” (Koolhaas, Bouman, and Wigley 2007:7). In cities like New York and Paris, the precise weight of history rules out new spatial experiences, renders impossible the enactment of the new on a grand scale. In a world of such dead end spaces, the desert—the smooth space of nature—presents the promise of salvation. “Sea and sand along the Gulf, like an untainted canvas, provide the ultimate tabula rasa on which new identities can be inscribed: palms, world maps, cultural capitals, financial centers, sports cities”(Koolhaas, Bouman, and Wigley 2007:194). Similar in its seductive powers to the white spaces of colonial maps, the tabula rasa of the Gulf presents to Koolhaas the final frontier for architecture: apparently limitless space that makes no historical claims and therefore holds limitless possibility for architectural conquest. Such comparison to the colonial imagination is not perfunctory. In describing the passage from state of nature to “rampant modernization” and “hyperdevelopment,” Koolhaas falls back on stock orientalist idealizations. Dubai, he writes, is modernizing in the same space “where nomads roamed unmolested only half a century ago.” Imagined again as a historical void, Dubai offers no resistance to the generic—no obligations to identity or context—and only this isolation of an

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ahistorical “nature” against which to build and design permits the messianic ideology of the “last chance.” Koolhaas’ notion of the last chance highlights a second kind of temporality—a correlate to the final modernist stage in which the instant city appears—that simultaneously pervades Dubai’s urban production. Time in Dubai is evidently eschatological. The approach of so many planners, developers, and architects like Koolhaas relies on some idea of an end-time: Dubai joins the West at the imagined close of history, and the city is more often discussed as a capstone to the edifice of global historical achievement. Falcon City of Wonders—tagline: “Beyond History”—demonstrates this tendency in no uncertain terms. It imagines the concluding chapter of history as an ultimate collection and canonization of previous iconic achievements, therein naming the close of an era of such “wonders” tied to specific and emplaced identities. In this fashion the site’s promotional video asks viewers to “imagine an Eiffel Tower, even bigger than the real Eiffel tower,” acknowledging the development’s structures as neither replicas nor simulations but real things equivalent to their models and unproblematically reproduced: “an Eiffel tower.” This is a possible corrective to Koolhaas’ vision of post-historical world space as an endless and faceless airport. Falcon City of Wonders instead envisions that condition as a globe overstuffed with duplicate architectural icons. Elsewhere, sales catalogues for the Palm Jumeirah declare it the “Eighth Wonder of the World” and so implicate Dubai as a global zenith. This sentiment was made explicit in a 2008 interview with the chairman of the Emaar construction company, Mohammad Ali Allabar, regarding the Burj Dubai (now the world’s tallest tower). “It is upon us,” he said, “to demonstrate to the world one more time some of the things you cannot realize anywhere except Dubai” (2009). Yet perhaps the boldest statement of Dubai’s position at the end of time came from Hamza Mustafa, general manager for Nakheel’s World islands: “There is nothing after the World” (AMO 2007:273). Mustafa’s particular articulation of the post-historical condition also illustrates its negativity—a foreclosing of possibilities and futures. The proliferation of the “wonder” and its architectural variations in Dubai amounts to an aggressive claim about the city’s prominence in the world, but so many demonstrations of how Dubai exceeds Europe in its urban production do not suggest resistance to the hegemony of its particular model of modernity, as much as full subscription to that dogma.



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Enacting the culmination of history via exaggerated performances of the modern as such, these architectures proclaim their assent regarding the exhaustion of alternative ways in which states might relate to the West. In Francis Fukuyama’s notorious essay on “The End of History” (1998:123), he identifies the close of the Cold War as the “unabashed triumph of economic and political liberalism,” and champions the slow rise of a world “dominated by economic concerns, in which there are no ideological grounds for major conflict.” (The likeness of this distinction to that of Dubai’s advertised “apolitical” system of economic success is plain.) Fukuyama proceeds to explain that for those states that have reached such an end of history, contention does not arise around different ideas about how we might be modern. States can concede this point, or they can remain “stuck in history,” (p. 124) and the result is a world “divided between a part that was historical and a part that was post-historical. Conflict between states still in history, and between those states and those at the end of history, would still be possible…large-scale conflict must involve large states still caught in the grip of history, and they are what appear to be passing from the scene” (p. 124). On such a map of the globe carved up into those states “stuck in history” and those having “emerged on the other side,” Dubai’s wonders enact its claim to the latter status. An aesthetics of the instant and eschatological announce that Dubai joins the stream of time after politics, after history. Monumentally post-historical, the city’s architectural megaprojects embody geopolitical affiliation in a divided world.

VI. While Dubai is thusly named a historical endpoint, a “last chance” that appears “beyond history,” the city’s architecture also refers to another mode of apocalypse and salvation—one that locates the city as a lone place of refuge amidst widespread cataclysm. Encapsulating the canonical wonders of history in the Falcon City of Wonders, or the planet itself in a constellation of dredged islands, the city comes to resemble a rather pessimistic museum: a great amassing of likenesses in anticipation of some yet unknown global catastrophe. Projects like The World and the Falcon City of Wonders are examples of Dubai’s trademark urban constructs, which are not characterized by any recognizable physical character so much as an ethos or logical premise. Beyond an extreme scale they are discrete and

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self-reliant “cities within a city,” carefully delimited enclosures with specific, albeit varyingly explicit political logics. These entities span the gamut of purposes: residential neighborhoods, entertainment facilities, “media cities,” logistics centers, outsourcing districts, industrial zones, terminals for humanitarian aid organizations, and free-trade zones. Peter Sloterdijk has commented that the late multiplication of the “enclosed environment”—in particular, the indoor ski slope—anticipates an future of climactic emergency begetting environmental privatization, a moment at which “breathing might be too important to be continued outdoors” and an “end of the atmospheric commons” (2008:143). While Sloterdijk’s remarks refer in particular to ecological disaster, the image of privatized enclosures formed in responses to a suddenly threatening exterior bears close similarity to the position widely imagined for Dubai in the political geography of the Middle East: a secure zone in what Al Manakh contributors identified as an “unstable world region” (Kirchner and Rab 2007:20), an apolitical retreat from a milieu in which, once more, “everything is political.” This is at least the imagery that energizes the work of Dubai’s urban expansion. At a panel discussion entitled “Why Dubai?” at New York’s Skyscraper Museum in 2007, John Braley (a representative of the Burj Dubai’s builder, Turner Construction International) offered that the city is “a cultural outlet, arguably the most liberal in the region, and therefore it is something of an outlet for people who live by otherwise strict norms” (Braley 2007). This distinction, between an illiberal region and a therefore appealing liberal Dubai, resembles the rhetoric of the apolitical and political, and Jordan Gruzman—an American contractor also affiliated with the Burj Dubai, and speaking at the same panel—expanded this distinction to characterize the distribution of political crisis in general. Dubai, he asserted, is “a safe haven in a very disturbed part of the world,” a repository for the storage of “flight capital” from Iran, Iraq, and other less “stable” places. Dubai is, therein, articulated as an escape hatch for privilege, a utopia specific to finances under threat. Dubai expands on its strategic physical position by assembling valuable milieus both political and cultural (although this is an ironic condition given the city’s frequent nomination as a regional leader and model for modernizing efforts elsewhere). If we follow Braley and Gruzman’s assertions to their logical conclusion Dubai’s success appears to rely on the perpetual fog of crisis beyond its gates. Later at the



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“Why Dubai?” panel, Gruzman intoned ominously that although the properties were usually purchased as safe investments, homes and apartments “could be occupied if they had to” (emphasis added). The last decade’s explosion of the “city within a city” instantiates the city’s status as a safe-haven with built environments that fracture Dubai into specific destinations for the flight, passage, and transformation of any number of populations and products. The free zone is the obvious example of this instantiation, and also one of the more urgent as the UAE establishes itself as a veritable “parliament” of such synthetic environments, which Dubai has “naturalized as the ideal urban growth unit” (Easterling 2005:9). A free zone, according to the World Federation of Free Zones (FEMOZA) is “a portion of clearly defined and isolated land or setting, with a special tax, customs, and imports regimes, usually involving a status of extra‐territoriality” (UAE Free Zone Investment Guide 2005:8–9). “Unresponsive to recognized systems of architectural language” (Easterling 2006:1), free zones eschew traditional architectural tools for less visible legal technologies in the organization of space. As its name suggestions, the free zone exists in its exception to the law of the land: whatever walls delineate the free zones are not in themselves powerful but rather trace the invisible limits of jurisdiction. They mark a partial void of the nation-state, and that such voids are held as impeccable markers of Dubai’s late capitalist modernity recalls again Timothy Mitchell’s point that the non-West can enter modern time “only at the point of its disappearance” (2000:5). Free zones replicate in miniature Dubai’s own geopolitical position as an island of exception, and yet taken together, constitute that apolitical condition. The proliferation of free zones in Dubai emerged in response to the UAE’s requisite kafil system of local sponsorship, under which the majority share of any registered company must be held by a UAE national. Passed in 1984, the “Commercial Companies Law” undermined Dubai’s reputation as “a laissez faire free port” (Davidson 2008:115), and Sheikh Rashid bin Said Al-Maktoum’s staff resolved to “circumvent federal law by creating special authorities to manage zones…that would technically fall out of UAE jurisdiction.” Built around the world’s largest man-made port, the aforementioned Jebel Ali Free Zone was the first such zone, and it guarantees to foreign operators 100 percent ownership, as well as free trade and a zone-specific labor policy (UAE Free Zone Investment Guide 2005:24). In Jebel Ali, foreign companies are empowered to hire from “the Asian countries

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with low salaries,” to do so “without exaggerated paperwork,” and house their employees in “eight-man bedroom” camps within the district (MeyerReumann 1991:77). The zone enjoyed rapid growth, and by 2002 some 5000 companies were registered in the zone. Popular as a site for the Middle Eastern headquarters of multinational firms, some companies have begun total relocation to Jebel Ali. In 2007 Haliburton, the U.S. oil- and militaryservices contractor, moved its base from Texas to Jebel Ali for its “conducive business environment,” and no doubt its proximity to Iraq and other “disturbed” regions of interest (Davidson 2008:116). Free zones have increasingly appeared to serve the distribution of intangible and virtual commodities. Dubai Media City is exemplary. Set just off of luxury beaches, DMC “aims to provide a free and flexible environment where ideas flow transparently and without barriers” (UAE Free Zone Investment Guide 2005:68). DMC, thus, represents a bizarre admission that barriers to the flow of ideas do exist in Dubai proper. The facilitation of “flow” is at the heart of the free zone’s architectural oddities: thoroughly concrete and physical spaces do not reproduce themselves in stable populations of users, but instead institute nimble circulation and transience. The DMC rents its infrastructure to “leading global players” like CNN, CNBC, and the Associated Press a “base of operations” from which “journalists can fly out and cover conflicts within a matter of hours” (El Batalji 2007) and in this way the commodification of regional violence becomes more explicit. Dubai Aid City offers similar facilities for humanitarian agencies, marketing its proximity to “60% of the world’s crisis areas,” which are “within a four-hour flight from Dubai.” In effect both zones sell front-row tickets to contemporary theaters of war.5 While other varieties of enclosures like The World terraforms or the indoor skiing facility Ski Dubai remain under the state’s traditional legal authority, they employ the same paradoxical logics of exception and exemption. Like free zones they are trademarks of Dubai but simultaneously void of it. The novelty of Ski Dubai beyond its extravagance and expense is the reproduction of a climate exactly opposite to that of Dubai and yet within city limits. The World terraforms are among the city’s best-known features, and yet the very appeal of private islands is that they repudiate association with the rest of the city-state. The project’s general manager claimed in 2005 that The World will be Dubai’s “most exclusive development ever. There will only be 300 islands. There will only ever be 300 buyers” (AMO



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2007:272).6 It is not easy to imagine a comparable union of national iconicity and exclusive privatization—this is something akin to the division and sale of the interior space of the Statue of Liberty for use as luxury apartments. A promotional pamphlet for Falcon City of Wonders perhaps best summarizes Dubai’s peculiar if ubiquitous hybrid of public monument and private space: the sub-development is meant as “a national icon befitting the exclusivity of Dubai.”

VII. The latest of Dubai’s finished landmarks, Burj Khalifa (renamed in 2009 from Burj Dubai after the city’s multi-billion dollar bailout from Abu Dhabi and its ruler Sheikh Khalifa bin Zayed bin Sultan Al Nahyan) epitomizes the global life of the city’s built environments. While the tower—the world’s tallest at over 828 meters—is relentlessly visible from any point in Dubai’s considerable sprawl, its photographic likeness reaches even further, as did computer-generated images in the years preceding its completion. The Burj Khalifa occupies a central position in Dubai’s iconography and branding efforts and it is regularly paired with the visage of the Emir in advertisements and brochures as a representation of Dubai’s own fantastic ascent. In the inescapable presence of the Burj Khalifa, it is difficult to deny Roger Keil’s suggestion that “the giant tower has become the most important symbolic product in the global economy…a sign used by states both to challenge the existing economic order and make their claims to contemporary modernity” (King 2005:322). Yet such self-periodizing efforts have more significance in regional context, where modernity is packaged as exception. “Much of the population,” an article in Asharq Al-Awsat reported in July 2007, “considers the Burj Dubai a symbol of wealth, modernity, and stability in the Middle East.” Modern architecture appears as crucial evidence of Dubai’s aspirations to regional predominance. In Abdul Khaliq Abdullah’s aforementioned article, the author is immediately attentive to the disparities that hold between the urban conditions of Dubai and its neighbors. “What is the story of Dubai?” Abdullah poses. “How has it realized what the old Arabic cities could not realize?”(2006:59). In answering this he turns repeatedly to incredible architectural projects—“the first underwater hotel” (p. 61) and the Burj Khalifa (p. 64) as examples of such realization. Monumental architecture is

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a potent affirmation of Dubai’s exceptional development—and it follows from these examples that Dubai is nominated as a kind of capital of the entire Arab world. Indeed, Abdullah positions Dubai’s ascendance within a storied history of Arabic capitals. “Just as Baghdad and Damascus and Cairo and after them Beirut had their moments, the star of Dubai is the brightest in the contemporary Arab constellation.” Dubai, he claims, is the first city to seize the role of the leading Arab city since Beirut’s decline amidst Lebanon’s civil war, and with that global role in mind, Abdullah asserts that “the strength of Dubai’s success is much greater that the successes of Beirut or Cairo” (2006:64). Thus installed in a lineage of the cultural and economic capitals of the Arab world, Dubai is to set an example for the region. Yet we begin to witness here the double (and of course thoroughly political) move that characterizes apolitical practice in Dubai. Dubai is claimed as a beacon for other Arab states, but in its broader international relations it is sustained on impressions of their relative amodernity—of their being stuck in historical time. Dubai, Abdullah writes, is in the midst of an environment “typically hostile to the world and to the contemporary age” (2006:60), and Dubai’s current Emir, Mohammed Bin Rashid Al Maktoum echoes this double claim on the region in his 2006 manifesto Ru’yati: altahaddiyat fi sibaq al-tamayyuz (“My Vision: Challenges in the Race for Excellence”). Like Abdullah, he inveighs against neighbors’ resistance to the global market: “some of us close the door…then turn out the light, and hold out their hands and ask, ‘Where is globalization?’ ”(p. 24) Yet Maktoum nonetheless offers a rousing, if vague, call to lead Arabic development: “We in the Arab community can win the race. We can realize success. We can give…this is not a dream” (p. 136). This vision that Dubai might serve as an example to the region is quite popular in a time of American military intervention in to the Middle East. Among others, Thomas Friedman, arguably America’s most influential popular commentator on the Middle East, has elaborated on this basic thesis for an American audience. In a March 2006 op-ed piece for the New York Times, entitled “Dubai and Dunces,” Friedman argued: Dubai is precisely the sort of decent, modernizing model we should be trying to nurture in the Arab-Muslim world. It is a bridge of decency that leads away from the failing civilization…to a much more optimis-



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tic, open and self-confident society…[Muslim] civilization is, in many places, in turmoil, falling further and further behind the world in science, education, industry and innovation, while falling deeper and deeper into the grip of crackpot clerics, tin-pot dictators, violent mobs and madmen like bin Laden and Saddam….Dubaians are building a future based on butter not guns, private property not caprice, services more than oil, and globally competitive companies, not terror networks. Dubai is about nurturing Arab dignity through success not suicide. As a result, its people want to embrace the future, not blow it up. Friedman’s essay registers the triumph of Dubai’s apolitical performance. It reflects each of the tropes of the city’s own architectural regime: a distinction between an Arab world that is behind in historical time and “falling behind in the world,” and Dubai’s own “modernizing model,” a dichotomy that parallels a disparity between so many signatures of the political as such—“guns,” “terror networks,” “[blowing] it up”—and the innocuous trademarks of contemporary economic liberalism. Indeed: “Success not suicide.” Friedman’s 2006 article closes, “Whatever happens with the Iraq experiment—but especially if it fails—we need Dubai to succeed. Dubai is where we want the Arab world to go.” A basic premise of this essay has been the implication of the apolitical in contentious politics, and Friedman’s conclusion makes clear that the two are indeed rather difficult to separate. Dubai appears within the same strategic optic as contemporary sites of war, and its value as an apolitical zone increases as Dubai’s surrounds are embroiled in political friction. Indeed, that Dubai is the object of increasing American “need” points to some precise deficiencies of the contemporary era. Despite so much cosmopolitanism claimed on behalf of a globalized world, Dubai’s architectural program indicates a globalization that demands nothing from its aspirants so much as their absence: that they appear without history or politics. At stake in these demands for frictionless world space is the distribution of capital and violence alike.

REFERENCES Abdullah, A.K. 2006. Dubai: Rihlat madina ‘arabiyya min al-mahalliyya ila l-`alamiyya. Al-Mustaqbal al-Arabi 323: 57–84. (Translations from Arabic by the author.)

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Allabar, M.A. 2009. Interview with Mohammad Ali Allabbar. Al-Aqariya 169, June 25. (Translations from Arabic by the author.) Al Maktoum, M.B.R. 2006. Ru’yati: al-tahaddiyat fi sibaq al-tamayyuz. Beirut: Arab Institute for Research and Publication. (Translations from Arabic by the author). AMO. 2007. The World Press Conference. In Al Manakh, ed. Moutamourat and AMO, pp. 272–287. New York: Columbia University Graduate School of Architecture, Planning, and Practice. Appadurai, A. 1996. Modernity at Large: Cultural Dimensions of Globalization. Minneapolis, MN: University of Minnesota Press. Asharq Al-Awsat. 2007 Burj Dubai Becomes the Tallest Human Structure in the World. Asharq Al-Awsat, April 4. (Translations from Arabic by the author.) ———. 2008. Emaar Extends the Height of the Burj Dubai and Delays Completion Until 2009. Asharq Al-Awsat, June 18. (Translation from Arabic by the author). Bagaeen, S. 2007. Brand Dubai: The Instant City; or the Instantly Recognizable City. International Planning Studies 12:173–197. Beirut Information and Studies Center. 2008. 1000 Numbers and Reasons Why Dubai. Beirut: BISC Publications. Braley, J. 2007. Why Dubai? Presentation at the Skyscraper Museum, July 18, in New York, New York. Comaroff, J., and J. Comaroff. 2000. Millennial Capitalism: First Thoughts on a Second Coming. Public Culture 12:291–343. Davidson, C. 2008. Dubai: The Vulnerability of Success. New York: Columbia University Press. Davis, M., ed. 2007. Evil Paradises: Dreamworlds of Neoliberalism. New York: The New Press. ———. 2006. Fear and Money in Dubai. New Left Review 41:47–68. Debord, G. 1994. Society of the Spectacle. New York: Zone Books. De Certeau, M. 1984. The Practice of Everyday Life. Berkeley: University of California Press. Deleuze, G., and F. Guattari. 1987. A Thousand Plateaus. Minneapolis: The University of Minnesota Press. Easterling, K. 2005. Enduring Innocence: Global Architecture and Its Political Masquerades. Cambridge: MIT Press. El-Batalji, D. 2007. Dubai: An Emerging Media Hub. Arab Media and Society 3. Friedman, T. 2006. Dunces and Dubai. The New York Times March 15. Fukuyama, F. 1998. The End of History? In The Geopolitics Reader, ed. S. Dalby, P. Routledge, and G.Ó. Tuathail, pp. 114–124. London, Routledge. Originally pub-



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lished The National Interest, Summer:3–18. Gieryn, T. 2002. What Buildings Do. Theory and Society 31:35–74. Greer, G. 2009. From Its Artificial Islands to Its Boring New Skyscraper, Dubai’s Architecture is Beyond Crass. The Guardian February 9. Gruzman, J. 2007. Why Dubai? Presentation at Skyscraper Museum, July 18, in New York City, New York. Hardt, M., and A. Negri. 2000. Empire. Cambridge, MA: Harvard University Press. Jameson, F. 2002. A Singular Modernity. New York: Verso. Kanna, A. 2010. Flexible Citizenship in Dubai: Neoliberal Subjectivity in the Emerging “City-Corporation.” Cultural Anthropology 25:100–129. ———. 2006. Not Their Fathers’ Days: Idioms of Space and Time in the Urban Arabian Gulf. Unpublished Ph.D. dissertation, Harvard University. King, A.D. 2005. Global Media Cities: Major Nodes of Globalizing Culture and Media Industries. In The Global Cities Reader, ed. R. Keil and N. Brenner, pp. 319–339. London: Routledge. Kirchner, M., and S. Rab. 2007. An Arabian Night’s Fantasy, and That’s Okay. In Al Manakh, ed. Moutamourat and AMO, pp. 18–22. New York: Columbia University/Archis. Kotkin, S. 2008. Dubai, the Glimmering Emirate, Revisited. New York Times December 6. Koolhaas, R., O. Bouman, and M. Wigley, ed. 2007. Last Chance. In Al Manakh, ed. Moutamourat and AMO, pp. 194–203. New York: Columbia University/Archis Koolhaas, R. 2007. Frontline. In Al Manakh, ed. Moutamourat and AMO, pp. 7–13. Amsterdam: Stichting Archis. ———. 2001. Mutations. Bordeau: Arc en rêve centre d’architecture, and Barcelona: ACTAR. ———. Generic City. In S, M, L, XL, ed. R. Koolhaas, B. Mau, J. Sigler, and H. Werlemann, pp.1248–1265. 2nd ed. New York: Monacelli Press. Kroft, S., narrator. 2007. A Visit to Dubai, Inc. Sixty Minutes, New York: CBS Television, July 30. Latour, B. 1993. We Have Never Been Modern. Cambridge: Harvard University Press. Marx, K. 1946. Capital: A Critical Analysis of Capitalist Production. London: Allen and Unwin. Matly, M., and L. Dillon. 2007. Dubai Strategy: Past, Present, & Future. Paper, Dubai Initiative, Belfer Center for Science and International Affairs, Harvard Kennedy School. Cambridge, MA. Meyer-Reumann. 1991. The Jebel Ali Free Zone in the Emirate of Dubai: A Commer-

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cial Alternative After the Gulf Crisis. Arab Law Quarterly 6.1: 68–78. Mitchell, T. 2000. The Stage of Modernity. In Questions of Modernity, ed. T. Mitchell, pp. 1–34. Minneapolis: University of Minnesota Press. Molavi, A. 2007. Profile: The Arab Sheikh. Newsweek August 6. Ourosoff, N. 2008. The New, New City. The New York Times June 8. Sampler, J., and S. Eigner. 2003. From Sand to Silicon: Achieving Rapid Growth Lessons from Dubai. London: Profile Books. Schmitt, C. 1996. The Concept of the Political. Chicago: University of Chicago Press. Shadid, A. 2006. The Towering Dream of Dubai. The Washington Post April 30. Sherwood, S. 2006. Is Qatar the Next Dubai? New York Times June 4. Sloterdijk, P. 2008. Foam City: About Urban Spatial Multitudes. In New Geographies 0:136–44. UAE Free Zone Investment Guide. 2005. Dubai: Crossborder Legal Publishing. Weizman, E. 2007. Hollow Land: Israel’s Architecture of Occupation. New York: Verso. White, M. 2008. London—capital of the 21st century? The Guardian July 1.

NOTES 5.1 This article was written in Spring 2009 and submitted as an undergraduate thesis to the University of Pennsylvania’s Department of Near Eastern Languages and Civilizations. The list of important works since published on Dubai would be long, but would almost certainly begin with Ahmed Kanna’s Dubai, The City As Corporation (Minneapolis: The University of Minnesota Press, 2011). I received the most generous and patient guidance from my supervisor, Professor Heather Sharkey, and fieldwork funds from Penn’s Institute for Urban Research and a Vagelos Undergraduate Research Award. I am grateful to Aaron Shapiro, Philip Rocco, Elias Saba, and Caitlin Hu for conversations about the topics considered in this article. 5.2 That such severe condemnation is published in a major daily newspaper on a continent distant from Dubai, and written by an individual not resident in the city, speaks again to the global life of its built environment. It is an object of narration and interpretation well beyond any stable population of inhabitants. 5.3 However, Gieryn adds the important caveat that buildings do so “imperfectly.” Always subject to unanticipated destruction, alteration, and interpretation, “they are vulnerable to wrecking balls or discourse.” On the latter see Kindstrand, Ghosts against Nikeification: Homeless as Paragon and Pariah in the Occupation of Tokyo’s Miyashita Park, in David Slater (Ed.) Alternative Politics: Emergent Forms of Engagement and Activism in Japan (forthcoming, Routledge).



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5.4 Bruno Latour has identified this opposed pair as the chief distinction of claimants to modernity, who emphasize the partition “between a natural world that has always been there and a society with stable and predictable interests” (1993:11). 5.5 The expansion of free-zone ethos from industrial logistics to the traffic in data and humans may be fully realized in Dubai World Central, a U.S. $33 billion development meant to occupy 140 square kilometers at the edge of Dubai. Assembling a “golf city,” “residential city,” “commercial city,” “logistics city,” and “aviation city,” all of them clustered around DWC Al-Maktoum International Airport—to be the world’s largest airport—Dubai World Central imagines a complete para-state in which nearly all possible activities are reproduced slightly beyond the law of the land. With Dubai World Central, the free zone is no longer an entrepôt for specific kinds of industry but moves toward a total scheme for life beyond the demands of place, state, and law. DWC’s promotional materials seize upon this potential paradigm shift: the city will “create a new epoch,” and “represent a phenomenal forward leap in the realms of commerce, technology, and enterprise.” 5.6 Keller Easterling has noted that this exclusivity will be policed by a kind of paramilitary—security boats will patrol inter-island waters to ensure buyers’ privacy (2005: 1). 5.7 For a study of the specific practices through which economy is purified of contentious politics see also Bright (2009) How to moot things with audit: the politics of CO2 verification in the European Union emissions trading system. Unpublished MA thesis, Institut d’etudes politiques de Paris.

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6 If There Is Food, We Will Eat: An evolutionary and global perspective on human diet and nutrition Janet M. Monge

INTRODUCTION

T

he diversity of diet across evolutionary time and over the expanse of the globe today highlights the range of tolerated and consumed foods that characterize humans as a species. The range, as it is oftentimes quoted, includes the full scope from almost exclusive animal food consumption to diets virtually devoid of any animal sources of nourishment (except for the incidental ingestion of insect residua). This diversity underscores the issues and problems in defining what constitutes an “optimal” diet for all humans. Indeed it appears that there is no optimal diet, although there are dietary guidelines that minimize a host of illnesses that are mediated by diet, including many manifestations of cardiovascular disease, various types of cancer, and systemic metabolic imbalances (Lindeberg 2010). There are many lines of evidence that bear on the issues associated with the adequacy of diet and the nutritional needs of humans in the modern world. Many of the studies that bear on this issue look at patterns of nutritional disease as a baseline for understanding what is normal, necessary, or optimal. Because of different genetic substrates, the necessary analyses are quite complex. Nevertheless, there appears to be a general agreement, reflected well in the nutrition reports by the WHO (World Health Organi-

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zation), that human nutritional requirements are best fulfilled by taking in calories and nutrients from a maximal variety of food sources. In addition, an evolutionary perspective confirms that it is best to choose foods from the vegetable and fruit categories with limited quantities of fats. It is also good practice to minimize the quantity of salt and simple carbohydrates in the diet (WHO, 10 Facts on Nutrition). In addition, an evolutionary perspective appears to indicate that, to maximize long-term health, an increased amount of foods rich in both calcium and potassium be consumed in all life stages. It is ironic that although approximately 180 million children globally are without adequate calories and nutrients to maintain an optimal potential for growth and development, in many nations, especially the United States, over-consumption of calories has caused the problem of obesity, which is most alarming (from a public health perspective) in childhood. In addition, the incidence of obesity is rising in many nations. In reality, in virtually all areas of the world a subset of the population, with access to greater resources, is overweight or obese (for the actual statistics see: WHO, Health Topics: Obesity). In the same way, within the confines of the richest nations in world, there are individuals or entire populations that are under- or malnourished. No one field of inquiry can possibly address all of the issues associated with nutritional adequacy and inadequacy. It does appear that (with everything else being equal) if there is available food and the means necessary for acquisition, humans will eat it. The evolutionary perspective, however, does give us a productive way to understand the baseline of some of the broad issues addressed within the various inter-related fields of the nutritional sciences. The question simply addressed is: can an understanding of the diet of our ancestors help us understand the choices that led to modern human diets and the adequacy of these diets for the maintenance of long-term health?

THE EVOLUTIONARY PERSPECTIVE This topic area has been invaded by a plethora of books that often feed into the popular “diet craze” that exists in our weight conscious society (see, for example: Cordain 2002; Cordain and Friel 2005; De Vany 2010; Wolf 2010; Audette and Gilchrist 1999). The first serious synopsis attempting to address this very topic was published in 1985 by Eaton and Konner and expanded into a book in 1988 (Eaton,



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Shostak, and Konner 1988), which emphasized the use of recent gatherer/ hunter studies. In this same time period, two other edited volumes set the stage for the analysis of diet from an evolutionary perspective (Harding and Teleki 1981; Harris and Ross 1989). Since that time, the accumulation of new data as well as an exponential expansion in techniques of analysis used to test these data sets, has further refined and reintegrated this research agenda. The basic premise of the evolutionary perspective as applied to an understanding of diet and human evolution is that all forms of life are adapted to the consumption of an optimal combination of foods and that selection has operated over time to produce not only the means to acquire these foods but also the means to extract nutrients from food once it is ingested. There has been a recent expansion of interest into the analysis of food sources that are used only under conditions where optimal food sources are no longer available. These are called “fallback foods” (Constantino and Wright 2009). These adaptations can be behavioral, biological, and in the case of humans and perhaps other animals as well, cultural or social. Tracking the dietary course of human evolution, it seems apparent that the major shifts in food acquisition and consumption can be broken down into the following stages (at least it is often presented in this way).

STAGES IN HUMAN DIETARY EVOLUTION 1. Generalized omnivory as part of our primate ancestry. 2. A shift in the emphasis on particular food types based on movements of hominid ancestors into novel environments early in the history of humans. 3. An economic adjustment that expands hominid food interactions into a social, at least familial network. In addition, at this stage of human evolution there is an increase in food preparation including cooking as well as the integration of higher quality protein into the diet primarily from animal sources. 4. A dramatic shift to food production associated with the origin of agricultural and the domestication of animals. 5. An expansion of global economies related to food production and distribution that allow food resources to be transferred over ever expanding distances and introducing humans to a unique range of food stuffs.

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Stage 1: General Omnivory Primates: Although it is difficult to know just how far to extend living primate studies to human evolution, it seems that it is safe to assume that the general pattern of omnivory can be applied to even the very earliest phases of human evolution. Primates appear to be generalized feeders responding to food availability opportunistically and when seasonally available, including animal source foods. Omnivory refers to general trophic level within the foodweb, and not to particular foods that are consumed by animals on this level. Since the hominoids, especially the large-bodied African chimpanzee, bonobo, and gorilla, are our closest relatives, much attention has focused on the diets of these animals. Beyond the general statement that their diets are varied both between and within species, and that it is best described as omnivorous, are there any statements that pertain to the question of the origin of human diet? Studies of the microwear (an indicator of abrasive elements in the food consumed and often used for comparison to fossil forms in the human lineage) on the dentition of the African hominoids illustrates the diversity of diets consumed by even individual animals and highlights that non-food items might be a contributor to their dietary strategies (Galbany et al. 2009). It is essential at this junction to state that while we are close relatives to these other hominoid species, they are not our ancestors and indeed that they have a long evolutionary history as distinct from our common ancestor as do humans. The usefulness of these comparative studies of living primates is probably of limited value. It is generally assumed that the chimpanzee is the best model for comparison to early human ancestors. Living chimpanzees are best categorized as ripe-fruit frugivores. If these animals are good models for the last common ancestor of the chimp and human lineages, then we can hypothesize that this last ancestor was an opportunistic feeder but with an emphasis on ripe fruit. Comparison of the earliest known members of our lineage, Ardipithecus ramidus and Australopithecus anamensis, using both microstructural analysis and overall dental morphology, indicates that at the origin of our lineage, dietary choices were distinct from any of the living hominoids (Suwa et al. 2009; Macho and Shimizu 2010). Thus, it appears as if an adaptive shift occurred at the very inception of our lineage and that this shift, reflected in both ecology and diet, sets the stage for future changes in our evolutionary line.



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Rodman (2002) summarizes much of the ecological and food-related behaviors associated with diet in the living hominoids. The conclusion, and one that can be applied to hominid ancestors, is that food choices among the apes encompass a broad spectrum of edible elements and that across this spectrum, choices are varied and random in respect to individuals, populations, as well as between species. In addition, making foods more readily available, many primates including hominoids engage in extra-oral food processing and food sharing (Hohmann 2009). Although not a perfect model for understanding diets in our ancestors, the commonalities across this broad range of non-human hominoids, allows us to make the assumption that this pattern was part of the common ancestry of all hominoids including humans. Similarly, the anatomy of the alimentary canal below the oral cavity as well as the basics of nutrient requirements and food transit times (with some population, individual, and dietary difference influencing this aspect of digestion) within the GI tract, are similar across all hominoid species (Milton 1999). Differences in dietary composition across these varied species apparently can be tolerated within these anatomical and thus evolutionarily constrained digestive tube. Although the portions of the digestive system can be somewhat modulated during life based on the diversity of consistent dietary choices over a long time span, these represent only small fluctuations from this basic design. For the most part, humans have a somewhat expanded small intestine accommodating a greater proportion of animal foods within the diet; gorillas, on the other hand, with their heavy concentration of low nutrient quality leaves with a high fiber concentration as a portion of diet, have larger segments of the GI tract devoted to the colon (Milton 1999). Lambert (1998), in a similar way, refers to these alterations within the compartments of the gastrointestinal system as “modularity” and that the basic composition of the GI tract does not limit the types and varieties of foods that compose the hominoid diet. One of the constraints within this research study is of course, the inability to derive appropriate soft tissue data from the fossil record of human evolution. Another limitation is that measurements of area devoted to each segment of the digestive canal gives no actual data on the histomorphology of the gut and microorganisms that are a necessary component of digestion (Walker 2007). Thus, animals with virtually identical digestive compartments may indeed have differing diets and different mechanisms for

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processing and extracting the nutrients from that food (Vrieze et al. 2010), possibly reflecting individual or population differences and not necessarily species-wide evolutionary adaptations. Thus, although not very fulfilling in a number of ways, the phenomenon of world wide variation in human diets is based very much on the primate pattern of nutrient acquisition and food exploitation. There are really no limitations in the food types that are consumed by humans and humans are very much opportunistic eaters. One essential limitation in understanding the evolution of the human diet, based on models derived from primate studies, is the absolute dearth of data on the micronutrient components of the diet in primates. Most studies factor in only broad categories of diet components like “meat,” “leaves,” or “fiber” (see, for example, Conklin-Brittain, Wrangham, and Smith 2002). The sustainability of particular diets does not rest on these overarching components alone, but on what are the actual sources of nourishment contained within these foods (Eaton and Eaton 2000) beyond, protein for tissue building, carbohydrates for energy, and fiber for altering transit times and the potential for nutrient absorption. Gatherer-Hunters: Nutritional studies of modern gathering-hunting peoples (sometimes also referred to as foraging peoples) have also contributed to the understanding of base-line human diets. As with primate models, gatherer-hunter models are inadequate in some respects. The question is: do modern (at least until very recently when many of these groups were subsumed within the economy of nation-states) gatherer-hunters reflect a more “natural” human dietary condition? At least, is this type of resource extraction strategy more similar to the ways our early ancestors collected resources? Modern gatherer-hunters are not our ancestors. With several caveats, the use of this model, at least as far as dietary information is concerned, is probably more informative than models based on agricultural peoples. Modern gatherer-hunter peoples have very sophisticated technologies for the extraction of resources from the environment that were not part of the distant evolutionary past of humans. In addition, the fossil record shows clearly that our early ancestors had relatively small brain sizes that probably translated to differing behavioral complexity, here associated with differences in resource extraction behaviors.



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The application of gatherer-hunter studies to diet and human evolution began in a systematic fashion with the data compiled as part of the Harvard Kalahari Research Project (1963–1976) on food, diet, nutrition, and health (summarized in Lee and DeVore 1968; Lee 1979) on the Dobe Ju/‘hoansi (!Kung language speakers, also called The Bushmen). While the emphasis was traditionally on meat and the acquisition of animal resources, Dahlberg (1981) amassed a series of articles in an edited volume on the role of women in traditional gathering hunting societies. The most recent synopsis of the Dobe Ju/‘hoansi research, including the analysis of life history, diet and disease, is contained within the work of Nancy Howell (2010). Other strategic early work on diet includes seven articles on forager and/ or gatherer-hunter food strategies and subsistence in Harris and Ross (1987; Part IV. Pre-State Foodways: Past and Present) and Hayden (1981). A more recent summary volume of foraging societies is the Cambridge Encyclopedia of Hunter-Gatherers (Lee and Daly 2004). Gatherer-hunter societies range broadly in the quantity and proportion of animal and plant materials in the diet with a major component of dietary choice based on availability most often associated with seasonality and latitude (Kelly 1995, 2007). In all of these groups, the proportion of foods from animal sources outstrips the quantity of food (including insects) that compose the non-human primate diet. Thus, there is a tendency, when discussing dietary changes in human evolution, to emphasize the role of “meat” in the diet. While it is true that sources of animal protein and fat are important in the gathering-hunting diet, there has been traditionally, an over emphasis on the importance of meat (Fiddes 1991; Stanford and Bunn 2001), while downplaying the role of gathering. It does appear that gathered foods (of plant or animal origin) were the base of virtually all gathering-hunting group diets in tropical and subtropical areas (the origin place of the human evolutionary lineage) which in turn allowed for the more risky behaviors associated with hunting the relatively rare animal (Zihlman and Tanner 1978). While many primate groups show behaviors described as food sharing, the place in human evolution when an economic shift towards resource extraction specialization (based on sex and perhaps age-groups) and resource sharing occurred is debated. Certainly the necessary tools for effective gathering-hunting do not make an appearance in the very earliest stages of human evolution although, like our primate cousins, tool use certainly

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occurred in the common ancestry of at least the apes and humans. It is also possible that even the simple digging stick could have significantly altered the types and quantities of food stuffs accessible by the typical clawless, pawless, bipedal hominid (Mann 1981). The dietary shift associated with gathering-hunting is one of the most important in all of human evolution. That this technique survives today is a testament to its effectiveness as a good extraction method. Of course, it appears in a modified form, since modern gatherer-hunters interact with other neighboring societies of all sorts and have been incorporated politically into nation-states, not only now but for thousands of years. In addition, gathering-hunting group diets give insights into the overall pattern of diet-mediated health issues in human evolution. The pattern in general is that gathering-hunting groups while experiencing times of low caloric extraction and intake, and could be considered under-caloried at certain times of the year, what nutritionists call calorie-restricted, rarely suffer from malnutrition (Cohen 1989). Thus, seasonality and low caloric consumption, may be part of a healthy human dietary pattern coming in part from our gatherer-hunter past and the benefits of caloric restrictive diets is now being explored within the framework of the biomedical research on modern human populations and how it influences disease and patterns of aging (Hursting et al. 2010; Fontana 2009).

Stage 2: Beyond Omnivory What do we know about the earliest deviations from the common ancestor, dietary or otherwise, in our lineage? Although we have some fossils that extend as far back as 6 million years ago that are purported to be members of our lineage, the first large more extensive sample and more thoroughly published species, Ardipithecus ramidus, is dated to approximately 4 to 5 million years BP (Before Present). Although chimpanzees are often used to model the earliest members of our lineage, it seems apparent that even at this early (and possibly inception) date, that Ardipithecus reflects not only a host of morphological differences from chimps, but also a substantive break from the environmental and behavior features, including dietary, of both the living chimp and the last common ancestor of chimps and humans. (A full issue of the journal Science on October 2, 2009 Volume 326 was devoted to the analysis of these fossils as well as to reconstructions of the behavior and biology of this species).



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Lovejoy (2009) has argued cogently that this early member of our lineage, with its unique morphology including bipedalism and notable changes in the dentition (the anatomical structure associated with the beginnings of food processing), shows a substantive adaptive shift from earlier forms as reconstructed from models of the last common ancestor of chimps and humans. Others have argued on even theoretical grounds and not based on fossil evidence, that at this early junction, chimpanzees’ behavioral and morphological models for this evolutionary transition, based on the general principles of evolutionary thought, would have dictated a total adaptive shift, with a distinct and unique combination of changes occurring early in our lineage (Hohmann 2009). Of most importance are the shifts that Lovejoy proposes in male-female interactions moving from the confines of the occasional food sharing and provisioning seen among living chimps, to full blown provisioning of females by males as well as a series of cascading changes that would have ensued including the inception of malefemale pair bonding and possible economic alterations in the ways that the sexes independently procure foods from the environment. Thus, it is possible that at this early juncture in human evolutionary history one of the key components of unique human ecological (including food extraction) behaviors, and social features like pair-bonding, emerged. That feature would be what Kaplan, Hooper, and Gurven (2009:3289) refer to as changes in “the degree of complementarity in male and female inputs into production.” From there, other unique or defining features of human social organization and food production would have emerged within our lineage. It is often argued that the shift to pair-bonding, based on primate models, is best illustrated in the fossil record by a reduction in the degree of sexual dimorphism. Plavcan (2001) aptly illustrates the complexity of ecological, social, and evolutionary factors that influence the degree and manifestation of sexual dimorphism. There is no real evidence that the large degree of sexual dimorphism shown in the fossil record within species in the hominid lineage in the early phases of human evolution obviates discussions of pairbonding and provisioning as models for this first in a series of adaptive shifts.

Stage 3: Meat and Food Aquisition and Preparation At some time frame in human evolution, and perhaps at multiple points, dietary composition was altered significantly and involved the exploitation of new environmental niches. When did this occur and how do we accumu-

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late the data from the fossil evidence with reconstructed environments to build a greater understanding of these shifts? After about 3 million years BP, the fossil record indicates that there are multiple species that compose the human lineage. The relationship of these to each other and to later forms in that lineage, is not completely clear. These early forms are all generally placed into the genus Australopithecus. This genus is generally broken into gracile and the more specialized robust types. By about 2 million years, we have the emergence of the genus Homo defined primarily based on increases in brain size. It is at this junction that most researchers indicate a substantive change in the quality of food resources that may be fueled by competition with multiple other species including Australopithecus. One of the most significant changes occurs with the transition to a greater quantity of meat, which is generally considered to have occurred with the ability of our ancestors to accumulate and consume a greater quantity of animal foods in the diet (some have argued for the role of scavenging of animal carcasses in human evolution; see Shipman 1986). The second significant change, perhaps occurring at about the same time, is the beginning of more elaborate tool technologies and eventually cooking. Cooking and other types of food preparation: Although there is no general consensus on the earliest habitual use and control of fire, it is possible that the first members of our lineage placed into the genus Homo, specifically Homo erectus, made use of fire for the preparation of foods (Karkanas et al. 2007; Clark and Harris 1985; Brain and Sillen 1988; Weiner et al. 1998). Whenever the origin of habitual fire use for roasting and/or cooking may have been, the process appears to yield great dietary benefits for our ancestors. Carmody and Wrangham (2009a, 2009b) list the major net positive changes of this alteration in technology: 1. chemical changes in the starch content of particular foods; 2. changes in the structure of proteins; 3. detoxification of foods containing pathogens and a variety of other toxins. In addition, and very importantly, cooking might improve the taste of foods especially animal proteins and fats (Wobber, Hare, and Wrangham 2008). Beyond cooking, direct preparation of vegetable foods could also change the digestibility and toxicity of many foods. Other preparation techniques using simple tools include: peeling, soaking, and crushing. These



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alterations could change the digestibility, content and toxicity of especially many roots and tubers. Luca, Perry, and Di Rienzo (2009) also note that cooking would have reduced the extent and time spent in processing food in the mouth. This might be associated with changes in not only the size of the dentition macroscopically, but the types of wear on the individual teeth microscopically. However, this can also be related to dimensions of the face and skull associated with the musculature of mastication and/or to the bony buttressing of skull. Back to Meat: As stated before, with the origin of the genus Homo, there is an expansion in brain size that is easy to document from the fossil evidence. This increase occurs beginning at about 2 million years BP. Although we can plot that this increase did indeed occur, the reasons for this expansion are contentious. One theoretical method used to understand brain size increase in the Homo lineage firmly rests on models that use dietary assumptions. Perhaps the best accepted was put forward by Aiello and Wheeler (1995) called the Expensive Tissue Hypothesis—the brain metabolically is a very expensive tissue using approximately 15% to 20% of all of the energy consumed by modern humans. Thus, in order to support selection for increases in neurological tissues, dietary quality would by necessity have to increase in order to maintain other energy consuming activities including digestion and to keep overall metabolic costs stable. Since animal foods are easier to digest, the GI system reduces in size as a proportion of body size and in energy consumptive costs allowing for the potential of increases in brain size. In this model, as well as in other proposed models based on meat consumption (Milton 2003; Leonard and Robertson 1994; with many earlier references), the acquisition and consumption of meat is the substrate underpinning increases in brain size concomitant with expansions in brain size and the origin of the genus Homo. Is there evidence that perhaps other dietary or life history changes (and evolution-based ways to study time frames in the life course of the animals within the species, e.g. infancy, childhood, etc.) are associated with the evolution of the genus Homo? Isotope studies (see below) on fossil bones do not seem to confirm a dietary shift to the consumption of more animal products at the junction in the fossil record with the origin of the genus Homo (Sponheimer and Dufour 2009). O’Connell, Hawkes, and Blurton Jones

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(2002) propose a model of the evolution of the genus Homo that does not require a dietary shift in this surviving branch of our lineage. Thus, there are alternative viewpoints on the expanded exploitation of animal products in the diet of our ancestors. Micro and Macro Anatomy Related to Diet: An extensive body of literature exists on the topics related primarily to the dentition and overall cranial anatomy of hominid ancestors. A partial synthesis is presented here integrating features of anatomy to diet. The range of morphological, biomechanical, enamel structure and microwear studies that explore the topic of diet in human evolution often produce conflicting results that are difficult to synthesize. These research studies are often based on the use of different samples and/or species, distinct protocols of data collection, and the use of very different statistical analytic tools (for an example of one meta-analysis study, see Grine et al. 2010). Does this avenue of research give us any insights into the evolution of diet in our lineage? Dental microwear studies are difficult to interpret since there is a great deal of individual variation in the appearance of microabrasive patterns on the dentition of fossil forms and on living forms that set the comparative and experimental base to which fossils are compared. In addition, these abrasion patterns might derive from non-food sources, like dust and dirt, and micro changes in the enamel that occur after the death of the individual, that all become part of the post mortem microwear patterning (Galbany et al. 2009). When possible to distinguish between pre- and postmortem influences on the appearance of these marks, microwear probably reflects just the last few days or weeks of the animal’s life and not the full range of possible dietary elements processed by that animal especially over different seasons and with the exploitation of differing environments. Also confounding dietary interpretations, some aspects of dental microstructure may reflect more the use of “fallback” foods rather than other more consistent aspects of the diet (Ungar 2009). Thus, it is difficult to interpret the meaning of the patterns observed in the range of fossil specimens that have been analyzed using this technique to infer dietary composition of extinct species (Teaford 2007). In the same way, studies of tooth size and shape, enamel structure, and biomechanical analyses of fossils often result in conflicting conclusions re-



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garding the diets of fossil species (for a summary study, see Teaford, Ungar, and Grine 2002). Furthermore, these studies can come into direct conflict with studies of microstructure and isotope composition (see below). Based on these studies, it appears that the early Australopithecus members of our lineage were in all likelihood able to consume a broad diet with a possible shift towards the ability to process hard objects like large nuts and seeds if not as a major component in the diet, but perhaps as “fallback” foods (Strait et al. 2009; Teaford, Ungar, and Grine 2002; Ungar, Grine, and Teaford 2008; Ungar 2009). With the evolutionary appearance of the genus Homo, the broad dietary base is maintained but with a reduced emphasis on hard foods (which are crushed or cracked) to tougher foods (for example, foods that have thicker skins or even animal (muscle) foods) (Constantino et al. 2010). In addition, the reduction in overall jaw size and shape, changes in molar tooth size and in occlusal surface relief, and perhaps in microstructure of the enamel itself, are all potentially associated with extra-oral food processing that comes from the increased use of tools and an increase in the variety of tool types used to process foods. Isotopic Studies: Isotopic studies, as applied in all varieties of fossil bone analysis, rely upon the extraction of chemical signature information from these ancient tissues that reflect the chemical elements of what was absorbed into the bony structural component of what once were living animals. Some of these extracted chemicals have been related to diet. There are several different chemical profiles used to reconstruct diets in the past. These include: Carbon isotopes, Oxygen isotopes, Strontium/Calcium ratios, and Strontium isotope studies. All of these studies rely upon the ability to distinguish between the original chemical components of the bone as it once was present and preserved in the living animal from the chemical alterations that are part of the fossilization process (for an excellent recent review of the literature, see Lee-Thorp 2008). Isotopic studies also present a complex picture of hominid-diet interactions in the past. Can these studies illuminate and clarify other sources of information on the dietary composition of members of our evolutionary lineage? Again, the emerging picture is in fact quite complex. From the summative studies of isotopes and unique hominid lineages, it seems apparent that the isotopic shift is reflective, at least in South Africa

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where many australopithecine grade fossils have been found, of a dietary shift towards the exploitation of grassy-open patches for a variety of foods (Lee-Thorp 2002). In both Australopithecus forms, and in early members of the genus Homo, there is not a significant dietary distinctiveness between them and this runs counter-intuitive to other biological and morphological distinctive features of these genera (explored above). Sponheimer and Dufour (2009) come to much the same conclusion. As the final word, there is an isotopic signature in australopithecines that distinguishes them from chimpanzees. The data from chemical analysis is not as easy to identify primarily as a direct result of small sample size. It does appear that in conjunction with the other lines of evidence directed towards this issue early Homo demonstrates a shift in emphasis but not an alteration in the dietary composition of earlier and contemporaneous australopithecine species. Some of this is probably best understood and mediated by changes in extra-oral food preparation and probably the incorporation of a repertoire of tools that can be brought to food preparation tasks.

Stage 4: The Origin of Agriculture and Animal Domestication The origins of agriculture, in many areas of both the Old and the New World, altered the course of human diet and evolution forever. Humans have been experimenting with sources of plant and animal food for many thousands of years. These experiments culminated in the almost total manipulation of food sources and over time have come to achieve complete control of the places where the foods are grown as well as the genetic composition of these foods through the process of artificial selection (Ross 1987). The most recent manifestation of this control is the production of genetically modified foods, a part of bio-technology applied to the food industry that alters the genetic composition of plants within just a few generations (an accelerated version of genetic changes fostered by artificial selection). The initial transition to agriculture and animal domestication occurred over millennia with the first recognition of this transition in the archaeological record at about 10,000 BP. Not all populations are part of this transition, although all populations are probably affected by proxy to agricultural groups. This includes living populations of gatherer-hunters. Ever expanding populations of members of our lineage have continuously developed tool technologies to more effectively exploit diversified food sources. Although archaeologists track the course of increases in



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complexity in the technologies for resource extraction, like all patterns of material cultural complexity this is probably a function of both innovation and necessity and manifests as diversity rather than a steady transition to more and more complex cultural elements (for a discussion of technologies and resource exploitation in Upper Pleistocene populations, see Shea 2009; Churchill and Rhodes 2009). The first stone tools make an appearance at about 2.5 million years B.P. Early stone tool technologies as part of the Early and Middle Pleistocene are more difficult to associate with particular patterns of resource extraction and in fact seem more conservative and generalized (Klein 2009). With the origins of agriculture, tool technologies reflect their function as extraction devices for horticultural products. What happens to the human-food interaction at the beginnings of agriculture? This is probably the greatest alteration in all human environmental interactions in the whole of human history. Not only do patterns of diet change, the entire dynamic of human populations is altered as well as the disease patterns that characterize our species. In a series of innovative papers, Eaton and Konner outline the dietary changes associated with the origin(s) of agriculture as well as the changes in the nutritionally-mediated diseases that occur as human populations diverge from our evolutionary dietary needs (for a subset of these, see Eaton and Konner 1985; Eaton, Shostak, and Konner 1988; Eaton, Eaton, and Cordain 2002; Eaton 2007). The primary disjoint between pre- and post-agricultural peoples is represented by a move away from the broad-based feeding strategy as part of the omnivory pattern of humans, to a more mono-product diet based on one of the high starch content grains. Indeed, most of the world’s population today subsists on a diet composed of over 90% of one of these grains.

Stage 5: Diet and Nutrition in the Globalized World It is becoming increasingly clear that much variation is contained within the genome of our species. More importantly, from the perspective of diet, many of these gene changes are the result of recent adaptations that occurred since the origin of agriculture and, thus, extend into the not so distant past (at least from the perspective of the entire course of human evolution) (Cochran and Harpending 2009; Luca, Perry, and Di Rienzo 2010). Of significance beyond merely the discussions of diet, these genetic adaptations illustrate the profound relationship between culture,

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here represented by the domestication of plants and animals, and the genetic foundation that allows for the maximum extraction of nutrients from those food resources. Two examples of the co-evolution of genes and culture illustrate this point well. The first is the relationship between cultures that have a long history with the use of domesticated animals for milk (Campbell and Tishkoff 2008; Itan et al. 2009); the second, an association between cruciferous vegetables (bitter-tasting to many humans) and malaria (Krebs 2009). In a general overview article, Hancock et al. (2010) demonstrate the relationship between the pattern of SNPs to specific environmental, and possibly dietary, ecozones. While their focus was particularly on genetic signals associated with starch and sucrose metabolism and diets dominated by the use of roots and tubers as staples, and with energy metabolic pathway genes in polar ecozone populations, the possibility exists that many other types of genetic variants can be associated with particular foods and diet. This may explain some of the worldwide variation in the tolerance of such varied diets like the ones witnessed around the globe today. It might also explain why, in a pattern of globalization, and the resulting transport of foodstuffs, all foods cannot be utilized equally well by all humans. The food industrial complex, with distribution networks that are globally based, may not be in the best interest of the diet and health of humans. As importantly, when foods are distributed by multinational corporations, little attention is paid to the cultural content of food choices, food preparation techniques, or how foods are integrated into local cuisines. Certainly the genetic contributions to tolerance and digestion are also not transported. This highlights yet another lesson from the evolutionary history of humans, that food is best utilized when grown and eaten locally (WHO 2004).

SUMMARY AND BEST GUESS FOR THE PRESENT AND FUTURE From an evolutionary perspective, a few general dietary guidelines emerge. 1. Broad-based feeding is a long-term evolutionary pattern of food acquisition and consumption in the Order Primates. 2. In addition, seasonal use of resources is common among Primates and also in Foraging/Gathering-Hunting societies.



If There Is Food, We Will Eat 189 3. Along with the seasonal availability of resources, the evolutionary history of our lineage seems to indicate that at different points in time, foods were either abundant or scarce. It makes sense that humans will eat when food is available and move into caloric restrictive patterns at other times. In addition, human evolutionary history indicates that members of our lineage were very active and rarely if ever moved out of metabolic energy balance. 4. High quality protein and fat parceled in a variety of ways, as animal meat (vertebrates and invertebrates from the land and sea including insects) and nuts, were a much sought after food resource. 5. Local combinations and distribution networks of foods as part of “cuisine” are key in understanding the relationship of humans to food. This includes food-processing techniques that can alter the mechanical and chemical properties of food and change patterns of digestion. 6. As nutrition science develops other strategies in understanding the components of food, micro-elements and phytochemicals will become increasingly important in understanding what constitutes an optimal diet for humans. 7. A clear pattern is emerging that there are genetic adaptations to particular foods and to diet in general. Thus, with any nutritionally mediated disease, there will be multi-causal factors involved that may not apply across population boundaries.

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7 Aspects of Animal Production in Global Food Supply David Galligan, James Ferguson, Alan Kelly, Zhengxia Dou, and Zhiguo Wu

P

opulation growth, emerging affluence especially in the developing world, changing dietary patterns (fast foods), technological advances, and changing societal concerns on food production are inevitable and are challenging the way we produce food animal products. The increasing global demand for animal products primarily in the developing world, along with rapid urbanization, increasing energy costs, decreasing availability of arable land and water place additional constraints on current and traditional animal production systems. Animal products (milk, meat, eggs), while containing high quality protein and, thus, highly desirable, are resource intensive to produce relative to plant based food. However, there are many complex nuances to this issue. Indeed, the generational challenge to emerging food animal veterinary students and animal scientists is “how to provide animal protein in a manner that maximizes the efficiency of input use and yet minimizes impact on the environment”. Future food animal production systems will have to adapt to these changes in a manner that advances societal needs and meets demands in a responsible manner. To define relevant effective sustainable solutions to these complex problems is going to require the integration of a number of diverse disciplines such as epidemiology, animal and farm management, economics, production systems, ecological and environmental sciences, animal and human nutrition. This paper will

196 David Galligan, James Ferguson, Alan Kelly, Zhengxia Dou, and Zhiguo Wu review some general global trends that impact animal production systems. It will review basic animal production concepts that affect the efficiency of resource utilization by contrasting intensive and “extensive” strategies. The U.S. and Chinese dairy industries will be compared regarding these strategies and their water use efficiency contrasted as an example of resource use efficiency.

GENERAL TRANSFORMATIONS AND TRENDS Food production has been a constant challenge for mankind over the centuries. One of the critical debate issues has been the estimated carrying capacity of the world. At the time of Malthus’s writing of “An essay on the Principle of Population,” famines were a relatively common occurrence and were ultimately a fundamental cause of the French revolution in 1789 (Trewavas 2002). As history has told us, the carrying capacity of the world is not a rigid fixed number but depends on a number of factors, with the most important one being the desired level of affluence (Cohen 1995). Income elasticity of demand for food is estimated at 0.5, meaning that if the income rises by 30%, then the demand for food will increase by 15% (Collier 2008). As a consequence of growing affluence, the consumption of meat grew three times faster in developing countries than in the developed world between the 1970s and 1990s, with the greatest changes occurring in Asia (FAO 2002). Human foods are varied around the world and involve a range of production systems. These systems differ in efficiencies of production depending on a host of factors including: available arable land, water, technology, transportation infrastructure, marketing infrastructure, cropping, and animal management technology to name a few. Over time, the global food production system has evolved at varying rates geographically, to where approximately 1/6 of our dietary energy intake and 1/3 of our dietary protein intake comes from animal origin (Delagado, Courbois, and Rosegrant 1998; FAO 2002). The world population is expected to reach 9.1 billion in 2050 and most of this growth will occur in the developing world where it is envisioned to be accompanied by an increase in average net incomes. It is estimated that world food production will have to nearly double in 2050 (UN DESA 2011). Furthermore, it is estimated that during this time, in the developing world, the current consumption of meat production will increase from 25.5 kg/ capita/year to near 37 kg. The current industrialized world consumption of



Aspects of Animal Production in Global Food Supply 197

meat is at 88 kg/yr—more then twice the projected intake for the developing world in the future. Per capita milk consumption is expected to follow a similar trend with the developing world increasing from 45 to 66 kg/year, far below the developed world current consumption of 212 kg/yr (Steinfeld 2004). Advances in the agricultural sciences and technologies, along with effective governmental policies that stimulate greater agricultural productivity, will be needed to effectively meet this demand (Bradford et al. 1999; Burney, David, and Lobell 2010; Trewavas 2001; Avery 2000). It is estimated that 70% of the additional food needed will come from new and existing agricultural technologies (Simmons 2010). The reasons that animal products are desirable around the world are varied. In addition to adding great diversity to the human diet, animal proteins have a much higher digestibility (96 to 98%) compared to plant proteins (50 to 70%). Additionally, the protein biological value, (a system that evaluates protein content relative to eggs being 100%) is much higher in animal products (90–100%) relative to plant proteins (50–70%). These traits are especially important in facilitating the normal cognitive and physical development of children, especially when diets are marginal (Neuman et al. 2007). Excessive consumption of animal products has been studied through observational studies and some potential negative effects have been postulated. However, due to many potential confounding factors associated with observational diet studies, additional direct experimental studies are needed to truthfully identify any causal relationships. In the next 50 years, animal products will remain an important component of the human diet for a number of reasons. To be complementary and yet competitive with other necessary human feed sources, animal production systems must continually evolve in a manner that promotes efficient production and minimizes environmental impacts. The future food production scientist must be versed in understanding the nuances of animal efficiency metrics so that production systems can be effectively contrasted.

FUNDAMENTAL PRINCIPLES OF ANIMAL EFFICIENCY METRICS Animal production systems are complex biological processes that involve the conversion of foodstuffs into useful animal products consumed by humans. Systems vary greatly in their use of feed inputs (human in-

198 David Galligan, James Ferguson, Alan Kelly, Zhengxia Dou, and Zhiguo Wu edible vs. edible food stuffs), land resources, facility requirements, and capital structure. For example, to obtain reasonable production levels, poultry and swine are fed diets that proportionally have more human edible feeds compared to ruminants. They are often housed in capital-intensive structures that allow management to control factors (weather, predation, and diseases) that can negatively affect production. Three broad classification terms have been used to describe animal production systems including, grazing, mixed animal crops, and industrial (Sere and Steinfeld 1996). These are basically characterizations not only of the animal housing systems involved but also of their feed types. In all production systems, feed is the number one input cost, often exceeding 50–60% of the final value of the product. In addition to being a large cost center, there are basic nutritional concepts that are common to all animal production systems and which are useful in understanding the complexity of animal production efficiency. These elements provide a basis to understand: resource use efficiency, economic efficiency as well as the potential environmental impact of changes in production systems. These basic elements will be presented using a simple hypothetical dairy example (adapted from Capper et al. 2009a).

Animal Maintenance Cost All animal production systems involve the daily maintenance of animals for some productive purpose. Cows (dairy or beef ), sows, fish, and chickens all use resources (energy, nutrients, and water) to maintain routine daily bodily functions. It is, in fact, the first demand on any nutrients consumed. Maintenance requirements can be altered by the housing conditions of the animals (temperature, humidity, wind/rain protection, etc.). When ambient temperatures increase from 68 to 95 degrees F, maintenance requirements of dairy cows can increase by 20% (NRC 1981), hence housing systems can influence maintenance cost. In general, energy maintenance requirements are proportional to the metabolic body weight (body weight75). For example, a cow with a body weight of 1400 lbs requires 10 mcals of NE/d whether she is milking at 50 lbs or 100 lbs of milk/d (NRC 2001) (Figure 7.1). There are maintenance requirements in terms of other nutrients (protein, minerals, etc.) that are also necessary to maintain the animal before any production purpose is undertaken. At a national annual level, these cost are directly proportional to the average number of animals



Aspects of Animal Production in Global Food Supply 199

(the “national herd”), maintained for a productive purpose over the course of a year. For example, on average, each of the 9 million adult dairy cows in the United States requires approximately 10 mcals of NE/d for maintenance and thus over the course of a year will a cow will consume 3,650mcals and over the course of its adult life (3 lactations, 13 months each) approximately 11,856 mcals for maintenance alone. Low nutrient density feedstuffs (generally in-edible for human use) can be used to support animal maintenance requirements and sometimes very low levels of production (Preston 1982). When production systems (locally or nationally) increase their operations by animal numbers, described as “extensification” in this paper, maintenance cost will accumulate directly proportionally to animal numbers.

7.1 An example of energy consumption of a hypothetical extensive system (2 cows) and intensive systems (1 cow) with both systems yielding a total 100 lbs of mild/d.

Replacement Feed Cost Animal production systems also must allocate resources (land, feed, water, labor) for the generation of replacement stock. Behind each dairy cow (beef cow, sow, chicken) is a fraction of a replacement animal that is being raised (consuming current resources) for future production. For example, in a well-managed herd of 100 adult milking cows, there would be approximately 84 replacement animals (heifers) being raised for future pro-

200 David Galligan, James Ferguson, Alan Kelly, Zhengxia Dou, and Zhiguo Wu duction (0.84 heifers/adult cow). Depending on the relative rate at which adult cows leave the herd against the rate which replacements can be raised, a herd will grow (increase productive herd size) or decrease. These replacement animals consume resources to grow and to maintain the acquired growth. In Figure 7.1, an average of 7.6 mcals of energy is being fed/d for the replacement heifer (growth and maintenance) for each adult cow maintained in a herd. Herds that are expanding in numbers will use more feed (thus, energy) in their replacement operations to have more productive animals in the future. Inefficient replacement systems with depressed weight gains as a consequence of low quality feeds or poor reproductive management, will take longer to reach mature production weights. The daily “maintenance costs” on these systems will accumulate over more days, leading to economic, nutrient, and environmental inefficiency. Since the replacement herd is proportional to the adult production herd, it contributes economic and environmental costs to any “extensification” strategy where animal numbers are being increased. In Figure 7.1, the extensive 2 cow system requires that 2 replacements be reared—each consuming on average 7.6 mcals of energy/d. There are other “costs” associated with extensification strategies that are proportional to animal numbers including veterinary cost, breeding cost, facilities, and labor as well. On a nutritional basis alone the 2 cow production system has 52% of its total energy input going into animal maintenance and replacement compared to the 1 cow system at 35%. The replacement cost becomes an issue when looking at national feed use and production records and attempting to look at efficiency metrics (feed/unit of production). If a country is growing its production animal population rather then merely maintaining it, part of the current feed will be used to feed replacements for future production. These feed amounts must be deducted to correctly estimate the feed needed per unit of production.

Marginal Production Cost Nutrients in excess of those required for maintenance are available for a productive purpose (growth, lactation, egg production, work, etc.). However, this occurs only after the animal’s maintenance requirements have been sufficiently met. Since animals have limited dry matter intake capacities, more nutrient dense feedstuffs (concentrates, grains) are often



Aspects of Animal Production in Global Food Supply 201

required to support additional production. The level of production (milk/d, weight gain/d, eggs/d) will be proportional to these additional nutrients fed. It takes about 0.325 mcals of energy per pound of milk (with 3.5% fat, 3.2% protein, 5.4% lactose components) produced, so in Figure 7.1, the cows milking at 50 lbs/day require an additional 16.25 mcals/d (each) for milk production alone, while the cow milking 100 lbs/d requires 32.5 mcals/d. As animal production systems increase “yield intensity” (yield/ animal), proportionally more product is produced per total nutrient fed (nutrients for maintenance + nutrients for production). So, in our example, 2 lbs milk/mcal of energy consumed (100 lb/50.1 mcal) is produced with the cow milking 100 lb/d verses 1.5 lb milk/mcal (50 lb/33.5 mcal) at 50 lb of production. Marginal income over feed cost ($9.19 vs. $7.07, respectively) and environmental efficiencies (measured as nutrients/unit of production output) are also improved as production increases since the fixed cost of maintenance and replacement are constant over production levels. This is a fundamental driver of intensification in all forms of agriculture—the dilution of animal maintenance and replacement costs over more units of production. Intensive strategies, which increase yield per unit of animal maintenance and replacement, will be able to meet societal needs with fewer animals and fewer resources. In the 2 cow vs. 1 cow example (extensive vs. intensive), 34% more energy was required in the extensive system to yield the same amount of total production as the intensive system. This concept would apply to other resources used in the production process.

THE COMPETITIVE/COMPLEMENTARY ROLE OF ANIMAL PRODUCTION IN HUMAN FOOD SUPPLY Animal products are resource intensive due to the additional biological processes involved in their production from plant feedstuffs. Resources used in animal production could be used for the production of other human edible feeds and given the inherent biological in-efficiencies associated with animal production systems it is often assumed that “more human food” could be made from the same resources. As was suggested in the Council for Agriculture Science and Technology (CAST) publication, Animal Agriculture and Global Food Supply (Bradford et al. 1999) the trade offs are not so simple and certainly not 1:1 for a number of issues expanded upon below.

202 David Galligan, James Ferguson, Alan Kelly, Zhengxia Dou, and Zhiguo Wu

ANIMAL USE OF CROP PRODUCTION CAPACITY The yield of animal products is not only a function of the animals ability to convert feedstuffs into useful products (metabolic efficiency, animal husbandry efficiency), but also a function of the crop yields of animal feeds versus the yields to be realized by the competing human desirable crop. For example, wheat—the predominant grain for human consumption (along with rice)—has half the yield/acre of corn, the predominant feed grain for animals (Figure 7.2). If concentrate feeding of animals is reduced, more wheat acres would be cultivated (corn acres would not be suitable for rice production). However, since wheat has a much lower yield/acre there would not be a direct 1 to 1 conversion. Annual improvement in corn yields have been greater than those of wheat over the years, with 2014 U.S. corn yields at 10,934 kg/hectare verse wheat at 2,944 kg/hectare.

7.2 U.S. corn, wheat, and rice yields (kg/hectare) (Data from USDA NASS: http:// www.nass.usda.gov/Statistics_by_Subject/index.php?sector=CROPS)

In addition to corn grain, corn silage is a common forage feed used globally in dairy and beef production systems. This is a highly efficient feed source using the entire plant (stalk, corn cob, and grain), leaving very little residue on the field and thus maximizes the total energy harvested per unit of land. Specific varieties of corn that have greater leafiness as well as the ability to retain water (so the feed can be packed and stored) have been selected for this purpose.



Aspects of Animal Production in Global Food Supply 203

Another major crop fed to ruminants is alfalfa, a high protein forage, which also has a relatively high tonnage yield/hectare (16.25 tons/hectare), relative to human edible wheat yields of 3.49 tons/hectare irrigated and 1.92 tons/hectare non-irrigated. Calculations on inputs and outputs suggested that more human food energy and protein is obtained per hectare when alfalfa is raised and fed to dairy cows compared to growing wheat (Bradford et al. 1999).

RUMINANTS AND CELLULOSE DIGESTION—PROS AND CONS Ruminants have the gastro-intestinal bacteria that can digest cellulose, the most abundant carbohydrate in the world (Van Soest 1994) and a carbohydrate form that is basically indigestible to humans. However, while this attribute does provide a vehicle in which to “harvest” a portion of solar energy in making useful products, the enteric digestive process also produces CO2 and methane, which are released into the atmosphere. While ruminants are “countable” and, thus, held “accountable” it is important to realize that there are other sources of cellulose digestion that contribute to global methane and CO2. In the Inventory of U.S. Greenhouse Gas Emission and Sinks:1990–2008 (2010), agriculture in general was estimated to be about 6 % of all U.S. emission with enteric fermentation and manure management being major factors. Globally, Burney, David, and Lobell (2010) estimated that in 2005 agriculture accounted for 10–12% of total anthropogenic greenhouse gas (GHG) emissions. A number of factors can influence methane emissions in animal production systems, such as poor feed quality, animal size, growth rate, and the number of animals needed to meet certain production goals. Capper et al. (2009b) compared the U.S. dairy industry of 2007 to 1944 showing a dramatic 37% decrease in the carbon footprint per billion kilograms of milk. This was basically due to higher yield/cow and, thus, fewer cows and replacements needed to meet societal demand.

ANIMAL PRODUCTION LIFE STAGES Even within a species, feeds systems and feed content can change over the life of the animal. In the U.S., many of our beef animals are born and raised in a pasture/grazing system where they will reach 50 to 70% of their

204 David Galligan, James Ferguson, Alan Kelly, Zhengxia Dou, and Zhiguo Wu slaughter weight. These lands have little alternative competing use due to a number of issues (limited irrigation availability, topography, location) and, thus, it is an economically effective practice. The final weight gain—contributing to the ending slaughter weights—occurs in the feedlots where human edible grain is fed at the required level of 5–7 lbs of feed/lb of weight gain. These high-intensity feeding systems last for a relatively short period of time (reducing animal maintenance accumulation) and should not be used as estimates of the daily gain efficiencies over the life of the animal. On average, over the entire life of the beef steer about 2.6 lbs of grain are required/lb of weight (Bradford et al. 1999). Capper et al. (2009a), using a deterministic model, estimated 2.78 fold reduction in methane/kg of gain for corn fed vs. pasture-fed beef steers achieving 1.61 kg/d for 237 days vs. 0.87 kg/d 438 days respectively with a common finishing weight of 635 kgs. The maintenance cost/d associated with the much shorter feedout period accounts for most of the reduction. Burney, David, and Lobell (2010) looked at agriculture in general and found that, while emissions from production factors has increased (fertilizer production and application) between 1961 and 2005, the net effect of increased yield has actually avoided up to 161 gigatons of carbon.

BY-PRODUCTS OF HUMAN FOOD PRODUCTION By-products are feedstuffs that have been produced while harvesting and processing commodities for human consumption. These products can be from plant or animal processing systems. Human food production generates a considerable volume of by-products that can be used in animal production systems. It is estimated that for each 100 kgs of human edible food from crops produced, approximately 37 kilograms of by products (Fadel 1999) is also produced. Animal agriculture plays a key and complimentary role in using these by-products. For example, distillers grains, whole cotton seeds, brewers grains, beet pulp, and almond hulls are commonly fed to dairy cows.

ANIMAL VS. PLANT PROTEIN QUALITY Steinfeld, de Haan, and Blackburn (1997) calculated that approximately 74 million tons of edible protein was used globally for livestock production,



Aspects of Animal Production in Global Food Supply 205

yielding 53 million tons of human protein resulting in an input/output ratio of 1.41 (74/53). If one takes the higher biological value of plant protein at 0.70, 1.4 units of plant protein (1/0.7) are required to give the same biological value of animal protein. Since the biological value of animal protein relative to plant protein is around 1.4, any gains in yield are largely offset by gains in quality (Bradford et al. 1999).

CONTRASTING THE UNITED STATES AND CHINESE DAIRY INDUSTRIES. Animal production systems have evolved over time as a function of emerging technologies that allowed various degrees of “extensification” and “intensification” strategies to be pursued by a given animal industry. To illustrate these concepts, the United States and Chinese Dairy Industries are compared over time from 1961 to 2007. Lastly, water efficiencies of both countries will be contrasted for the dairy industry in 2007 to illustrate the differences in resource use efficiency. The U.S. dairy industry has reduced the adult producing cow numbers over time from approximately 17 million cows to 9 million (Figure 7.3). The replacement herd, approximately 85% of the adult herd, has also been reduced over this time. This national trend has decreased the feed, land, and water per unit of milk produced to meet societal milk. China, to meet its growing demand, has gradually and then rapidly pursued a positive extensification strategy (Figure 7.3) from less then 0.5 million cows to almost 10.5 million cows. Over the same period of time, the U.S. dairy industry adopted a host of technologies and improved nutritional strategies resulting in an average annual yield increase of about 126 kg/cow/year. From 1961, China had a relatively slow improvement in yield/cow but from 2001, China has dramatically increased its annual yield increase/cow to approximately 151 kg/ cow/year. In 2007, the U.S. dairy industry has produced a total greater than 81 million metric tons of milk from 9 million cows, while China has produced 33 million metric tons from 10.5 million cows. The differences are due to the dramatic differences in yield/cow. To contrast the difference of these systems in terms of their use of a limited resource, estimates of the water consumption of the two countries

206 David Galligan, James Ferguson, Alan Kelly, Zhengxia Dou, and Zhiguo Wu

Cow Numbers (Extensification)

7.3 Adult dairy cow populations from 1961 to 2007 (FAO data) for the U.S. and China.

Table 7.1: Comparison of estimated water consumption efficiency of the 2007 U.S. and Chinese Dairy industries using the Penn State Water model. Water used in processing of milk is not included. A cow unit includes the milking cow, dry cow and replacement. U.S.

China

Cows

9,132,000

10,557,309

Average Yield/d (lbs)

65

22

Gallons/d/cow unit

34

27

Total Water/d gallons

307,132,756

280,194,870

Total Milk/d lbs

230,654,978

89,918,068

Water Gallon/Milk Gallon

10.65

24.93



Aspects of Animal Production in Global Food Supply 207

were calculated based on FAO 2007 animal numbers and production levels. A model developed by Penn State to estimate water consumption was used to make the calculations. In this model, water consumption is largely a function of dry matter intake (equation from Galligan et al. 1986), which in turn is a function of daily milk production level. The replacement herd was considered to be 85% of the adult herd and dry cows 19%, for both coun-

Yield/cow (Intensification) And Societal Demand

7.4 Annual Milk yield/cow (kg) and total societal milk yield (million metric tons) for the U.S. and Chinese Dairy Industries.

tries. Milk processing water was not considered in the evaluation since that is a function of the size of the herd and milk tank size, etc. Even though U.S. cows numbers were less then those of China, the U.S. Dairy industry used more water due to the high milk yield. However, this increase use was more than offset by the higher milk yield resulting in a dramatic decrease in water consumption/gallon of milk produced, 10.65 versus 24.9.

208 David Galligan, James Ferguson, Alan Kelly, Zhengxia Dou, and Zhiguo Wu

SUMMARY Animal production systems are complex processes that vary geographically as well as within and across species. They are in constant evolution as new production concepts and technologies emerge and as the world population increases in number and changes in demand characteristics. Animal products are an important part of the “global diet” and involve a variety of input resources that have competing as well as complementary uses. Production practices that can meet societal demand on an economic basis and be environmentally responsible will define future sustainable animal production systems. There are fundamental attributes of animal production in terms of maintenance, replacement, and production cost that can help us better understand the efficiency of resource use in different production environments and identify sustainable practices.

REFERENCES Avery, D. 2000. Saving the Planet with Pesticides and Plastics. 2nd ed. Indianapolis, IN: Hudson Institute Inc. Bradford, E., et al., 1999. Animal Agriculture and Global Food Supply. CAST report No. 135. Burney, J.A., S.J. David, and D.B. Lobell. 2010. Greenhouse Gas Mitigation by Agricultural Intensification. Proceedings of the National Academy of Sciences USA June 1. doi:10.1073/pnas.0914216107. Capper, J.L., R.A. Cady, and D.E. Bauman. 2009a. Demystifying the Environmental Sustainability of Food Production. Cornell Nutrition Conference. ———. 2009b. The Environmental Impact of Dairy Production: 1944 compared with 2007. Journal of Animal Science 87:2160–7. Cohen, J.E. 1995. How Many People Can the Earth Support? New York: W.W. Norton and Co. Collier, P. 2008. Politics of Hunger. Foreign Affairs Nov/Dec:67–79. Delgado, C.L., C.C.B Courbois, and M.L. Rosegrant. 1998. Global Food Demand and the Contribution of Livestock as We Enter the New Millennium. http://www.ifpri.org/sites/default/files/publications/pubs_divs_mtid_dp_papers_dp21.pdf. Accessed 9/1/2014. Fadel, J.G. 1999. Quantitative Analysis of Selected By-product Feed-stuffs: A global perspective. Animal Feed Science and Technology 79:255–68. FAO. 2007. Statistics. https://spreadsheets.google.com/pub?key=rL99H3xS4I_UxMUHPPeTVA. Accessed 9/1/2014.



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———. 2002. Protein Sources for the Animal Feed Industry. Expert Consultation and Workshop, Bangkok, 29 April–3 May 2002. Galligan, D.T., J.D. Ferguson, C.F. Ramberg, and W. Chalupa. 1986. A Dairy Ration Formulation Computer Program. Journal of Dairy Science 69:1656–64. Inventory of U.S. Greenhouse Gas Emissions and Sinks: 1900–2008, April 2010 U.S. EPA # 430-R-10-006 Agricultural (6). National Research Council (NRC). 1981. Effect of Temperature on Nutrient Requirements of Domestic Animals. Washington, DC: National Academies Press. Neuman C.G., S.P. Murphy, C. Gewa, M. Grillenberger, and N.O. Bwibo. 2007. Meat Supplementation Improves Growth, Cognitive, and Behavioral Outcomes in Kenyan Children. Journal of Nutrition 137:1119–-1123. Penn State Spreadsheet Water Use Model. Ishler V. http://resources.cas.psu.edu/WaterResources/pdfs/dairywateruse1.xls. Accessed 9/1/2014. Preston, T.R. 1982. Nutritional Limitations Associated with the Feeding of Tropical Forages. Journal of Animal Science 54:877–84. Sere, C., and H. Steinfield. 1996. World Livestock Production Systems. Animal Production and Health Paper 127. Rome: FAO. Simmons J. 2010. Technologies role in the 21’st Century: Food Economics and Consumer Choice. https://www.beefboard.org/news/files/beef%20enewsletter%20files/ food%20economics%20and%20consumer%20choice%20white%20paper%20 0609.pdf. Accessed 9/1/2014. Steinfeld, H., C. de Haan, and H. Blackburn. 1997. Livestock Environment-Interactions: Issues and Options. Rome: FAO. Steinfeld, H. 2004. The Livestock Revolution—A Global Veterinary Mission. Veterinary Parasitology 125:19–41. Trewavas, A. 2002. Malthus Foiled Again and Again. Nature 418:668–670. ———. 2001. The Population/Biodiversity Paradox. Agricultural efficiency to save wilderness. Plant Physiology 125:174–9. Van Soest, P.J. 1994. Nutritional Ecology of the Ruminant. 2nd edition, Ithaca, NY: Cornell University Press United Nations Department of Economics and Social Affairs (UN DESA). 2011. World Economic and Social Survey 2011: The Great Green Technological Transformation http://www.un.org/en/development/desa/policy/wess/wess_current/2011wess. pdf. Accessed 9/1/2014.

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8 Issues in Global Health Nancy Biller and Neal Nathanson

INTRODUCTION

G

lobal health is a vast territory, with many definitions (Cohen 2006). In contrast to established academic disciplines, global health is best construed as an umbrella that draws upon many disciplines, both in the traditional health sciences but also in the social sciences, and includes fields as disparate as business, ethics, and education. Furthermore, most of the important issues in global health are highly controversial and many of the acknowledged authorities tend to be champions of a specific viewpoint. In other words, buyer beware. In this short overview, we will focus on a few of the salient issues, recognizing that numerous other important areas are omitted. We teach an introductory course in global health and our comments owe much to lectures from representatives of many disciplines. For a systematic treatment of the subject, readers are referred to textbooks of global health and a compendium of monographs, each of which deals with a specific aspect of global health (Table 8.1). In the following account, we will highlight some of the most important problems in global health, but also stress the opportunity for practical interventions. All of these issues are complex, and in the brief compass of this chapter we cannot explore any of them in depth.

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Nancy Biller and Neal Nathanson Table 8.1 Books on global health.

TOPIC

REFERENCES

Introductory texts

Jacobsen, 2008; Lindstrand et al, 2006;Markle et al, 2007; Seear, 2007; Sharma and Atri, 2009; Skolnik, 2008

Definitive texts

Birn et al, 2009;Merson et al, 2006

Specialized texts

Drain et al, 2009; Holtz, 2008; Johnson and Stoskopf, 2009; Murthey and Smith, 2009; Perlman and Rohy, 2008

General monographs

Garrett, 2000; Levine, 2007

Careers in global health

Bortolotti, 2006; Kidder, 2004; McKenna, 2004; O’Neill, 2006

Economics and demography

Bloom et al, 2003; Calderisi, 2006;Collier, 2007; Jamison et al, 2006; Moyo, 2009; Prahalad, 2006; Sachs, 2005; Yunus, 2003

Social issues

Kristof and WuDunn, 2009; Marmot, 2004

Health care systems

Arole and Arole, 1994; Taylor-Ide and Taylor, 2002

Ecosystems and demography

George, 2008; Gore, 2006; Harkavy, 1995; Kennedy et al, 2007; Kurlansky, 1997; Roberts, 2008; Segal, 2003

Communicable diseases

Abraham, 2005; Desowitz, 1981; Epstein, 2007; Henderson, 2009; Packard, 2007; Thornton, 2008

STATE OF THE PLANET: POPULATION, RESOURCES, AND THE ENVIRONMENT As we write, the global population is about 7–8 billion, and is projected to plateau at about 12 billion in 2100 (Figure 8.1). Furthermore, most of the increase will occur in the low income countries, which can least afford to support an additional burden. To put this in perspective, in 1950, the total population was about 2.5 billion, of which slightly more than half was in the developing world. In 2100, the population of the developing world will exceed 10 billion while the population of the high and middle income countries will remain at 1–2 billion. This imbalance has major implications for the health and welfare of the world’s population.



Issues in Global Health 213

8.1 Projected increase in the world's population, by developed and developing regions. Redrawn from U.S. Global Change Research Information Office, 2010.

The increase in population in India, Africa, and other developing countries is driven by the demographic transition, where death rates have decreased without a concomitant reduction in birth rates (Bloom, Canning, and Sevilla 2003). Eventually, based on past history, there will be a reduction in birth rates and the populations will plateau but at a much higher level than before the transition. In a simplistic construct, the size of the population can be considered to drive the global need for resources and the generation of waste requiring disposal. Two major resources are food and potable water. Food supplies depend upon the availability of arable land, the availability of water for irrigation, and the per acre productivity (Roberts 2008). Productivity is determined by the methods of farming, the use of fertilizers, and the intrinsic genetic properties of the particular type of wheat, rice, and other crops. It will be challenging to increase food supplies beyond the

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present level for several inter-related reasons (Garrett 2008): (i) almost all of the arable land is already under cultivation and any extension would involve intrusion into jungles and other precious habitats that should be conserved not plundered; (ii) there is a shortage of water for irrigation in a substantial part of the land now under cultivation and that water shortage is becoming greater (Anonymous, 2008); (iii) the conversion of individual farming to industrial level farming might increase productivity but would displace rural farmers, increase unemployment, and aggravate urbanization. Other issues also complicate the food supply. In countries such as China and India, where large populations are emerging from poverty into higher income classes, there is a transition from consumption of vegetable to animal protein. This further stresses agricultural productivity, since it takes 10 times as much water to convert corn into beef as it does to use corn itself as a food. Another important source of animal protein is fish, and, properly utilized, it is a renewable source of protein. Unfortunately, an increasing number of stocks are now being overfished (Figure 8.2). At the present rate, many of these fish populations will be reduced to the point that they are not self-renewable even if they are no longer harvested.

8.2 Status of the world’s fisheries, 1950–2000. Overfishing has led to the collapse of about one-third of the fish stocks, while only about a third are at the limit of sustainability. This dramatic depletion has occurred in the last 60 years. After (The New York Times, 2008).

These factors will endanger the global food supply and could produce intermittent famines in poor countries. Furthermore, a significant propor-



Issues in Global Health 215

tion of children in these countries already suffer from an insufficiency of calories or protein, as well as a number of essential micronutrients such as iodine, fluorine, and vitamins (Figure 8.3).

8.3 World hunger map, 2009. It is estimated that over 1 billion of the world’s population are undernourished, defined as less than 2,000 calories daily for an adult. The map shows the percentage of the population undernourished by country. Redrawn from The World Food Programme, 2010.

Another important resource is access to safe drinking water, within a reasonable distance of housing. A significant proportion of the population in low income countries does not have such access, and is forced to drink water that is contaminated with sewage, thereby spreading a plethora of diarrheal infectious agents to young children (Bartram 2008). Death from cholera and other diarrheas is a major contributor to mortality of children under age 5. Human waste already constitutes a major environmental problem in poor countries where a large part of the population does not have access to even the most primitive privies and is forced to contaminate their environment every day (George 2008). The accumulation of human waste contributes to the perpetuation of bacterial, viral, and parasitic infections at high prevalence in these populations. Also, industrial wastes constitute a major health hazard, often aggravated as a by-product of rapid economic development.

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Interventions There are a number of proven interventions that can ameliorate undue population growth (Bryant 2007). Historically, a reduction of childhood mortality, an important goal in its own right, often leads to a reduction in birth rates. A change in cultural norms regarding family size and the use of contraception can also speed this process. Finally, an active family planning program, integrated into a system of primary care, is critical for population control. Currently, there is a reduction of birth rates in areas of some developing countries, such as southern India. Another approach to reducing the demand for resources, is to reduce consumption at the individual and family level. For instance, the per capita use of water is three times higher in the United States and some other countries than in the larger European countries. The per capita demand for animal protein varies enormously among well-nourished populations, and is a potential target for intervention. Basic cesspits and privies can be constructed in rural areas, and simple wells can often provide sources of safe drinking water.

ECONOMIC DETERMINANTS OF HEALTH There is a dramatic correlation between per capita income and life expectancy, which is captured in the “Preston curve” (Figure 8.4) originally put forward in a seminal paper (Preston 2007b). As stated by Pritchard and Summers (1996), “wealthier is healthier”. Figure 8.4 plots data for many countries at several different time points, with two salient correlations. (1) Life expectancy is much lower in countries where incomes are under the poverty level (per capita incomes less than $700 per year) than in countries with incomes greater than $ 5,000. This correlation can also be seen for infant mortality rates (live births surviving to one year of age) or child mortality (survival to age 5 years), pointing out that “excess” mortality occurs mainly in infants and young children born into poverty. There are many intermediate variables that explain the impact of income on life expectancy. For instance, the number of health workers, nurses, and physicians per capita as well as the number of hospital beds, correlates with the income level. Also the investment in specific diseases, for research, drug development, and the like, is much greater for diseases of rich than of poor countries.



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8.4 The “Preston curve” showing the relationship between life expectancy and per capita income, for many countries and several different time periods, 1900 to 1990. Redrawn from Preston, 2007a.

(2) Over the last 100 years, life expectancy has increased in most countries. This is reflected in the curves for successive time periods. This suggests that, superimposed upon the economic driver, are other significant determinants of health. These determinants have changed over the course of the last 250 years, and are summarized in a magisterial analysis (Cutler, Deaton, and Lleras-Muney 2006:106), which suggests three phases in the historical improvement in life expectancy, for England and Wales (Figure 8.5): Looking at this evidence as a whole, we see the history of mortality reduction as encompassing three phases. The first phase, from the middle of the eighteenth century to the middle of the nineteenth century, is the one where improved nutrition and economic growth may well have

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played a large role in health—although this is hotly debated, and incipient public health measures were certainly important as well. In the closing decades of the nineteenth century and into the twentieth, the second phase occurred, in which public health mattered more—first negatively, because of high mortality in cities, then positively in the delivery of clean water, removal of wastes, and advice about personal health practices. The third phase, dating from the 1930s on, has been the era of big medicine, starting with vaccination and antibiotics, and moving on to the expensive and intensive personal interventions that characterize the medical system today.

8.5 Life expectancy, England and Wales, 1751–1990. Increases in life expectancy can be roughly divided into three phases: 1750-1850, “early”, where economic growth and improved nutrition are believed to be important drivers; 1850-1930, “middle”, where public health infrastructure and personal hygiene are proposed as important drivers; and 1930-present, “late”, where modern medical advances (preventive, diagnostic, and therapeutic) are considered the main determinants. After Cutler et al., 2006 based on data in Wrigley and Scholfield, 1981.

Although the foregoing is based on a historical analysis of trends in England and Wales, it provides a paradigm for events in developing countries on a different time scale. The important implication of this analysis is that



Issues in Global Health 219

a variety of determinants—other than economic development itself—have a major impact upon child survival and life expectancy. These can be subsumed under several headings, including (a) public health infrastructure such as clean water and safe disposal of wastes; (b) a variety of preventive measures, such as vaccines, adequate diet including micro-nutrients; (c) healthy behavior at the level of individuals and families, including risk aversion such as safe sex, defensive driving, and avoidance of tobacco and other addictions, and (d) a basic primary care system that both provides essential treatments and promotes the manifold paths to disease prevention, including maternal and child health care. The observation that marked improvements in child survival and life expectancy—in countries such as India and China during the period 1960–2010—have occurred mainly independently of economic development, provides convincing evidence that these noneconomic drivers are highly significant (Cutler, Deaton, and Lleras-Muney 2006). As Preston (2007c:503) points out: [This should be] a cause for celebration. It means that a critical element of human well-being can be improved without having to wait for the ponderous processes of economic growth to inch countries forward on the life expectancy/income curve.

Interventions Many economists have proposed programs of economic development, arguing that development is a sure way to improve health (Sachs 2005). One approach focuses on micro-lending and development at the level of the poorest segment of the population (Yunus 2003). This approach has been quite successful in Bangladesh and has had worldwide recognition. Another approach has been the encouragement of investment of capital from the industrial countries to develop new industries in poor countries, and break out of the mold that poor countries provide raw materials while rich countries process them and create added value. There have been a number of critiques by economists about the inauspicious history of investment by the World Bank and other donors who have tried in vain to promote development in low-income countries (Calderisi 2006; Collier 2007; Moyo 2009). However, the analysis presented above suggests that more rapid progress may be made by a focus on “social development” rather than economic

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development (Marmot et al. 2008). Some of these potential interventions are noted below.

HOW TO INVEST: PRIMARY CARE VS DISEASE-SPECIFIC INTERVENTIONS Much of the investment in global health has focused on specific diseases, such as HIV/AIDS, tuberculosis, and malaria. This is driven by the decisions of sponsoring organizations, both private philanthropic, non-governmental international organizations, and the World Health Organization and United Nations agencies. Programs of this sort have the attraction that it is relatively easy to assess the burden of each disease, to identify present available interventions, to frame research programs, and identify potential future interventions, such as therapeutic drugs and vaccines. Furthermore, focused programs are easier to monitor and evaluate. It is even possible to estimate the return on investment, such as the cost per case averted or patient cured. Unquestionably, certain investments in global health must be framed for individual diseases. For instance, the search for new anti-malarial drugs requires a very targeted program of research and development, best conducted within a research institute with much cognate expertise in many relevant areas. However, at the level of field programs designed to utilize proven interventions, this “silo” approach is much more questionable. An obvious example is pediatric immunization. Currently, there are at least 10 diseases that are best prevented through a program of immunization utilizing established vaccines, including measles, polio, influenza, hepatitis B, rotavirus, and bacterial meningitis. Many of these vaccines are underutilized in developing countries, because of a weak system of primary care for families and children. This raises the question, is there an appropriate balance between investment in specific diseases versus investment in a national system for health care and prevention? The matter is highly debated; for instance, the Bill and Melinda Gates Foundation has been criticized for the lack of investment in primary care (Birn 2005). An analysis was conducted to estimate the proportion of childhood (under age 5) deaths that could be prevented with optimal utilization of available interventions ( Jones et al. 2003). Close to 10 million such deaths occur each year in the 42 countries that have about 90% of all childhood death. It was estimated that almost two-thirds of these deaths (about 6 mil-

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lion per year) could be prevented with the full utilization of established interventions (Table 8.2). Unquestionably, the greatest barrier to effective utilization is the lack of a robust system of primary care in many of these countries. This is the calculus that drives the argument for greater investment in health systems relative to disease-specific programs (Travis et al. 2004; Macinko et al. 2007). Table 8.2 Deaths among children under age 5 that could be prevented utilizing proven interventions. These estimates are based on year 2000 data from 42 countries with 90% of the childhood deaths. Adapted from Jones et al., 2003. Number of deaths (millions)

Estimated deaths prevented (millions)

Diarrhea

2.135

1.886

Pneumonia

2.055

1.328

Malaria

0.915

0.829

HIV/AIDS

0.312

0.150

Measles

0.103

0.103

Neonatal disorders

3.187

1.748

Other

0.919

0

Total

9.262 (100%)

6.039 (65%)

Disease or condition

What is the cost for a basic health care system in a low resource setting? The World Bank has estimated an annual per capita cost of about $35. For a low-income country with an annual GDP of $700, this would represent 5% of total GDP, not necessarily achievable even for this minimal cost. Various approaches have been suggested to financing a basic system, such as community-based approaches (Perry et al. 2006; Perry et al. 2007; Preker et al. 2002).

ETHICAL MANDATES AND CULTURAL NORMS Over the last 60 years, several international declarations have dealt with human rights, including the right to well being and health care (United Nations 1948; World Health Organization and UNICEF 1978). Many of these have been formally endorsed by a large number of sovereign nations, in-

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cluding developing countries. The impetus to formulate and support such declarations has been the documented abuses that occur in many countries. However, existing rights abuses may also represent widespread practices, which can therefore be construed as “cultural norms”. This raises difficult questions such as: who determines what is ethically acceptable or unacceptable in a particular country at a particular time? Do persons external to a country have the right to dictate ethical standards to those in the country? Is the imposition of an international declaration a form of “cultural imperialism”? And, within a country, who determines what is acceptable? Few human rights declarations have ever been subject to national referenda. Some rights issues have a direct impact on health. An important set of examples involves women’s rights, which have been called the “human rights cause of our time” (Kristof and WuDunn 2009). One example is child marriage, defined as marriage of girls below “full age” (18 years). This is stated to be a violation of human rights in the 1948 UN Universal Declaration of Human Rights (United Nations 1948). Child marriage puts girls at reproductive health risks, since maternal mortality is much greater for births to mothers under age 18 compared to older women in the same setting (Nour 2006). Furthermore, girls are at much greater risk of developing fistulas during the birth process than women over age 18. Also, child marriage handicaps girls since it interferes with their education, bonding with peers, and being able to participate in the choice of a husband. Nevertheless, in 2010, in many areas of the world, between 25% and 50% of marriages involve females below age 18. If a significant proportion of girls are married below “full age”, then such a custom is likely to be considered a cultural norm. Until widespread practices change, it is unlikely that this particular “health right” will be respected.

CONCLUDING COMMENTS We have attempted to give the reader a flavor of some of the leading issues in global health, as we perceive them. The examples cited convey the breadth of disciplines that are relevant to framing and solving the big questions that impact health at a population level. Furthermore, these issues are controversial, and experts with different backgrounds provide a range of analyses and propose a variety of interventions. Anyone interested in global



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health might wish to consult some of the primary sources listed in Table 1. Explore this universe with a healthy skepticism, keeping in mind that as John Donne (1624) famously wrote: No man is an island, entire of itself; every man is a piece of the continent, a part of the main. If a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friend’s or of thine own were. Any man’s death diminishes me, because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee...

REFERENCES Abraham, T. 2005. Twenty-first Century Plague. The story of SARS. Baltimore, MD: Johns Hopkins University Press. Anonymous. 2008. A fresh approach to water. Nature 452:253. Arole, M, and R. Arole. 1994. Jamkhed, a comprehensive rural health project. Comprehensive Rural Health Project, Maharashtra, India. Bartram, J. 2008. Improving on Haves and Have-nots. Nature 452:283–4. Birn, A-E. 2005. Gates’ grandest challenge: transcending technology as public health ideology. Lancet 366:514–19. Birn A-E, Y. Pillay, and T.H. Holtz. 2009. Textbook of International Health: Global health in a dynamic world. Oxford, UK: Oxford University Press. Bloom, D.E., D. Canning, and J. Sevilla. 2003. The Demographic Dividend. Santa Monica, CA: Rand. Bortolotti, D. 2006. Hope in Hell. Buffalo, NY: Firefly Books. Bryant, J. 2007. Theories of Fertility Decline and the Evidence From Development Indicators. Population and Development Review 33:101–27. Calderisi, R. 2006. The Trouble with Africa: Why foreign aid isn’t working. New York: Palgrave Macmillan. Cohen, J. 2006. The New World of Global Health. Science 311: 162–167. Collier, P. 2007. The Bottom Billion: Why the poorest countries are failing and what can be done about it. New York: Oxford University Press. Cutler, D., A. Deaton, and A, Lleras-Muney. 2006. The Determinants of Mortality. Journal of Economic Perspectives 20:97–120. Desowitz, R.S. 1981. New Guinea Tapeworms and Jewish Grandmothers. New York: W.W. Norton.

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Donne, J. 1624. Meditation 17, Devotions upon Emergent Occasions. Drain, P.K., S. Pirtle, and K. Chan. 2009. Caring For the World: A guidebook to global health opportunities. Toronto, ON: University of Toronto Press. Epstein, H. 2007. The Invisible Cure. Why We Are Losing the Fight Against AIDS in Africa. New York: Farrar Straus and Giroux. Garrett, L. 2000. Betrayal of Trust. The Collapse of Global Public Health. New York: Hyperion. ———. 2008. Food Failures and Futures. Working paper, Council on Foreign Relations. George, R. 2008. The Big Necessity: The unmentionable world of human waste and why it matters. New York: Henry Holt and Co. Gore, A. 2006. An Inconvenient Truth: The planetary emergency of global warming and what we can do about it. New York: Rodale Press. Harkavy, O. 1995. Curbing Population Growth. New York: Plenum Press. Henderson, D.A. 2009. Smallpox—The Death of a Disease: The inside story of eradicating a worldwide killer. Amherst, NY:Prometheus Books. Holtz, C. 2008. Global Health Care: Issues and policies. Jones and Bartlett, Sudbury. Jacobsen, K.H. 2008. Introduction to Global Health. Sudbury, MA: Jones and Bartlett. Jamison, D.T, J.G. Breman, A.R. Measham, G. Alleyne, M. Claeson, D.V. Evans, P. Jha, and A. Mills A, and P. Musgrove, ed. Priorities in Health. Washington, DC: World Bank Publications. Johnson, J.A, and C.H. Stoskopf. 2009. Comparative Health Systems: Global perspectives for the 21st century. Sudbury, MA: Jones and Bartlett. Jones. G., R.W. Steketee, R.E. Black Z.A. Bhutta, and S.S. Morris. 2003. How Many Child Deaths Can We Prevent This Year? Lancet 362:65–71. Kennedy, D., and the editors of Science. 2007. State of the Planet, 2006–2007. Washington, DC: Island Press. Kidder, T. 2004. Mountains Beyond Mountains: The quest of Dr. Paul Farmer, a man who would cure the world. New York: Random House. Kristof, N.D., and S. WuDunn. 2009. Half the Sky, Turning Oppression Into Opportunity For Women Worldwide. New York: Knopf. Kurlansky, M. Year? Cod. New York: Penguin Books. Levine, R. 2007. Millions Saved: Proven successes in global health. Sudbury, MA: Jones and Bartlett. Lindstrand, A, S. Bergstrom, H. Rosling, B. Rubenson, B. Stneson, and T. Tylleskar. 2006. Global Health, an Introductory Textbook. Lund, Sweden: Studentlitteratur. Macinko, J., M.F.M. de Souza, F.C. Guanais, and C.C. da Silva Simoes. 2007. Going to Scale With Community-based Primary Care. Social Science and Medicine 65:2070–80.



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Markle, W.H., M.A. Fisher, and R.A. Smego Jr. 2007. Understanding Global Health. New York: McGraw Hill. Marmot, M. 2004. The Status Syndrome: How social standing affects our health and longevity. New York: Henry Holt. Marmot, M., S. Friel, R. Bell, T.A.J. Houweling, and S. Taylor. 2008. Closing the Gap. Lancet 372:1661. McKenna, M. 2004. Beating Back the Devil. On the front lines with the disease detectives of the Epidemic Intelligence Service. New York: Free Press. Merson, M.H., R.E. Black, and A.J. Mills. 2006. International Public Health. Sudbury, MA: Jones and Bartlett. Moyo, D. 2009. Dead Aid. New York: Farrar, Straus and Giroux. Murthy, P., and C.L. Smith. 2009. Women’s Global Health and Human Rights. Sudbury, MA: Jones and Bartlett. Nour, N.M. 2006. Health Consequences of Child Marriage in Africa. Emerging Infectious Diseases 12:1644–50. O’Neil, E. Jr. 2006. A Practical Guide to Global Health Service. Chicago, IL: American Medical Association. Packard, R.M. 2007. The Making of a Tropical Disease. A short history of malaria. Baltimore, MD: Johns Hopkins Press. Perlman, D., and A. Roy. 2008. The Practice of International Health: A case-based orientation. Oxford, UK: Oxford University Press. Perry, H., M. Cayemittes, F. Phlippe, D. Dowell, J.R. Dortonne, H. Menager, E. Bottex, W. Berggren, and G. Berggren. 2006. Reducing Under-five Mortality Through Hôpital Albert Schweitzer’s Integrated System in Haiti. Health Policy Planning 21:217–226. Perry, H., W. Berggren, D. Dowell, H. Menager, E. Bottex, J.R. Dortonne, F. Philippe, and M. Cayemittes. 2007. Long-term Reductions in Mortality Among Children Under Age 5 in Rural Haiti. American Journal of Public Health 97:240–246. Prahalad, C.K. 2006. The Fortune at the Bottom of the Pyramid. Eradicating poverty through profits. Upper Saddle River, NJ: Wharton School Publishing and Pearson Education. Preker, A.S., G. Carrin, D. Dror, M. Jakab, W. Hsiao, and D. Arhin-Tenkorang. 2002. Effectiveness of Community Health Financing in Meeting the Cost of Illness. Bulletin of the World Health Organization 80:143–150. Preston, S.H. 2007a. The Amazing Decline in Mortality: Dimensions and causes. Presented to a Symposium on Health and Wealth, Royal Swedish Academy of Sciences, May 29, 2007.

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———. 2007b. The Changing Relation Between Mortality and Level of Economic Development. Population Studies 1975, 29:231–248. Reprinted, International Journal of Epidemiology 36:484–90. ———. 2007c. Response: On ‘The changing relation between mortality and level of economic development. International Journal of Epidemiology 36:502–503. Pritchard, L., and L.H. Summers. 1996. Wealthier is Healthier. Journal of Human Resources 31:841–68. Roberts, P. 2008. The End of Food. Boston: Houghton Mifflin. Sachs, J. 2005. The End of Poverty: Economic possibilities for our time. New York: Penguin Books. Seear, M. 2007. An Introduction to International Health. Toronto, ON: Canadian Scholars Press. Segal, S.J. 2003. Under the Banyan Tree. A population scientist’s odyssey. Oxford, UK: Oxford University Press. Sharma, M., and A. Atri. 2009. Essentials of International Health. Sudbury, MA: Jones and Bartlett. Skolnik, R. 2008. Essentials of Global Health. Sudbury, MA: Jones and Bartlett. Taylor-Ide, D., and C.E. Taylor. 2002. Just and Lasting Change: When communities own their futures. Baltimore, MD: Johns Hopkins University Press. Thornton, R.J. 2008. Unimagined Community. Oakland, CA: University of California Press. Travis, P., S. Bennett, A. Haines, T. Pang, Z. Bhutta, A.A. Hyder, N.R. Pielemeier, A. Mills, and T. Evans. 2004. Overcoming Health-systems Constraints to Achieve the Millennium Development Goals. Lancet 364:900–06. Yunus, M. 2003. Banker to the Poor: Microlending and the battle against world poverty. New York: Foreign Affairs. United Nations. 1948. Universal Declaration of Human Rights. www.un.org/en/documents/udhr. The U.S. Global Change Research Information Office. 2010. http://gcrio.gcrio.org. The World Food Programme. 2010. An Organization of the United Nations, www. wfp.org. World Health Organization and UNICEF. 1978. Primary Health Care: Report of the International Conference on Primary Health Care. Alma-Ata USSR. 6–12 September, 1978. Geneva: WHO. Wrigley, E.A., and R. Schofield. 1981. The Population History of England, 1541–1871: A Reconstruction. Cambridge, MA: Harvard University Press.

9 Global Oral Health Robert J. Collins

Oral health is a state of being free from chronic mouth and facial pain, oral and throat cancer, oral sores, birth defects such as cleft lip and palate, periodontal (gum) disease, tooth decay and tooth loss, and other diseases and disorders that affect the oral cavity. Risk factors for oral diseases include unhealthy diet, tobacco use, harmful alcohol use, and poor oral hygiene. —WHO 2010

T

he traditional dental diseases are dental caries (tooth decay) and periodontal disease (gum disease); however, in the past four decades, maintenance and restoration of “dental” health has been expanded beyond consideration of just the teeth and supporting structures to “oral health” which includes soft and hard lesions of all kinds in the oral cavity and the methods to diagnose, treat and prevent these conditions. Oral health varies in countries around the globe although within any one country, including the U.S., disparities in oral health are invariably associated with poverty, education, and other socio-economic variables. Other conditions of public health concern are: oral cancer, cranio-facial trauma, oral manifestations of HIV-infection and noma (cancrum oris). Oral cancer is one of the ten most frequent cancers worldwide but varies considerably by region. In some Asian countries, oral cancer accounts for up to 50% of all cancers and three quarters of oral cancer cases occur in developing countries. Noma, a wasting disease that destroys the hard and

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soft tissues of the mouth and face, is strongly linked to poverty and general medical and social conditions (Secure Our Children 2002). Oral diseases are widespread and detract from quality of life by limiting one’s ability to complete tasks associated with everyday living. The World Health Organization (WHO) estimates that 60–90% of children worldwide have dental cavities. (Petersen et al. 2005) Appropriate nutritional intake can be disrupted by inability to masticate due to the pain or dysfunction attributable to oral diseases. Oro-pharyngeal cancer and noma are potentially life threatening and can result in life-long functional impairment or disfigurement. Oral appearance affects self-esteem and the willingness to interact with others. Many national and international leaders have cited oral health as a neglected area of health and health promotion, a conclusion supported by a range of oral disease measurements across many countries (FDI World Dental Federation 2009) The WHO has stressed the importance of the following concepts in addressing the oral health needs of nations, underscored in the 2004 oral health planning conference for Africa held in Kenya (WHO 2004): •

• •

•

•

The development of appropriate oral health policies at national and local level backed by a sustainable oral health dataset to facilitate subsequent evaluation The pursuit of environmental changes and the promotion of lifestyles to the benefit of health The support of affordable preventive strategies, services and the strengthening and rationalization of human resources for oral heath [sic] Policies enabling all people access to an appropriate locally determined program of essential oral health care that includes pain relief, oral disease control and promotion of oral health, and The integration of oral health care in primary health care programs in an environment that is free from the transmission of infectious disease

The above principles guide intervention by NGOs, universities, and collaborating centers. In addition, the WHO Oral Health Program in Geneva maintains a Global Oral Health Database (http://www.who.int/oral_ health/databases/global/en/).



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Taken from WHO Pathfinder surveys conducted in various countries, these data provide some insight into the oral health status of many countries of the world.

GLOBAL ORAL HEALTH AND THE SCHOOL OF DENTAL MEDICINE: WHO ORAL HEALTH COLLABORATING CENTER For more than two decades the School of Dental Medicine (SDM) has had significant involvement in global oral health. A World Health Organization Oral Health Collaborating Center (OHCC) was located within the SDM from 1997 to 2012. The Center’s work focused predominantly on oral infectious disease and resulted in a number of collaborations and publications. These include surveys of U.S. dental schools’ involvement in international oral health education, evaluation of ART for dental caries in Mexico, a study of HIV and Noma in Malawi, and evaluation of oral health in African immigrants from Sudan, Ivory Coast, Mali, Mauritania, Togo and Haiti living in West Philadelphia. More recently, the OHCC worked on projects in Botswana and, until the devastating earthquake there, had been assisting the Pan American Health Organization (PAHO) to develop an oral disease prevention program for children in Haiti. In addition, the OHCC provided consultation for the introduction of low cost, fluoride toothpaste in Madagascar and assessed the need for a similar development in conjunction with a non-profit health organization in Bangladesh. Recently, the OHCC completed a pilot study in Botswana, demonstrating the utility of cell phone camera technology to support remote diagnosis of oral lesions. By mutual agreement, the SDM and WHO discontinued the OHCC designation in 2012; however, the SDM continues its focus on global health (The University of Pennsylvania has one remaining WHO Collaborating Center located in the Penn School of Nursing.) The SDM has appointed an Associate Dean for Global Affairs and has developed additional relationships with institutions in Asia and other countries with the aim of improving oral health via the provision of SDM continuing education for dental professionals in overseas countries.

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OTHER INTERNATIONAL HEALTH PROGRAMS AT THE SDM •

Program for Advanced Standing Students (PASS) is for graduates of foreign dental schools who wish to practice dentistry in the U.S. It is a two-year program leading to a Doctor of Dental Medicine (DMD) degree. About thirty individuals are accepted each year and these students are fully integrated into the third and fourth year curricula with students in the full, four-year program. Completion of the PASS and receipt of the DMD degree allows foreign-trained dentists to take licensing exams in any state or region of the U.S..

•

SDM student externships coordinated by the Office of Hospital Affairs are based on exchange agreements that SDM has with approximately 30 institutions worldwide. Fourth-year students are required to complete a four-week, hospital-based externship in an approved setting in the U.S. or a foreign country. A student may also choose to acquire this training in two hospitals, including one domestic and one foreign, with two weeks in each location.

•

SDM students in good academic standing are able to participate in an International Honors Program. A program in community-based health in Botswana is currently under development in conjunction with the School of Nursing at Penn. Dental students would be paired with nursing students in community health settings in Botswana for 4–6 weeks, learning to connect oral health with the settings in which patients live and work, and participating in ongoing research.

•

The Office of International Relations coordinates a program for dental students from international schools who wish to spend from two to six weeks at SDM attending lectures and observing in clinic. Approximately 30–40 students participate in this program each year. Students must come from a school that has a formal exchange agreement with the SDM.



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LOOKING FORWARD Developed countries have made tremendous progress over the past three decades in reducing the impact of dental caries and periodontal diseases; however, there remain populations within these countries who have not benefited to the same degree. Generally speaking, these disparities are noted primarily in groups that are poor, have limited access to dental providers, are not covered by dental insurance, or suffer from physical, mental or other disabilities. In the U.S., unlike many developed countries, more than one-half the population is without dental insurance. Adults who retire at age 65 lose medical and dental coverage. Medicare replaces the loss of employer medical insurance but doesn’t cover dental care. Recently passed health care reform (Affordable Care Act of 2010) does improve dental care coverage for children up to age 21 but does not include coverage for adults. In developing countries, dentists are often few in number and disparities can be great. More importantly, the dental knowledge and self-care practices that we take for granted in developed countries are often not available. For example, dental caries can be greatly reduced by the use of fluorides. In developed countries, fluoridated water is widely available and nearly all dentifrices contain fluoride and are used in combination with brushing by the majority of the population. Salt fluoridation (addition of fluoride to salt) is common in South American and in some other countries where the lack of large, public water supplies precludes the use of water fluoridation. These public health measures are usually not available in developing countries or, in the case of fluoride dentifrice, too expensive for most citizens to afford. To minimize oral disease, both developed and developing countries need to ensure that fluorides are made available in appropriate forms where they are most needed. In developing countries, innovative efforts can produce surprising results. For example, through the efforts of the Pan American Health Organization (PAHO) and ministries of health in the Caribbean, Central and South America, salt fluoridation has had a remarkable effect on the prevalence of dental caries (Estupinan-Day 2005). In the U.S. American Indian population, a focus on water fluoridation and dental sealants in the 1980s produced a dramatic decline in caries by the early 1990s (Collins, Jones, and Martin 2001).

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The WHO concepts cited earlier stress effective primary prevention methods so that individuals can take the lead role in maintaining their own oral health. At the same time, WHO also encourages the development and support of a system of dental care acceptable and appropriate to each country to help control oral diseases. Through its work in local and global communities, the faculty and students of SDM also follow these principles and strive to promote effective oral health practices, primary prevention, and a level of healthcare-worker training consistent with the required level of intervention needed. A focus on meeting basic care needs rather than comprehensive care for all will yield good oral health at a reasonable cost. Effective, low cost programs that are sustainable are essential for making progress in developing countries and in underserved communities in developed countries. Increasingly, scientists are identifying links between oral health and general health. Conditions, such as diabetes, cardiovascular disease, low-birthweight babies, and pulmonary infections, have been shown to be associated with poor oral health. Further research is needed to explore potential causative relationships. In addition, salivary diagnostics is an area of research burgeoning with the potential for using saliva as a diagnostic fluid in lieu of blood. The development of rapid testing that can be conducted by clinicians or other trained healthcare workers at chair or bedside without the need for the expense and delay associated with sending fragile samples to distant laboratories may one day make much earlier intervention for serious health conditions a possibility in many international settings.

REFERENCES Collins, R.J., C.M. Jones, and R.F. Martin. 2001. Oral Health. In American Indian Health, ed. E. Rhoades, pp. 370–387. Baltimore, MD: Johns Hopkins Press. Estupiñán-Day, S. 2005. Promoting Oral Health: The use of salt fluoridation to prevent dental caries. Washington, DC: Pan American Health Organization. Petersen, P.E., D. Bourgeois, H. Ogawa, S. Estupinan-Day, and C. Ndiaye. 2005. The Global Burden of Oral Diseases and Risks to Oral Health. Bulletin of the World Health Organization 83:661–669. FDI World Dental Federation. 2009. The Oral Health Atlas. http://www.fdiworldental. org/media/11443/atlas_table.pdf accessed 30 July 2013. Secure Our Children. (2002). What Is Noma? www.secureourchildren.org/what-isnoma/index.html accessed 30 July 2013.



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World Health Organization (WHO). 2010. Oral Health. www.who.int/topics/oral_ health/en/ accessed 30 July 2013. ———. 2004. Planning Conference for Oral Health in the African Region. Nairobi, Kenya, 15–16 April 2004—Organized by the FDI World Dental Federation and co-sponsored by the WHO Oral Health Programme http://www.who.int/oral_ health/events/africa_conference/en/index.html accessed 30 July 2013. ———. WHO Oral Health Program in Geneva maintains a Global Oral Health Database http://www.who.int/oral_health/databases/global/en/ accessed 30 July 2013.

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10 Cities: Threats and Opportunities for Women’s Health Marjorie Muecke

I

n this chapter, I will present literature-based rationales for scholarly and applied concern with the health of girls and women in cities worldwide. I will first explicate two key terms: urban/cities, and women’s health/gender disparities in health to indicate the urgency of examining them together from a global perspective. In the final section of the chapter, I will present efforts by University of Pennsylvania School of Nursing faculty to improve women’s health in cities around the world.

WHY BE CONCERNED WITH CITY-BASED POPULATIONS? In 1950, 30% of the world’s human population lived in cities. By 2000, that figure had mushroomed to 47%, and the trajectory of geometric increase is widely predicted to continue (University of Michigan 2002). In fact, it is thought that worldwide—until around the year 2007—rural populations always outnumbered urban, but since then, the ratio is reversed (Cohen 2005). The United Nations estimates that by the year 2050, two-thirds of the world’s population will be urban (United Nations 2011:4). Thus, we are at a point of key demographic and political transformation in the life styles and eco-niches of humans on earth, a transformation that has serious implications for health, and, as I will argue later in this chapter, particularly for the health of girls and women worldwide.

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What makes an urban place a city is usually an administrative, political boundary that is measured in terms of population size within that boundary. However different countries, agencies and cities may use different definitions of population size. At the global level, a useful indicator of accelerating urban growth is the megacity, or cities with more than 5 million inhabitants. In the year 2000 there were 41 megacities; by 2015 it is predicted that there will be 50 megacities as more rural places spawn towns, towns become urbanized into cities, and cities grow into megacities. There are clearly benefits and losses in this transformation, but the losses are of interest here as they undermine human health. As summarized on the University of Michigan webpage Global Change (2002): “The rapid growth of cities strains their capacity to provide services such as energy, education, health care, transportation, sanitation and physical security”. The presence or absence of these services is widely indicated as a precursor to (ill-) health. Recently Freudenberg and others have viewed such urban living conditions as fundamental determinants of health, thereby shifting explanations for health from individual behavior to the urban environment and to the impact cities have upon health (Freudenberg, Galea, and Vlahov 2005; Takano 2003). Another consequence of this rapid urbanization is that it is happening to a much greater extent in low- and middle-income countries than in higher income countries. Cohen (2005:50) predicts that “whereas in 1950 the less developed regions had roughly twice the population of the more developed ones, by 2050 the ratio will exceed six to one.” Thus, countries with lower incomes and more fragile infrastructures are being increasingly confronted with the major threats that cities can pose to the health of their inhabitants. Furthermore, recent studies suggest that the highest rates of urban poverty are in newly emerging cities and in the “urban sprawl” edges of larger cities (Montgomery 2008, 2009). For example, Rashid (2007:109) found that urbanization in Bangladesh: is contributing to the process of underdevelopment and poverty. The urban population is…increasing rapidly, leading to enormous growth of shack settlements and poverty.…As much as 40–70 percent of urban population growth is attributed to rural-urban migration.…Most urban migrants cannot afford housing and live in insecure tenure.…The health indicators are worse for the urban poor than for the rural poor...



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Building upon this work, some urban planners advocate revitalizing neglected urban areas by promoting public health and equity as the wisest means to achieve healthy urban places. These scholar practitioners show how city environments and urban planning affect population health. In reference to urban areas of the U.S., Coburn (2009: publisher’s blurb) found: In distressed urban neighborhoods where residential segregation concentrates poverty, liquor stores outnumber supermarkets, toxic sites are next to playgrounds, and more money is spent on prisons than schools, residents also suffer disproportionately from disease and premature death. Such social and physical conditions of living become, in Freudenberg, Galea, and Vlahov’s words (2005:5), “’embodied’ in individuals and populations in a specific time and place and constrain people’s options for health. As usefully integrative as these approaches are, they nonetheless lack a gender perspective, and also do not take account of how different life stages affect individual, neighborhood, and city health. Nonetheless, there are health benefits of urban living. They include greater accessibility of large portions of the population to public health services such as immunizations, and particularly in lower income countries with weak health care services, access to hospitals. This access helps reduce maternal and neonatal mortality in the event of obstetric emergency. This decline in child (under 5 years of age) mortality promotes higher ages of life expectancy. However, increasing age provides biological time for the body to age and therefore to express the chronic diseases that have now become chief causes of morbidity and mortality in low- and middle-income countries, as well as in high-income countries (Leon 2008).

WHY FOCUS UPON URBAN WOMEN’S HEALTH GLOBALLY? Until very recently, gender was rarely considered to have an influence on the distribution of urban health (Freudenberg, Galea, and Vlahov 2005). Taking a gender perspective on health in cities has revealed that despite significant shifts in gender roles in the past 50 years, women and men still often occupy different physical and social spaces in urban areas (Hubbard 2004; Peterson et al. 1978; Wekerle 1980), spaces that may act to reinforce

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traditional gender roles in society and the gendered division of labor (Frye, Putnam, and O’Campo 2008:617). Worldwide, the people most responsible for the production and maintenance of human health are women. Mothers, wives, sisters, grandmothers, daughters, aunts, aides, nurses, and midwives are typically the care-givers in sickness and in health. Why? Because gender roles around the world root women in the domestic sphere where the production of health is grounded. True, women don’t and can’t do it alone. To create and sustain a healthy family and community, women need the resources and support of their communities, and of their governments, but those supports are too often lacking among the poorest countries and population groups such as those in migrant labor or refugee camps, and urban slums and sprawl settlements. Particularly in such under-resourced dense human settlements, governments tend to rely upon women voluntarily to provide the health care that the governments don’t. Even though women comprise the largest number of health care providers in both the domestic and the public spheres, their care is largely under-reported, unsupported, and uncompensated. Some would argue that on average, women’s life expectancy is higher than men’s, so they ask: why focus upon urban women’s health? Because the health advantage of living in cities accrues to those with higher incomes, and the majority of them are men. Also because longer life spans do not mean that the extra life years are healthy and happy (Chan 2009). Quality of life is more often undermined among urban women than among urban men. For example, women disproportionately suffer from domestic abuse, trafficking, sex abuse, poverty, malnutrition, isolation, neglect in old age, and low level of formal education. Twice as many women as men worldwide are illiterate, reflecting a pervasive gender bias that limits women’s options in life and health (Chan 2009). These factors contribute to their lower status than men in society and in the major religions (WHO 2009). Furthermore, childbearing kills over 1000 women a day in the world (based upon 356,000 known maternal deaths in 2008) (World Health Organization, United Nations Children’s Fund, United Nations Population Fund, and the World Bank 2010). Women die because of complications of pregnancy and delivery, and unsafe abortions (Grimes et al. 2006). Men don’t. The viciousness of maternal mortality becomes clear when one realizes that it creates orphans of many children yet most maternal deaths are preventable (Science Daily 2010). Reproductive services worldwide are concentrated in cities and target



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women to a far greater extent than they do men. The services go beyond trained birth attendants facilitating deliveries. The services include reproductive health and family planning, safe abortion (where it is legal), infertility clinics, surrogacy services, counseling and testing for sexually transmitted infections including HIV, and stem cell research. The urban locus of these services, however, means that they are not evenly distributed across urban populations. Rather they tend to be directed at those who can afford them. While family planning services are more equitably accessible due to some governments’ interests in containing the growth of the population in poverty, other services generally are provided by the private sector seeking profit. For example since the 1980s, fertility/IVF clinics sell “spare” human embryos to research centers, and have made surrogacy a growing and profitable international industry (Gentleman 2008; Hewitson 1997; Anderson 1990). Even though surrogacy is illegal in China, it is a thriving underground and on-line business. China’s large number of women in poverty provides a pool of women offering to become pregnant with a fertilized ovum from another woman. The volunteer women are in double jeopardy. Only IF the ovum donor accepts the baby after it is born does the gestational mother get paid. If the newborn is not well formed and healthy, payment is less likely to occur, and the volunteer surrogate is left with a sick or handicapped infant. This exploitation of women in urban poverty exposes them to this and the many other health risks associated with pregnancy. Those who suffer most from the disadvantages of urban living are women who are older, widows, living in poverty, heads of household (Goebel, Dodson, and Hill 2010), or trafficked (including girls). Recently, researchers from the World Health Organization studied women’s health across the lifespan in the different regions of the world. They found that “societies and health systems continue to fail women at key times of their lives, particularly in their adolescent years and in older age” (WHO 2009:v). This finding represents a major shift of focus from the earlier medical and international health concerns about women in the 1960s and ‘70s that centered upon pregnancy, delivery, and early childhood survival. Since then, the world has moved into an era of reproductive health and family planning, which, in combination with improved living conditions, has significantly reduced the need for induced abortion, and reduced maternal mortality, but also increased risk-taking behavior such as unprotected sex among adolescents (Call et al. 2002), resulting in unplanned pregnancies and sexually transmit-

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ted diseases including HIV. The most vulnerable girls are those who are new to urban areas; living in the poorest areas of the cities; heads of household or taking care of an HIV-positive relative; orphaned by loss of one or both parents; or in domestic service (due to the risk of abuse by their employers and to their isolation from a support network) (Bruce and Hallman 2008). The WHO (2009) study researchers found that gender disparities exert a primary constraint upon girls’ and women’s health worldwide, undermining their health by increasing their exposure to health risks, and by limiting their access to health information and care. These findings increase our understanding of how interventions in childhood, adolescence, during the reproductive years, and beyond affect health later in life and even across generations. The study exemplifies a trend to rechart the medical and public health disease-and mortality-focused paradigm to include social determinants of girls’ and women’s health. This entails addressing the whole person and her life context, not just her disease. The trend towards taking context or life-space into consideration when assessing health actually began long ago with attention to the relations of environment to health. Nursing theorists from Florence Nightingale and Lillian Wald to the present have been in the forefront of the trend, but it was not until the 1960s that there was a focus upon women for reasons beyond their maternal and reproductive roles. Betty Friedan’s The Feminine Mystique (1963) and The Boston Women’s Health Collective’s Our Bodies Ourselves (1971) were pace-setters that riveted public attention in the U.S., leading to the Supreme Court’s Roe vs. Wade decision that gave women the legal right to induce abortion and thereby gain control over their bodies and reproductive lives. Global momentum favoring women’s right to protect their bodies and to decide how to use their bodies grew largely through grass roots and international non-governmental organizations (NGOs). In 1994 women’s NGOs took their visions for women’s empowerment and agency to the United Nation’s International Conference on Population and Development. At that conference they successfully influenced the adoption of a Programme of Action (aka the Cairo Consensus) (United Nations 1994). The Programme of Action represented a major shift in population policy and politics towards a focus upon the empowerment of women as the best means to promote both their health and socio-economic development. The following year, the momentum was expanded by the Fourth World Conference on



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Women held in Beijing, China. In 2000, world government representatives were convened by the United Nations in New York where they agreed to work towards alleviating poverty worldwide in a set of eight Millennium Development Goals (MDGs) to be achieved by the year 2015. Two of the eight goals focus directly upon women—one to “promote gender equality and empower women,” (mainly through increased access to education), and the other to “improve maternal health” (mainly by reducing maternal mortality) (United Nations 2013). Nonetheless no movement to address urban women’s health has been identified.

WHY BE CONCERNED ABOUT URBAN WOMEN’S HEALTH GLOBALLY? As mentioned earlier, the fastest growth of urban populations is, and in the next 50 years will continue to be, in existing or new cities of developing countries (Cohen 2005). This growth is putting the world’s largest proportion of urban girls and women in the cities of low-income countries. In addition, displaced persons including refugees typically live in dense rapidly constructed low-resource settlements that on the basis of population density can be considered urban. One subset of the urban poor is the 51.2 million who have been displaced by conflict or persecution (UNHCR, 2014:2,5). In 2008, 80% of the displaced urban poor were hosted by lowincome countries—Pakistan, Syria and Iran, each had around a million or more in their borders (UNHCR Annual Report 2009). In addition in the same year, about 36 million were displaced due to sudden-onset natural disasters (United Nations, Office for the Coordination of Humanitarian Affairs and Internal Displacement Monitoring Centre 2009). Women and children comprise 70 to 80% of all displaced persons worldwide.

UNIVERSITY OF PENNSYLVANIA SCHOOL OF NURSING’S LEAD ROLE IN FOCUSING UPON URBAN WOMEN’S HEALTH GLOBALLY Evolution of the focus at the organizational level ICOWHI: In 1983, a group of women at Dalhousie University School of Nursing began to plan a women’s health congress. That plan led to 20

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subsequent congresses hosted in 10 different countries, and to the founding of the International Council on Women’s Health Issues (ICOWHI). ICOWHI’s membership of researchers, clinicians, educators, and community advocates is committed to (1) enhancing women’s empowerment so they can make informed decisions about their health, health care, and lives; (2) reducing inequities, and (3) promoting the health and well-being of women worldwide (Woods 2009). Afaf I Meleis, Dean of University of Pennsylvania School of Nursing from 2002–2014, is a former President and Council General of ICOWHI, and Co-Chair of its latest Congress, held April 2010 at the University of Pennsylvania. The theme of the Congress was “Cities and Women’s Health: A Global Perspective.” It attracted over 400 participants from 32 countries. Its theme has been carried forward virtually through an active e-commons, or social networking website, the Urban Women’s Health Collective. Twelve mid-career professionals from a variety of fields (law, medicine, nongovernmental advocacy, nursing, population studies, psychiatry, urban planning) and countries (Armenia, Bangladesh, Kenya, Korea, Nigeria, Pakistan, Peru, Thailand, U.S.) populated the content of and mobilized interest in urban girls’ and women’s health worldwide through an interactive website. Several key events were precursors to the 2010 conference. In April 2005, the University of Pennsylvania School of Nursing and School of Medicine held a two-day international colloquium entitled the Penn Summit on Global Issues in Women’s Health: Safe Womanhood in an Unsafe World. The Summit drew participants from around the globe, including: Dr. Esohe Aghatise, activist lawyer and member of the Coalition Against Trafficking in Women in Europe; Justice Unity Dow, high court judge in Botswana; Dr. Mary Robinson, former President of Ireland and former UN High Commissioner of Human Rights; and Ambassador Lewis, UN Special Envoy for HIV/AIDS in Africa. The Summit made the gender disparity in health safety explicit, and made headway in identifying and deconstructing American/Western hubris in providing foreign “aid” that too often results in undermining rather than improving (women’s) health. In 2007, the Rockefeller Foundation convened a Global Urban Summit at its Bellagio Center in Italy. The Summit brought together international experts, from grassroots organizers to financiers, to explore solutions to the challenges of the fast-paced, unplanned growth of cities. University of Pennsylvania scholars who participated in the meeting returned from the



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meeting convinced of the power of campus diversity to address the complexity of urbanization and women’s health. To further this work, heads of the Penn Institute of Urban Research and the School of Nursing hosted and commissioned papers for an interdisciplinary think tank held the 9th–11th of September 2007, entitled Women’s Health is the Community’s Health: Impacting Women’s Lives in Urban Places. The ideas and networks generated at that meeting coupled with the strong interests of School of Nursing faculty in women’s health led to the School’s co-hosting the ICOWHI Congress in April 2010 on Cities and Women’s Health: A Global Perspective. Scholarly advocacy for attention to the challenges of cities for girls and women continues post-ICOWHI 2010 not only in the Urban Women’s Health Collaborative webbased social networking, but also through post-conferences on the topic with nursing and other Penn alumni in Florida, London, New York, and San Francisco. Outreach continues: Penn’s President Amy Gutmann hosted the Fifth United Nations Global Colloquium of University Presidents in April 2011, entitled Empowering Women to Change the World: What Universities and the U.N. Can Do. The School of Nursing’s Dean Afaf I Meleis and Deborah A Driscoll, Chair of Obstetrics & Gynecology at the University of Pennsylvania Health System co-chaired the UN Colloquium. The meetings just described have been rare opportunities for thought leaders from diverse fields and areas of expertise to come together to share perspectives, lessons learned, and best practices, as well as to begin to plan for concerted action. The aims of this focus upon cities and women’s health are broad but simply stated: to mobilize efforts to identify ways to make health the easy choice for urban planning, to build on the communities and environments that urban women create in order to promote sustained economic development, and to identify best models of disease and injury prevention and health promotion for urban women surviving in poverty.

Individual School of Nursing Faculty Activities in Urban Women’s Health Worldwide A critical mass of individual nursing faculty who are engaged in research on girls’ and women’s health in cities in the U.S. and worldwide exists within the School of Nursing at the University of Pennsylvania (University of Pennsylvania School of Nursing 2013). Practice Associate Professor Kathleen Brown, CRNP, PhD, FAAN, has rare clinical expertise in advocacy and support for child and adult survi-

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vors of sexual assault. She helped develop the Sexual Assault Nurse Examiner (SANE) program, which is used nationally and internationally (Sexual Assault Nurse Examiner Sexual Assault Response Team 2013). She implemented the first sexual assault response team in Pennsylvania, and has trained over 1,000 SANE nurses. As part of Dr. Marilyn Sommers’ (see below) research project study of the relationship of skin color to disparities in sexual assault care, Dr. Brown has trained 20 nurses and physicians in the use of a forensic kit for evidence collection in San Juan, Puerto Rico. Van Ameringen Professor in Nursing Excellence, Emerita, Lois Evans, PhD, FAAN, RN, has been at Penn since 1984, distinguishing herself as a teacher, researcher, scholar, practitioner, and administrator. Dr. Evans is one of the nation’s foremost researchers in care of the elderly. Along with her colleague, Dr. Neville Strumpf, Dr. Evans developed new groundbreaking research lessening the use of restraints on frail elders in the nation’s nursing homes and hospitals (Evans and Strumpf 2010). As faculty director, Dr. Evans played a major role in launching academic clinical practices of the School of Nursing, offering primary care to both frail elders and low-income families who otherwise might go without health care (Kong, Deatrick, and Evans 2010). Her current research focus is upon women transitioning out of professional roles into retirement, and upon empowerment of the next generation of urban women. Professor Emerita in the Schools of of Public Health, Nursing, and Medicine Jeane Ann Grisso, MD, MSCE, returned to Penn following seven years at the Robert Wood Johnson Foundation (RWJF) where she led the development of a major initiative on Intimate Partner Violence (IPV), including a new national program to prevent dating violence, an expansion of the CDC’s DELTA program to prevent IPV through state and community domestic violence coalitions, and several projects related to addressing IPV in the workplace. Dr. Grisso’s research is focused on urban women’s health issues (Hirschinger et al. 2003). She has served as principal investigator of federally-funded investigations of reproductive health, IPV, menopause, and aging. Her primary focus has been IPV. Currently, she is working on developing new research related to workplace interventions to address IPV (Pollack, Austin, and Grisso 2010), studies of teen dating violence, and an intervention in primary health care with women experiencing IPV. She also conducts a study to test the effectiveness of an IPV intervention in four Philadelphia Department of Public Health centers. Finally, Dr. Grisso is work-



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ing with the Maternity Care Coalition to enhance the Riverside prison’s program for pregnant and newly parenting women inmates, as well as with a multidisciplinary group to assess the impact of urban agriculture on lowwealth communities. Van Ameringen Professor in Psychiatric Mental Health Nursing, and Director of the Center for Health Equities Research Loretta Sweet Jemmott, PhD, RN, FAAN, is one of the nation’s foremost researchers in the field of HIV/AIDS prevention among African American adolescents, having been involved with $74 million in federal funding devoted to this issue during the course of her career. Several of her curricula have been designated for national use by the Centers for Disease Control. For more than 10 years, Dr. Jemmott has been involved in extensive outcome-based, theory-driven, and culturally-competent National Institutes of Health-funded research designing and evaluating interventions to reduce HIV risk-associated sexual behaviors (Villarruel, Jemmott, III, and Jemmott 2006). Dr. Jemmott and her colleagues have conducted a series of randomized controlled behavioral intervention trials aimed at increasing safer sex behaviors among inner-city minority youth, women, and family members ( Jemmott, Jemmott, and McCaffree 2010; Jemmott et al. 2010). These trials have demonstrated remarkable success reducing HIV risk-associated behaviors among adolescents and women. Currently, Dr. Jemmott is Principal Investigator on two NIMHfunded 5-year randomized controlled studies entitled, “The Church-Based Parent-Child HIV Prevention Project” and “Reducing HIV Sexual Risk Among Black Substance Abusing Women.” She is also a Co-Investigator on seven other randomized controlled trials, including a NIMH funded HIV risk reduction study for South African youth. In addition to her HIV risk reduction intervention studies among urban black communities in the U.S., she has designed HIV risk reduction programs for adolescent girls and their mothers in Jamaica (Hutchinson et al. 2007), and for youth in Botswana, Mexico and South Africa ( Jemmott, et al., 2010; Jemmott, et al., 2011). Professor of Nursing and Sociology Emerita Afaf I Meleis, PhD, DrPS(hon), FAAN, and recent Dean of the School of Nursing (2002–2014) was Professor at the University of California Los Angeles and the University of California San Francisco for 34 years before coming to Penn. She is a Fellow of the Royal College of Nursing in the United Kingdom; a member of the Institute of Medicine, the Forum of Executive Women, and the Pennsylvania Women’s Forum; a Trustee of the National Health Museum;

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and a Board Member of the Consortium of Universities for Global Health, CARE (a global intervention group), the Nurses Education Fund, Inc., and Life Science Career Alliance. Dr. Meleis’ scholarship is focused on global health (Meleis 2006), immigrant and international health, women’s health (Ratinthorn, Meleis, and Sindhu 2009, Meleis 2005), and on the theoretical development of the nursing discipline (Bhutta et al. 2010). She is the author of more than 150 articles in social sciences, nursing and medical journals; 40 chapters; and numerous monographs, proceedings, and books. She is also the author of an award winning book, Theoretical Nursing: Development and Progress (Philadelphia: Lippincott Co. 1985, 1991, 1997, 2004, 2006) and Women’s Work, Health and Quality of Life (Binghamton: Haworth Medical Press, Inc., 2001). Dr. Meleis is a sought-after keynote speaker for national and international conferences on women’s health and development, disparities in healthcare, and international health. She has been invited for visiting professorships, to conduct symposia, present keynote addresses, serve on boards, to plan conferences, and consult on women’s health research and doctoral education nationally and internationally (in Asia, Africa, Europe, Australia, South America and North America). Adjunct Nursing Professor Marjorie Muecke, PhD, RN, FAAN, retired from her position as Assistant Dean for Global Health Affairs, Associate Director WHO Collaborating Center for Nursing & Midwifery Leadership in the School of Nursing the end of June 2014. She is P.I. of the ChiangMai Family Health Research Project, a long-term (27 year) 4-phase ethnographic birth cohort study of urban families in Thailand that examines shifting meanings of gender and socioeconomic position over time, across the life span and between generations (Muecke 2004a; Muecke 1992). She has numerous publications on the health of resettled refugees in the U.S. (Muecke 1987). She has received grant funding from Fulbright, NICHD, the Ford Foundation, the University of Washington, the Rockefeller Foundation, and the U.S. Dept. of Education. Prior to coming to Penn in 2006, Dr. Muecke was Professor of Nursing at the University of Washington for 27 years; a visiting scholar at ChiangMai University Faculty of Nursing and Women’s Studies Center; the Institute of Education, University of London; and the University of Melbourne’ Women’s Studies Research Center. She was Director of the Southeast Asia Center and Studies Program at the Jackson School of International Studies at the University of Washington, and Program Officer in Reproductive Health & Sexuality for the Ford Foundation



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in New York. She has led study abroad trips for nursing students and nurses to Botswana, India, Indonesia, Nepal and Thailand. Lillian S. Brunner Professor of Medical-Surgical Nursing and Director of the Center for Global Women’s Health Marilyn (Lynn) Sawyer Sommers, PhD, RN, FAAN, studies injury related to sexual assault and risk-taking behaviors in vulnerable populations at risk for health outcomes disparities. Her populations of interest (women, older adolescents, young adults) who live in poverty have poorer health than those who do not, and bear a larger burden of injury. Dr. Sommers has also been developing innovative strategies to understand patterns of physical injury resulting from sexual assault. In the groundbreaking first phase of her team’s research funded by the National Institute of Nursing Research, it was found that females with dark skin had a lower genital injury frequency and prevalence following consensual and non-consensual sexual intercourse than females with light skin. This novel finding points up a significant health disparity: females with dark skin may be at a disadvantage at multiple points in both the health care and the criminal justice systems. Her current research uses digital image analysis to identify the effects of skin color on injury findings of forensic examination of female sexual assault survivors in the USA and Puerto Rico, and determines innovative strategies to measure injury across the continuum of skin color and range of skin mechanics. Professor Emerita of Women’s Health Nursing Marilyn Stringer, PhD, CRNP, RDMS, FAAN, is one of a small number of nurses nationally certified in diagnostic obstetrical and gynecological ultrasonography. Dr. Stringer influenced national and international standards and incorporated this valuable assessment technique in expanding the scope of nursing practice to improve infant outcomes (Stringer, Menihan, and Yehuda 2010). Her clinical scholarship focuses on cervical cancer risk reduction, and on the promotion of a healthy pregnancy and the reduction of preterm births for high-risk women (Stringer et al. 2008). Dr. Stringer has also been engaged in a collaborative effort focused on health promotion for childbearing women in the West Philadelphia community. The women face numerous health disparities, especially high rates of preterm birth. Along with women of the West Philadelphia Community, the Hospital of the University of Pennsylvania’s Women’s Health Department, and the School of Nursing’s Healthy in Philadelphia initiative, Dr. Stringer’s team has promoted evidence-based, sustainable interventions intended to reach at-risk women. She and stu-

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dents founded the Philadelphia Alliance for Labor Support (PALS) which has trained some 400 doulas who have assisted in hundreds of births across Philadelphia. She and students also partner with a domestic violence shelter in West Philadelphia and Hospital of the University of Pennsylvania nurses to teach mothers techniques of stress reduction, decision-making, reacting to abuse, leaving an unsafe environment, family planning, sexual health, and about alcohol and drugs. Before becoming Dean and Professor of the New York University School of Nursing in 2012, Eileen Sullivan-Marx, PhD, CRNP, RN, FAAN, was Associate Professor for Scholarly Practice, and Associate Dean for Practice and Community Affairs at Penn Nursing. She focuses her research on outcomes of care for frail older adults and sustaining models of care using advanced practice nurses. Her work links city initiatives with those of the university as in the LIFE (Living Independently for Elders) model run by the Penn School of Nursing in West Philadelphia: 85% of the care is women’s practice. She is the 2010–11 Health and Aging Policy Fellow with the American Political Science Association. She also conducted an applied research project in partnership with the IKP Center of Technology for Public Health (ICTPH) in Chennai, Tamil Nadu, India, to develop roles for nurse specialist—community health worker teams to provide rural health care in India, where the majority of family care-givers are women. Associate Professor of Nursing Anne M. Teitelman, PhD, CRNP, focuses her research on HIV prevention among adolescents and on understanding IPV as an HIV risk factor (Teitelman, et al. 2008). She is currently conducting a 5-year NIH-funded study to develop and test a theory-based HIV and partner abuse prevention intervention for adolescent girls who attend family planning clinics and live in economically challenged urban communities (Teitelman, Bohinski, and Tuttle 2010). Another one of her current projects involves examining narratives of minority urban adolescents in opposite sex relationships in order to inform the prevention of HIV/STI and partner abuse. She is also co-investigator for a CDC funded study examining precursors to youth violence, including intimate partner violence. She is interested in promoting health and equity of the girl child internationally and in the role of primary care providers in health promotion and advocacy (Teitelman, Seloilwe, and Campbell 2009). Dr. Teitelman is also co-PI with Dr. Marilyn Stringer on a funded pilot study examining adolescents’, parents’, and young women’s attitudes about and access to the new HPV vaccine.



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Themes common to nursing faculty research on and practice with urban women include safety of the urban social environment across the lifespan; empowerment by listening to urban girls and women to harness their wisdom and helping to make their voices heard among decision makers; transitions that women experience; and gender and class-based health inequities. All of these point our faculty toward developing new paradigms of health care for urban girls and women, with the aim of fostering the creation of urban environments that protect and promote girls’ and women’s health, and through their health, family and community health. To this end, a Center for Global Women’s Health (CGWH) was recently established within the School of Nursing under the directorship of Dr. Marilyn Somers. The CGWH is the School’s seventh Research Center.

REFERENCES Anderson, E.S. 1990. Is Women’s Labor a Commodity? Philosophy and Public Affairs 19:71–92. Bhutta, Z.A. et al. 2010. Education of Health Professionals for the 21st Century: A global independent commission. The Lancet 375:1137–38. Boston Women’s Health Collective. 1971. Our Bodies Ourselves. Boston, MA: New England Free Press. Bruce, J. and K. Hallman. 2008. Reaching the Girls Left Behind. Gender and Development 16:227–45. Call, K.T. et al. 2002. Adolescent Health and Well-being in the Twenty-first Century: A global perspective. Journal of Research on Adolescence 12:6998. Chan, M. 2009. Launch of the Report on Women and Health: Today’s Evidence, Tomorrow’s Agenda. World Health Organization. Coburn, J. 2009. Toward the Healthy City: People, Places, and the Politics of Urban Planning. Cambridge, MA: MIT Press. Cohen, J.E. 2005. Human Population Grows Up. Scientific American 293:48–55. Evans, L.K., and Strumpf, N.E. 2010. Two Decades of Research on Physical Restraint: Impact on practice. In Shaping health policy through nursing research, ed. A.S. Hinshaw, and P. Grady, pp. 167–184. New York: Springer. Friedan, B. 1963. The Feminine Mystique. New York: W.W. Norton and Company. Freudenberg, N., S. Galea. and D. Vlahov. 2005. Beyond Urban Penalty and Urban Sprawl: Back to living conditions as the focus of urban health. Journal of Community Health 30:1–11.

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———, eds. 2006. Cities and the Health of the Public. Nashville, TN: Vanderbilt University Press. Frye, V., S. Putnam, and P. O’Campo. 2008. Whither Gender in Urban Health? Health and Place 14:616–22. Gentleman, A. 2008. India Nurtures Business of Surrogate Motherhood. New York Times. 10th March. Goebel, A., B. Dodson, and T. Hill. 2010. Urban Advantage or Urban Penalty? A case study of female-headed households in a South African city. Health and Place 16:573–580. Grimes, D.A., et al. 2006. Unsafe Abortion: The preventable pandemic. The Lancet Sexual and Reproductive Health Series. Available from: http://www.who.int/ reproductivehealth/publications/general/lancet_4.pdf. Accessed 20 Oct. 2010. Hewitson, G. 1997. The Market for Surrogate Motherhood Contracts. Economic Record 73:212–24. Hirschinger, N.B., et al. 2003. A Case-control Study of Female-female Nonintimate Violence in an Urban Area. American Journal of Public Health 93:1098–103. Hutchinson, M.K., et al. 2007. Culture-Specific Factors Contributing to HIV Risk Among Jamaican Adolescents. Journal of the Association of Nurses in AIDS Care (JANAC) 18:35-47. Jemmott, L. et al. 2010. The NIMH Multisite HIV/STD Prevention Trial for African American Couples Group. The contribution of male and female partners’ substance use to sexual risks and STDs among African American HIV serodiscordant couples. AIDS and Behavior 14:1045–54. Jemmott, L.S., J.B. Jemmott, and K. McCaffree. 2010. Sisters Saving Sisters: An evidenced-based approach to reducing HIV, STD and pregnancy. New York: Select Media. Jemmott, J.B. III, L.S. Jemmott, A, O’Leary, Z. Ngwane, L.D. Icard, S.L. Bellamy, S.F. Jones, G.A. Heeren, J.C. Tyler, and M.B. Makiwane. 2010. School-based Randomized Controlled Trial of an HIV/STD Risk-reduction Intervention for South African Adolescents. Archives of Pediatrics and Adolescent Medicine 164:923–929. Jemmott, J.B. III, L.S. Jemmott, A, O’Leary, Z. Ngwane, L.D. Icard, S.L. Bellamy, S.F. Jones, J.R. Landis, G.A. Heeren, J.C. Tyler, and M.B. Makiwane. 2011. Cognitivebehavioural Health-promotion Intervention Increases Fruit and Vegetable Consumption and Physical Activity Among South African Adolescents: A clusterrandomised controlled trial. Psychology and Healt, 26:167–185. doi:10.1080/08870 446.2011.531573. Kong, E.H., J.A. Deatrick, and L.K. Evans. 2010. The Experiences of Korean Immigrant Caregivers of Non-English-speaking Older Relatives with Dementia in



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American Nursing Homes. Qualitative Health Research 20:319–29. Leon, D.A. 2008. Editorial: Cities, Urbanization and Health. International Journal of Epidemiology 37:4–8. Meleis, A.I. 2005. Safe Womanhood Not Safe Motherhood: Policy implications. Health Care for Women International 26:464–71. ———. 2006. Human Capital in Health Care: A Resource Crises or a Caring Crises?. Global HealthLink 139:6–7:21–2. Montgomery, M.R. 2008. The Urban Transformation of the Developing World. Science 319:761–4. ———. 2009. Urban Poverty and Health in Developing Countries. Population Bulletin 64, no. 2. Muecke, M. 1987. Resettled Refugees’ Reconstruction of Identity: Lao in Seattle. Urban Anthropology and Studies of Cultural Systems and World Economic Development 16:3–4:273–89. ———. 1992. Mother Sold Food, Daughter Sells her Body: Prostitution and cultural continuity. Social Science & Medicine 35:891–901. ———. 2004a. Female Sexuality in Thai Discourses About maechii (“lay nuns”). Culture Health and Sexuality 6:221–238. ———. 2004b. Women’s Work: Volunteer AIDS Care Giving in Northern Thailand. Women and Health 33:1–2:21–37. Pollack, P., W. Austin, and J.A. Grisso. 2010. Employee Assistance Programs: A workplace resource to address intimate partner violence. Journal of Women’s Health 19:647–649. Rashid, S.F. 2007. Durbolota (Weakness), Chinta rog (Worry Illness), and Poverty. Medical Anthropology Quarterly 21:109. Ratinthorn, A., A.I. Meleis, and S. Sindhu. 2009. Trapped in a Circle of Threats: Violence against sex workers in Thailand. Health Care for Women International 30:249–69. Science Daily. 2010. http://www.sciencedaily.com/releases/2010/02/100218092852. htm. Accessed: 2 March 2010. Sexual Assault Nurse Examiner Sexual Assault Response Team. 2013. (Online) Available from: http://www.sane-sart.com/ Stringer, M., et al. 2008. Symptoms Described by African American Women Evaluated for Preterm Labor. Journal of Obstetrical, Gynecological and Neonatal Nursing 27:196–202. Stringer, M., C. Menihan, and I. Yehuda. 2010. Ultrasound Examinations Performed by Nurses in Obstetric, Gynecologic, and Reproductive Medicine Settings: Clinical competencies and clinical guide. 3rd Ed. Washington, DC: AWHONN.

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Takano, T. 2003. Healthy Cities and Urban Policy Research. New York: Routledge. Teitelman, A.M., et al. 2008. Sexual Relationship Power, Intimate Partner Violence and Condom Use Among Minority Urban Girls. Journal of Interpersonal Violence 23:1694–712. PMID: 18349344. Teitelman, A.M., E.S. Seloilwe, and J. Campbell. 2009. Voices From the Frontlines: The epidemics of HIV/AIDS and violence among women and girls. Health Care for Women, International 30:184–94. PMID: 19191112 Teitelman, A.M., J.M. Bohinski, and A. Tuttle. 2010. Condom Coercion, Sexual Relationship Power (SRP) and Risk for HIV and Other Sexually Transmitted Infections (STIs) Among Young Women Attending Urban Family Planning Clinics. Family Violence Prevention & Health Practice. http://endabuse.org/health/ ejournal/2010/06/condom-coercion-sexual-relationship-power-and-risk-for-hivand-other-sexually-transmitted-infections-among-young-women-attending-urban-family-planning-clinics/. Accessed: Summer 2010. UNHCR. 2009. UNCHR Annual Report for 2008. Geneva: WHO. http://www.unhcr. org/4a2fd52412d.html. ______. 2014. UNHCR Global Trends 2013: War’s Human Cost. Geneva: WHO. Available from: http://www.unhcr.org/5399a14f9.html United Nations Office for the Coordination of Humanitarian Affairs and the Internal Displacement Monitoring Centre. 2009. Monitoring Disaster Displacement in the Context of Climate Change. http://www.internal-displacement. org/8025708F004BE3B1/(httpInfoFiles)/12E8C7224C2A6A9EC125763900315A D4/$file/monitoring-disaster-displacement.pdf. United Nations. 1994. Report of the International Conference on Population and Development, Cairo, 5–13 September 1994. Geneva: WHO. http://www.un.org/ popin/icpd/conference/offeng/poa.html. ———. 2008. World Urbanization Prospects: The 2007 Revision. New York: United Nations Population Division. ______. 2012. World Urbanization Prospects: The 2011 Revision. New York: United Nations Department of Economic and Social Affairs, Population Division. ———. 2013. We Can End Poverty 2015: Millennium Development Goals. New York: United Nations. http://www.un.org/millenniumgoals/bkgd.shtml University of Michigan. 2002. Urbanization and Global Change.(Lecture) University of Michigan. http://www.globalchange.umich.edu/globalchange2/current/lectures/urban_gc/. Accessed 12th September 2010 University of Pennsylvania School of Nursing. 2013. Faculty and Staff. (Online) http://www.nursing.upenn.edu/faculty/.



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Villarruel, A.M., J.B. Jemmott III, and L.S. Jemmott. 2006. A Randomized Controlled Trial Testing an HIV Prevention Intervention for Latino youth. Archives of Pediatrics & Adolescent Medicine 160:772–777. Woods, N.F.A. 2009. Global Imperative: Development, safety, and health from girl child to woman. Health Care for Women International 30:195–214. World Health Organization (WHO). 2009. Women and health: today’s evidence, tomorrow’s agenda. Report by the Department of Gender, Women and Health (GWH). http://www.who.int/gender/women_health_report/en/. World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA) and the World Bank. 2010. Trends in maternal mortality. Geneva: WHO.

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11 Pharmaceuticals and the Competitive Logic of Global Clinical Trials Adriana Petryna

TREATMENT SATURATION

I

n more than seventy percent of all medical consultations in the United States, doctors will prescribe, continue, or provide a medication to a patient. On average, two drugs or “drug mentions” have been documented per medical visit.1 Antidepressants are the most highly prescribed drugs, followed by high-blood pressure medicines, anti-cholesterol agents, anti-arthritics, and anti-asthmatics. Our pill-taking life, “mediated by proton-pump inhibitors, serotonin boosters and other drugs that have become permanent additives to many human bloodstreams” (Gorman 2004), is by and large taken for granted. Sustaining this way of life is a complex globalized system of drug testing and drug development. Clinical trials systematically evaluate new drugs or new ways of using known treatments in humans. They meet the regulatory requirement that the safety and effectiveness of drugs or treatments are established before they enter the market. In the past two decades, the United States landscape of commercial clinical research has suffered from dire shortages of investigator sites and trial volunteers. Ambitious federal and industry efforts have been underway to recruit more people for clinical trials in the U.S. and abroad. The number of health professionals and patients being recruited into clinical trials in middle- and low-income countries has been unprecedented. An array of professionals

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and business entities now make up a specialized clinical trials industry that facilitates the decisive step of human subjects research, which supports a global science of drug development. This essay takes the reader into the workings of this industry as well as a competitive world of capital and power that allow pharmaceutical companies to move their research to middle- and low-income countries. An outsourced clinical trials industry provides a window into the “massive arbitrage” that, according to the head of a large pharmaceutical firm, “is really the definition of globalisation” (Garnier 2005:2). As global clinical trials are integrated into local health systems internationally, questions about the value of clinical research arise. I show how reigning definitions of vulnerability and governing rules of accountability are often limited in the face of a private activity that one clinical trials professional described to me as “cutthroat commodity work.” Transparency becomes a critical issue. Moreover, host countries are not just passing homes for transient studies; they are emerging markets for new and costly therapeutic interventions that can also significantly change the way public health resources are allocated (and to whom). The essay concludes with a discussion of problems in the creation of centralized registries through which the scope and impact of the global trial enterprise might be revealed. Throughout, I point to policy gaps with respect to how the benefits and risks of trials are distributed as well as novel practices of accountability that can possibly reverse the troubling forms of business control that have evolved in local settings. First off, it is important to note that the offshoring of clinical research is not merely about opportunism or exploitation. As an example, drug companies annually invest almost half a billion U.S. dollars in clinical research in Poland, a country with until recently one of the lowest shares of public expenditure on health in the Organisation for Economic Co-operation and Development (OECD) countries.2 Trials for everything from hypertension treatments to high-risk surgical techniques have moved to Poland because of medical professionals’ English proficiency, technical competence and expertise, and the country’s high rates of untreated diseases. Data from such trials will be used to attain drug approval from the U.S. Food and Drug Administration (FDA) or the European Medicines Agency. Dr. Jiri Stanek, a Czech public health specialist who sensed a chance for professional mobility when western pharmaceutical companies began setting up new subsidiaries in the Czech Republic, has spent the last de-



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cades transforming what he calls “non-competitive health infrastructures” into competitive “clinical trial markets” in Central-Eastern Europe.3 He got his start in the early 90’s, retooling aspects of ailing but centralized public health care systems into nominally functional clinical trial platforms. “For companies it was cheap,” he told me in 2006. “They got good data quick. There was a need for services, and all of a sudden Western companies realized the huge potential here. There was an extremely good population pool in terms of medical indicators for both chronic and acute diseases. Our populations did not have access to remedies that were available in the West, so it was all quite attractive. We had many untreated populations. There were treatment-naïve, steroid-naïve, statin-naïve people—people you could hardly find in the U.S. or Western Europe. We had extremely high recruitment rates.” Trials in Central-Eastern Europe were relatively easy to launch in those early years, he said. “If a western European drug company was involved, its research associates drove across the border. They just drove the experimental product to the investigational site. No customs payments. No one cared about the contents of the investigations. No ethical committees on site. The Minister of Health’s signature was very simple to get.” He spoke of the emergence of this clinical trial order as one sign of his country’s successful transition from political collapse to economic competitiveness. Yet that order has a predictable and restricted shelf-life, with a discrete beginning, middle, and end stage. The first stage was “the opportune moment,” when most citizens could hardly afford the new Western medicines that turned up in pharmacies. The state health sector was not willing or able to buy them either. Local physicians recruited as investigators accepted relatively low payment in return for recruiting large numbers of undertreated patients into trials that were largely driven by the concerns of the pharmaceutical sponsor. Then the second phase of the clinical trial life cycle—the peak moment— sets in. At this stage, experiments became a “normal part of health delivery. People no longer view trial participation in terms of being examined like rabbits,” according to Stanek. With the rush of clinical trial programs and human and financial capital, governments must eventually catch up with the new practices. They foster a culture of regulation, compliance, monitoring, and auditing, however soft or simulated, but with all the capability of supporting transnational commercial research.

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Inevitably, this trials expert explained, clinical trial markets in specific countries will “become exhausted.” At this concluding stage, “trials start to migrate eastward, to Ukraine, Russia, Uzbekhistan, and Kazhakhstan.” There are simply too many firms contending for a limited pool of high-quality local investigators who, in turn, become “too choosy.” They select trial protocols corresponding to their research interests and “begin to charge the equivalent of western European prices for their expertise.” Stanek added that clinical trial subjects for the most part are only “temporarily loyal” and, after a while, “they no longer see the immediate benefit in participating in trials.” People start to access drugs from state institutions or pay for them on their own. For instance, he said, pools of “steroid-free asthmatic children are starting to get exhausted a little” in the Czech Republic. At a point of heightened competitiveness for the right kind of patients and investigators, and when state regulators show signs of less flexibility, he said, “It simply becomes too expensive for us, just like in the United States, Western Europe, and Canada.” Prior to the decline of the experimental life cycle, and always thinking ahead, the clinical trials industry initiates research sites elsewhere, moving eastward in this case. Experimental landscapes disappear only to appear elsewhere, in another host country trying to find its place in the global economy. According to Dr. Stanek, the Czech clinical trial market “has less than ten years left.” In the end, the globalized clinical trial floats away, having shifted public health care into an ever-greater mosaic of private sector involvement and mounting patient demand for new drugs. A coworker of Dr. Stanek’s working in Poland told me how the value of patient data is defined in industrial terms. Each region’s productivity, he said, is viewed in terms of output of clinical research units (shorthanded as “CRUs”), a measure of the labor intensiveness involved in the monitoring of a single trial subject. In that formula, patient data value is a product of factors linked to the complexity of a patient’s disease and the difficulty of his or her monitoring. So one patient in an oncology study is like two patients in a respiratory or simple hypertension study. Alzheimer’s patients are very expensive to monitor, thus, the relatively high “CRU” (and high financial reward for recruitment of such patients). Poland is still trailing behind the United States in terms of these units, but it is ahead of Latin America by about five years. Central-Eastern Europe is in the second phase, when experiments remain a “normal” part of health care delivery and is seeing signs of the third phase (exhaustion).



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What drives this dynamism of the research enterprise, and what happens when there is no one left at home so to speak? In my book, When Experiments Travel: Clinical Trials and the Global Search for Human Subjects (2009), I explore the workings of the global clinical trial and analyze how it is crafted and made to work in different locales. As an anthropologist, I worked among the foot soldiers and day-to-day implementers of global clinical trials in Poland and Brazil, two regions whose aggressive neoliberal reforms initially delivered high social and economic insecurity, tracing their connections to health and legal systems, markets, and public health priorities and entitlement programs. I interviewed regional trial managers and monitors and publicly-funded academic scientists to understand how research is divided, how responsibilities are delegated and risks managed, and ultimately, how people actually access new drugs. Contract research organizations (or CRO’s) were my primary lens into this expansion. Emerging in the early 1990s, CRO’s evolved into a specialized clinical trials industry focusing, among other things, on subject recruitment and clinical development. The roots of CRO’s are traceable to the post–World War Two pharmaceutical expansion when a fee-for-service industry evolved in the United States response to a demand for more safety testing in animals. By the early to mid-1980s, pharmaceutical companies were outsourcing laboratory and clinical services, including the monitoring of investigational sites and data and conducting bioassays. Later, when drug development became a more commonly global endeavor, CRO’s offered know-how in regulatory submissions and conduct market analyses of existing and prospective drugs. The clinical trials industry is now highly regulated and the quality of its performance is defined by existing regulations. Its clients are pharmaceutical firms that are weighing the cost of a study, its quality, and timeliness. I initially explored how a clinical trials industry evolved and has been operating in the United States. I paid particular attention to the work of CRO’s, the biggest and most profitable sector of this industry. In the U.S., I interviewed corporate executives, administrators, and scientists. I asked them how they defined their work and overcame operational and technical problems. Because one of my principal concerns was the question of scientific integrity, I also tracked the evidence-making practices that have evolved with the offshoring of clinical trials—to Poland, for example, which was considered a highly desirable country from a clinical trial industry

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standpoint and also an important gateway to other pharmaceutical markets in the region. There I also assessed the impact of privately funded clinical research in ailing public health systems. My investigation into global trials led me into a decentralized chain of entrepreneurial activity comprised of pharmaceutical sponsors, CRO’s; patient recruitment firms; for-profit research ethics review boards; and stand-alone research sites nestled in urban and peri-urban communities.

THE GAME OF CLINICAL TRIALS The clinical trials industry claims about one-third of all clinical trial development expenditures. While drug company growth has leveled off somewhat in recent years, the clinical trials industry has boomed owing to several factors. First, the sheer number of trials being run, as well as the fact that there are many compounds around that have yet to undergo clinical testing. Second, to fulfill U.S. regulatory requirements, larger numbers of patients including children must be included in clinical trials to prove a drug’s long-term safety. Third, some therapeutic categories are expanding. With minimal pharmacological alteration, me-too or copycat drugs build on or mimic blockbuster drugs and exploit well-established markets. Competition to get drugs tested and approved and to bring them to market steps up the search for subjects and investigators. In the words of one scientist, “When a therapeutic class gets hot, it’s like a cattle stampede [for trial participants and investigators].” Changes in the scientific base of drug development also affect subject recruitment. As new molecules are discovered, more experiments are taking place before formal phases of human testing to determine their clinical and market viability. Finally, the available pool of human subjects in traditional Western pharmaceutical markets is shrinking. Treatment saturation, the biochemical double of the treatment naivete that Dr. Stanek prized, is making Americans and Western Europeans less usable from a drug testing standpoint. We exhibit the late-stage symptoms of a pill-taking life. Our bodies, saturated with treatments, produce too many drug-drug interactions and are thus less able to show specific drug effectiveness, making test results less usable. The leading business model of drug development, with its propensity towards me-too drugs, is plagued by diminishing returns and a loss of surplus-producing potential. That the statistical bias-reduction strategy of ran-



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domized controlled trials (the current gold standard for research) is not only applied but also circumvented is by now a truism. There is bias induction in protocol design and in the biased sampling of convenient populations to maximize drug benefit. This process of biasing is the engine of what one industry expert described to me as the “big game of clinical trials.” Recruitment strategies can employ subject inclusion criteria that are so selective that the possibility of adverse events ever being seen can literally be “engineered out.” Or a new drug can be shown to be superior by “engineering up” a side effect in another drug (by doubling that drug’s dose, for example). This serious big game generates new episodes of risk in which the actors involved retain significant amounts of moral discretion outside formal rules and regulations.4 To satisfy regulatory rules, pharmaceutical manufacturers seek out unexplored territories, and they turn to various subcontracting agencies to supply endless laboratories for the sake of the (drug approval) experiment. Yet study protocols requiring ever more tailored populations increase risk for the human subjects recruited on the ground. Physicians have a degree of latitude—particularly in countries where medical malpractice laws hardly exist—to hold off on giving treatments in order to produce the right kind of undertreated patients or, in the words of one frustrated Polish clinical trials expert, “to bring non-existent patients into existence.” This professional worked for a large CRO in Poland; he noted that “providing an experimental treatment to someone who should not get it or who should be getting something else can be very dangerous.” Even as the pharmaceutical research engine adheres to international and national regulatory requirements, mitigating potential risk-laden practices such as these remains a major challenge. The value of offshoring from the perspective of pharmaceutical sponsors is access to clinical trial data that can facilitate drug approvals, as well as the ability to triage unwanted or negative data. Local experts like Dr. Mazur, who oversaw the eastward expansion of one CRO, typically do not pronounce judgment on the comparative value of the drugs they test (though, indeed, they have much to say about their short- and long-term safety). They were critical of randomization strategies that focus on homogenous patient groups and that exclude real-life users. Mazur’s U.S.-based colleague offered a sobering view of globalizing trials from the perspective of safety. He noted that in Poland the “level of scientific rigor is just as good or better in other countries where our drug research takes place.” The problem is

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the generalizability of results. “How can I generalize the data? So I’ve got a million patients to choose from in Eastern Europe. Now I can narrowly and homogenously define who I use [in my study] in order to pick out the right 10,000. Is that a bad thing? Is it a bad thing for the patients and the health care community in Poland? No. But that does not mean that bad things aren’t going to happen.” In his view, an operative model of drug development can create short-term benefits for local communities, but also long-term unknowns for end-users of a new drug. These unknown risks are hard to quantify in what he artfully termed a paradigm of expected failure. In under-hypothesizing potential harms, this paradigm “searches” for new locales that can absorb or neutralize the impact of its own myopia. Echoing economist Albert Hirschman’s concept of “slack” proposed four decades ago, the fortunes of the pharmaceutical enterprise are closely connected to the management of “more or less permanent pockets of inefficiency and neglect” (1970:15). In this messy managerial space, my clinical trials interlocutors, for example, were in a constant fix over having to make personal judgment calls, choosing between alternatives that were not obviously right or wrong. They rarely spoke about any specific transgression but, rather, about systemic flaws. This slack, in turn, created its own effervescence—ever more specialized niches for other business entities to enter into the clinical trial chain. In the process, responsibility for dangerous protocols could be deferred. The risks attached to this sort of deferral and the incentives driving them can go unaddressed, at least for some (profitable) time period. All this running of slack occurs not because of gaps in existing regulatory structures in the countries in which trials take place. The principle of containment and of monitoring risks (once captured in idea of the randomized control trial) is systematically lost in the global clinical trial’s peculiar locomotion.

INVESTIGATORS Dr. Mazur, himself once a physician in the Polish public health system, introduced me to his large network of collaborators and recruited investigators. He grouped them into those he said he trusted and those who “required too much monitoring.” Some investigators were too sympathetic toward their patients and had a tendency to over-enroll them for medical care purposes. These persons, potential “protocol-violators” as he called



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them, had to be weeded out. Mazur also spoke of “overeager” investigators who wanted to use the system for immediate benefit, and thus jeopardized the outcome and sustainability of the enterprise. For example, he had recently contracted with hypertension specialist Dr. Kaminska, who had for two decades worked at a leading medical institute and its outpatient ward. With a colleague, she had recently opened a private clinical trials center in the institute’s immediate vicinity. She recruited patients from the institute for industry-sponsored trials (related to the treatment of chronic diseases such as hypertension and metabolic disorders such as diabetes and obesity), which she coordinated at the center. She identified potential trial subjects who, given the high demand on the institute’s services, “had to wait a long time in the public health system to get examinations and treatments or could not afford to them privately.” While Kaminska could attract many volunteers—“I get two new patients a day,” she told me—she was one of the overeager investigators Dr. Mazur was wary of. Early one morning at Dr. Kaminska’s office, twenty volunteers had been sitting on a bench along a corridor, awaiting examination. Her phone was ringing off the hook because, as she explained to me, she had given patients “permission to call me anytime of the day if they have any complaints or concerns…. I have a group of fifteen long-term patients who I treat. They keep asking me, ‘do you have another research program for me?’” Dr. Kaminska said she was particularly skilled at enticing “stubborn patients with diet and lifestyle problems, as well as behavioral and compliance issues” into research. Her work, she suggested, was as much about research and it was about getting patients to take new medications. “I also have patients who don’t want to take medicines,” she told me. “They say they just want to be on a good diet. Then I say to them, ‘I have a research program, let’s see whose theory is right.’ We get more details about a patient’s health and in the end, we both win.” Dr. Kaminska described herself as a very dedicated scientist, but that state science was vastly underfunded. She said that it usually takes a long time to become familiar with a new trial protocol—“It is a lot of work.” She resented the fact that the number of patients allocated to her part of the study “was so small.” She wanted to interpret the data she gathered and she rejected the rule that any investigator who takes part in a multinational study “cannot really have access to their own data in isolation because their sample is too small.” Dr. Kaminska didn’t think of herself as a passive tech-

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nician and strove to capitalize on her recruitment opportunities and control data. When she turned to the subject of being monitored by outside agencies, it became clear why Dr. Kaminska was potentially untameable. She said that the study monitors who visited her from the CRO weekly were more of a problem than a help: “They are too young and they want to be too smart. In fact, they should just be a medium of communication.” Dr. Kaminska was not interested in becoming an instrument for others. “I want to enroll more patients in my trials, not just a few.” In spite of her prodigious enrollment talents and enthusiasm, Dr. Mazur’s CRO dropped her as a paid investigator and would have to move on to other research sites. The origins of global clinical trials have their roots, in part, in the United States, when ethical scandals and new regulatory rules made the pharmaceutical industry look abroad. A first phase of offshoring arguably began after wide-scale prisoner testing in the U.S. would be denounced and severely limited. An estimated 90 percent of drugs licensed in the U.S. prior to the 1970s were first tested on prison populations. In 1980, the U.S. Department of Health and Human Services banned the use of prisoners for particular phases of drug testing and the industry lost a major source of human volunteers. By then, it had shifted a good deal of its research elsewhere— namely, to countries such as England and Sweden where regulation did not necessarily hinder initiating trials. The floodgates of globalizing clinical research opened in the early ‘90s, when the FDA began promoting the globalization of clinical research by instantiating the International Conference on Harmonization (ICH), which eased the acceptability and transference of clinical data from foreign sites to the U.S. FDA. To attract pharmaceutical investments, the regulatory agencies of many countries soon signed on to the ICH. Signing on meant these countries would begin setting up agencies that could standardize and monitor the conduct of trials in their countries. They would also set up ethical review boards to ensure protections for patients. Implementation varied from country to country, yet the number of subjects involved in international clinical trials swelled from an estimated 4,000 in 1995 to 400,000 in 1999 (OIG 2001). As the upsurge of clinical trials was underway, scandals emerged that uncovered the defects and deficiencies of institutionalized protection in a now-globalized system. There was the infamous 1996 case of a popular antibiotic that had been taken off the market in the U.S. because it was found to have serious liver side effects. Other scandals followed, such as



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those involving the suppression and selective reporting of trial results (for the antidepressant Paxil, for example) that benefited proprietary interests rather than public health risk and safety concerns. Then came the troubles with Vioxx, an anti-arthritic drug, whose clinical trials left behind even less obvious evidentiary tracks of a safety risk. Its maker Merck, like other companies, began actively offshoring part of its clinical research by the mid-nineties. A meta-analysis of all Vioxx trials suggested that different contexts with different background risks can lead to an underappreciation of adverse cardiovascular events on the part of local investigators ( Juni et al. 2004). Poland, one of several countries hosting Vioxx trials, had one of the highest rates of cardiovascular-related deaths in the world. This high background risk, in turn, “could have biased results in trials that did not include external appraisal of safety outcomes” (the use of study monitors, for example).5 The trial protocol was a quintessential example of how the science of drug development focuses on proving efficacy and fails to model potential harms, in part, because the designers the protocol selected for subjects who did not look like the end-users of the drug. New study sites with high background risks afforded a possibility of engineering out knowledge about a drug’s potential safety problems. When I spoke to one investigator who was contracted to run Vioxx studies in Poland, he, perhaps understandably, denied any problem at his investigative site. Rather, he offered an elaborate explanation that focused on the drug’s dangerous biochemical mechanisms “that should have been evident to the manufacturer before human trials began.” But then again, he said, “Without clinical trials, we would never know which medicine is safe.” As if to shift the burden of responsibility of deciphering the risk of trial protocols onto his patients, he added, “They come knowing that this is a risky enterprise.” The fact is that the competitive environments of commercial research have degraded the quality of trial protocols and patient and consumer safety. Moreover, as can be read between the lines in the above investigators’ statements, there are significant disincentives for investigators to flag the risks of any given trial protocol. Such action may lead to the unblinding of a study or even its possible suspension, which may mean no future contract for the local investigator. Harm, post-experiment, is difficult to prove let alone track back to the multiple decision-making points where background risks obscure real risks, where the detection of harms can be filtered out,

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and where investigator sites (in which all of the above took place) are supposed to remain anonymous by proprietary design.

THE STRATEGIC LANDSCAPE OF TRIALS The clinical trials industry took the Vioxx scandal and other cases like it as a serious wake-up call to the liabilities of their profitable enterprise. The workers of this subcontracted industry could no longer afford to be viewed as a pawn of big pharma. Largely drawn from the same labor pool as pharmaceutical and biotech employees, questions have been periodically raised about their “degree of independence from their pharmaceutical-industry clients.” (Shuchman 2007:1365). The industry’s main trade group suggests that the scrutiny is misplaced, as “[s]ponsors call the shots. Sponsors shoulder final responsibility for the trials they design” (ClinPage 2007). One CRO professional observed that some pharmaceutical clients were “out of touch” with the realities and exigencies of on-the-ground research. He said, “It used to be that, when you are a CRO, you just get handed the study protocol and do it.” Post-Vioxx, the “market ethics” that drove the design of human subjects research had to be tempered because, as he told me, “no one sets the bar properly in terms of what is and isn’t ethical.” The competitive landscape of global clinical trials was clearly getting out of hand. In 2004, the International Committee of Medical Journal Editors had issued a statement: “Unfortunately, selective reporting of trials does occur, and it distorts the body of evidence available for clinical decision making” (DeAngelis et al. 2004:1363). The editors declared that their medical journals would only consider publishing articles that were based on registered trials.6 But the problem was not just about selective reporting or a lack public trust, but about given protocols and paradigms that over-determined drug value and underappreciated risk. Regulatory and public policy actors in new clinical trial markets had yet to delineate their own medical research priorities and needs. State regulatory bodies needed strengthening and a clearer mandate to protect their own citizens from the market ethics of clinical research. Also, state regulators still had no way of assessing the impact that the growth of clinical research was having on their own national and underfunded health systems. Frameworks for registering global clinical trials and monitoring trial conduct have remained limited. In 1997, the Food and Drug Administration



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Modernization Act Section 113 mandated the registration of all new drug efficacy trials for “serious and life threatening diseases” and this mandate led to the creation of ClinicalTrials.gov.7 This trial databank was first made publicly available via the Internet in early 2000, and it offers information on enrollment in federally and privately supported clinical research. By 2005, the registration of trials was becoming mandatory, but “only 48 percent of industry-sponsored trials were registered during the initial period of the law’s implementation” (Sim and Detmer 2005:1090). Existing trial registries were still partial and fragmented, and there were holes in a system of registration that was, in effect, still voluntary.8 Kay Dickersin and Drummond Rennie, Deputy Editor of the Journal of the American Medical Association, listed some of the major barriers to a comprehensive repository of clinical trials: “industry resistance, the lack of a funding appropriation for a serious and sustained effort, lack of a mechanism for enforcement of policies, and lack of awareness of the importance of the problem” (2003:516). Even counting the number of clinical trials proved to be complicated. Some clinical trials require FDA oversight and others do not, such as studies of new uses of drugs already FDA-approved.9 With the picking and choosing of data that globalization now afforded, one can appreciate the number of trials that led to new products, as well as the ones that were not submitted and hence, not counted. According to the director of ClinicalTrials.gov, “only about 20% of Investigational New Drug applications result in approved drugs; this means that most trials submitted to the FDA are not eligible for inclusion” in a database of FDA-approved products (Zarin et al. 2007:2119). With all the picking and choosing of data that a global data-producing site affords, one can imagine the number of clinical trials with negative findings that are not submitted to the FDA and thus are not counted.

TRANSPARENCY AND VALUE-BASED DECISIONS At the same time as medical journal editors were promoting transparency, the World Health Organization (WHO) began in late 2004 to outline plans for a global trial databank that aimed not only to register all trials, but to get some idea of the sheer number of trials. The International Clinical Trials Registry Platform or ICTRP, a meta-register of trials, encourages principal investigators or sponsors of trials to declare their studies in re-

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gional, national, or international register coordinated by the WHO. The registry seeks to provide a public record of the health problems being studied and the countries where research is underway. It collects and analyzes data from twenty registration criteria, including the identity of the medical intervention being tested (and placebo and comparator controls being used), key subject inclusion and exclusion criteria, target sample sizes (the number of subjects the study plans to enroll), and anticipated primary and secondary outcomes (trial results). The aim of this registry is to guarantee public access to information about ongoing, completed and published clinical trials, and to ensure that all trials in all phases of testing are registered at their inception. This move however drives into the heart of the latest drug-development strategies. For instance, to weed out poor drug candidates sooner, the industry is making unprecedented investments in early-stage testing. There has been a boom in early-phase trials (which largely focus on drug dosaging and safety).10 Phase one studies have, at times, doubled as drug-efficacy trials. During an open commentary period of debate, industry lawyers wrote letters to the WHO protesting the registration of all trials. They argued that disclosure of early-phase trials would create dangerous confusion; desperate patients might equate early-phase trial results with actual treatment. They claimed that public knowledge of such trials would be a threat to public safety. Lawyers also objected to some of the registration criteria, arguing that in order to maintain competitive advantage firms must retain the right to withhold the name of the intervention, including the target sample size of trial volunteers and anticipated study outcomes. Reveal the target sample size in a given location, industry lawyers argue, and you give competitors the chance to identify proprietary aspects of protocol design and the statistical powers needed to achieve a desired outcome. Yet skeptics of the industry’s position countered that companies “generally know what their rivals are working on” thus “competitive advantage would not be seriously affected if all companies were obliged to register all trials” (Godlee 2006:1108). They also argued that patients need to be aware of ongoing trials internationally. Ethics committees and institutional review boards need to know what other trials are ongoing when deciding whether to approve a new trial. At stake in all of these arguments was the uncovering of a broader, largely invisible, and strategic landscape of ongoing trials. As the debates wore on, and as the industry began to sense its weakening position, it



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ratcheted up the argument against disclosure, claiming that this requirement would undercut “the sovereignty of worldwide regulatory authorities empowered to make value-based decisions for their citizens.”11 There is an assumption that regulatory authorities make value-based decisions (as the debate over health care costs in the United States shows, they often do not). Industry lawyers not only complained of potential intellectual property theft, they claimed the WHO initiative was out of legal bounds: “We must be assured that external entities, working outside the law, do not act to disrupt the economic basis of our industry.”12 This economic basis depends, in part, on the limited and often underutilized power of regulators to set priorities and create value-based decisions. This is particularly evident in the way trial sponsors will sort out a strategic cartography of where to carry out trials. The sorting out is not just about cost-effectiveness, it is about “creating value” for new drugs, for which there is usually an important regulatory approval strategy. As the chief executive officer of a large CRO told me in 2005, “Location of testing is crucial for us to get the right indication [or reason to prescribe] for the drug.” In choosing a particular country in which to carry out a trial, companies seek to acquire data that they need to support the right indication for a drug. This executive also explained that their client drug manufacturers normally want to ensure the drug’s “highest precedent price.” Since there are no price controls in the United States, initiating regulatory approval for a given drug application in the U.S. allows companies to set a highest possible precedent price for a particular drug. When marketed globally, this drug will “ideally” be sold on the basis of that highest precedent price. It is crucial for companies to carefully orchestrate the subsequent filing of a drug’s application outside the U.S. to maximize pricing in regional markets. “File in the wrong country, get a precedent price set in a low pricing country, and this sweeps across the region and that is a disaster,” he told me. Once the drug is approved, postmarketing studies can act to insure maximum pricing in regional markets. In such studies, involving patients, more information is gathered about a product’s safety, efficacy, and optimal use. That is, long after pharmaceutical interests have calculated that a drug works for a particular indication, they continue to recruit subjects and investigators into trials as a way of promoting their product and building brand loyalty (Elliott 2011). We do not know the number of subjects involved in postmarketing studies, in part, because we do not know how

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specific companies distinguish between research and development expense and marketing expense (Light 2008). This blurring of purpose suggests that host communities are not simply temporary homes for fleeting research projects; they are emerging markets for new interventions that can further the inequality of access to medicines. In short, the clinical trial landscape embodies a host of value-based calculations that can dramatically redistribute public health resources. Advocates of the WHO-based trials registry see it as a crucial instrument of transparency that can hopefully rectify imbalances in the global health research agenda that commercialized clinical trials can instantiate. The industry’s somewhat defensive reaction to the implementation of a WHO trials registry is perhaps not surprising. More striking is the reluctance of major regulatory bodies to engage the effort. WHO specialists are trying to verify that the trial information that drug firms send to ClinicalTrials.gov, the public Web-based registry, simply corresponds to the information these firms provide to the FDA.13 FDA officials however have been reluctant to assist in verification efforts (Zarin et al. 2007). Deborah Zarin, the director of the ClinicalTrial.gov team, and colleagues note that the FDA “uses its own internal identification system that is never made publicly available” (2007:2116). The regulatory agency has been slow to assist in verification efforts as, reportedly, proprietary issues have not been resolved. But “without access to trial protocols it is not possible to determine, with complete certainty, that all data are accurate” (Zarin et al. 2007:2115). Zarin and colleagues also note that “[w]ithout the ability to validate entries, selective reporting of trial results could still occur” (2007:2118). Companies registering new investigational products on ClinicalTrials.gov for example have been known to change their serial numbers, or use various serial numbers, names, or aliases (ibid., p. 2116)—this gives them the opportunity to select which trials to publish. The inability to properly identify agents also raises safety concerns: “Serial numbers (and trials) of drugs that are never approved may remain ‘masked’ in the database” (ibid., 2117). This means that potential research subjects or research or public health professionals searching ClinicalTrials.gov cannot access relevant safety information in prior research or its possible links to other investigative agents being studied (ibid.).14 Regulatory officers working in Poland’s national drug regulatory agency gave me insights in 2006 into the concrete challenges they face in their at-



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tempt to reconcile a private commodity-making enterprise with sound public health decision-making. These administrators were involved in the approval and monitoring of trials in their country.15 With their stamps of approval, Polish clinical trial data can become part of drug applications submitted to the European Medicines Agency and the FDA. In my brief interview with them, I inquired into some of the problem areas that they felt particularly confident about having solved. “[Getting rid of] the garbage trials,” they told me, almost in unison, referring to postmarketing studies that ensure drug value, as well as to other types of research which did not directly serve national interests. The quickness of their response reflex suggests that they were well-aware of the inadequacies of the research enterprise, marked by significant duplication of research and requiring better adjudication of an experimental drug’s comparative medical advantage. They also said that of the four hundred new trials registered in 2004, ten were rejected because of “no insurance documents,” “poor randomization ratio” (fewer patients were randomized to an expensive treatment and more to a placebo), and a “sponsor wanted to conduct a Phase 3 study without showing Phase 2 documentation.” These regulatory officers conceded that they had no precise record of how many patients were even enrolled in trials. The lack of this type of data is certainly not unique to Poland. “No one knows,” they said, “Patients can be enrolled two or three times, but we don’t know for sure.” They said that the European Union now required “sponsor-site agreement documentation so that we know who is assuming responsibility for the trial, not a virtual person.” These officers expressed particular concern with “how real the patients are” in some trials. Because recruited local investigators are normally paid on a per-patient basis, they were worried about the built-in incentive to make up patients; hence, to make up data. Their regulatory task was to make sure patients and data were not being fabricated. But “there are not enough checks to prevent this from happening,” they told me. At stake in this story of non-transparency is a larger question of the institutional design of clinical trials. The WHO’s International Clinical Trials Registration Platform is not an endpoint in itself but can be viewed as one tool in capturing and making more transparent a strategic calculus of global trials which girds the cost of new drugs and can be filled with sometimes redundant research that itself can lead to questionable claims of drug value and meaningful comparative advantage. That is not to say that this is

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the only way or that the WHO should have sole responsibility. But if there is something like sound evidence-based medicine, scientific integrity, and an idea of universally valid knowledge as a public good, it better have a database—one that is capable of capturing some of the competitive dynamics, in part linked to a “paradigm of expected failure,” that have up till now been difficult to capture. From an anthropological standpoint, those competitive dynamics reflect a series of minute and multiple decisions that are all too often linked to an insistence on a statistically significant result, but that can lead to poor accountability, safety problems, and bad outcomes (Graham 2004). Until now, the extent to which this methodological inattention towards harm affects public welfare is being adjudicated on a very piecemeal basis, here as in most countries where research takes place.

THE CHALLENGES AHEAD In 2007, the inspector general of the U.S. Department of Health and Human Services published a report highlighting the FDA’s failure to provide adequate oversight of clinical trials in the United States. The FDA, the document charges, is “unable to identify all ongoing trials and their associated trial sites” and that “uncertainty of timing and lack of coordination impede the FDA’s ability to conduct […] inspections” (OIG 2007:ii). The report estimates that the agency inspected only 1 percent of clinical trial sites between 2000 and 2005. Moreover, the FDA’s guidance and regulations “do not reflect current clinical trial practices” (ibid). Writing in response to this scathing report, bioethicist Arthur Caplan wrote, “How can it be that we know how many pigs, frogs, rats and monkeys are used in research and who uses them without knowing what is going on with respect to human beings?” (2007). The inspector general’s report recommends improving information systems, creating more clinical trial databases and an institutional review board registry, and establishing post-auditing feedback mechanisms. Caplan agrees that such technical fixes are long overdue, but notes that without political will and adequate funding from Congress, the FDA will not be able to remediate its failings or close loopholes. The connection between offshoring and increased adverse risk merits further investigation. While critics like to focus on the more usual suspects of lax regulation or single bad actors with conflicts of interests, it is important to note that even in the finest regulated environments, professionals



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still have enough latitude to make the wrong choice. In considering the offshored dimensions and competitive logic of globalized trials, this essay has raised questions about the adequacy of norms of protection that are in place in the United States and internationally, how they are modified, how they vary from place to place, and how data is strategically manufactured and, at times, strategically withheld. So long as the business focus of this industry is on portability of data, uncertainties of context, ethical decision making, and patient-related variables will be engineered out. This in itself, as some of my trials industry interlocutors suggest, is a risk that may show up later as harm. Indeed, the health-related and non-monetary benefits of globalized research remain uncertain for patients, consumers, and researchers alike. Current ethical protocols about patient protection remain very narrowly conceived; questions of human subjects protection should move beyond scripted procedures of informed consent.16 As clinical research redefines the terms of public participation in private-sector biomedical research, better patient protections need to be articulated and agreed upon before trials commence. The risk of harm in broader contexts of experimentation needs to be explicitly defined within national and local settings of research. Critical issues such as continuity of treatment and control of patient data by trial sponsors—points generally not formally considered in contracts and not articulated in informed consent forms—must also be addressed. Secondly, clinical trial data should be treated as a public good; its importance and value from a public health perspective cannot be underestimated. Auditing and regulatory oversight must be coupled with innovative legal strategies that would make pharmaceutical companies responsible for trial and drug safety in a direct and timely manner. Through intensified local and national monitoring and legal pressure, several public health goals can be achieved, including the disclosure of risks, deterrence of harmful practices, and adequate prevention of and compensation for adverse risks as they affect individuals and health institutions.17 Critiques of intellectual property regimes in the last decades have been central to promoting treatment access (for AIDS therapies in the developing world, for example). Yet, clearly, what kind of public good clinical research does has become more complicated than sheer access to new drugs. With thirty percent of the overall pharmaceutical market growth coming from non-traditional research areas, more work needs to be done to address the gap between commercial drug research and patient and consumer safety

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on the one hand, and clinical trial priorities and public health practice on the other. State support for health technology assessment programs should increase so that public health institutions with limited means can promote comprehensive and sustainable healthcare delivery, rather than succumbing to a high-cost pharmaceutical-centered form of care (Biehl 2007). Images of health, illness, and healing have become key media, a fragile salvation, through which societies and groups struggle with central values and beliefs, and negotiate social and political progress. In Poland, the United States, and elsewhere, lives and bodies are often precariously tethered to new medical commodities as they enter the value chains of transnational medicine and capital. Improving trust in the relationship between researcher and researched, patients and doctors is crucial to reform. Even more crucial are the polities and citizens that are in the making but that all too often are also at the mercy of assenting regulatory states and a pharmaceutical industry fighting against aspects of its own decline. Their voices must surely influence the terms of the ongoing debate surrounding the ethics and regulation of international research. Failures to protect the most vulnerable are almost assured owing to the asymmetries of knowledge illustrated here. Corporate and regulatory support of a paradigm of expected failure has far-reaching social and political impacts that matter for global health.

REFERENCES Biehl, J. 2007. Will to Live: AIDS Therapies and the Politics of Survival. Princeton, NJ: Princeton University Press. Bosk, C. 2005. What Would You Do? The Collision of Ethnography and Ethics. Chicago: University of Chicago Press. Bosk, C., and R. de Vries. 2004. Bureaucracies of Mass Deception: Institutional Review Boards and the Ethics of Ethnographic Research. Annals of the American Academy of Political and Social Science 595:249–263. Bourgeois F., S. Murthy, and K. Mandl. 2010. Outcome Reporting Among Drug Trials Registered in ClinicalTrials.gov. Annals of Internal Medicine 153: 158–66. Caplan, A. 2007. Commentary: Report paints grim picture of drug trial safety. Sept. 28, 2007. http://www.msnbc.msn.com/id/21029879/. Accessed October 5, 2007. Centerwatch. State of the Clinical Trials Industry: A sourcebook of charts and statistics. 2005. Boston: Thomson CenterWatch,. Cherry, D., D. Woodwell, and E. Rechtsteiner. 2005. National Ambulatory Medical



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Care Survey 2005 Summary. Division of Health Care Statistics, CDC. ClinPage. 2007. NEJM Indicts CROs. October 18. http://www.clinpage.com/article/ nejm_indicts_cros/ DeAngelis C.D., J.M. Drazen, F.A. Frizelle, et al. 2004. Clinical Trial Registration: A statement from the International Committee of Medical Journal Editors. Journal of the American Medical Association 292:1363–4. De Vries, R. 2004. How Can We Help? From ‘‘Sociology in’’ to ‘‘Sociology of ’’ Bioethics. Journal of Law, Medicine, and Ethics 32:279–293. Dickersin, K., and R. Drummond. 2003. Registering Clinical Trials. Journal of the American Medical Association 290:516–523. Elliott, C. 2011. Useless Studies, Real Harm. New York Times Op-Ed, A27 Godlee, F. 2006. An International Standard for Disclosure of Clinical Trial Information (editorial). British Medical Journal 332:1107–08. Gorman, J. 2004. The Altered Human Is Already Here. New York Times. April 6: F1. Gostin, L. 2007. Global Regulatory Strategies for Tobacco Control. Journal of the American Medical Association 298: 2057–58. Graham, D. 2004. Statement of David J. Graham before the Senate Finance Committee Hearing, 108th Congress, The FDA, Merck, and Vioxx: Putting Safety First. Washington, DC. Guidance for industry: information program on clinical trials for serious or life-threatening diseases and conditions. 2002. Washington, DC: U.S. Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research, Center for Biologics Evaluation and Research. Hirschman, A. 1970. Exit, Voice, and Loyalty: Responses to Decline in Firms, Organizations, and States. Cambridge, MA: Harvard University Press. Juni, P., L. Nartey, S. Reichenbach, R. Sterchi, P.A. Dieppe, and M. Egger. 2004. Risk of Cardiovascular Events and Rofecoxib: Cumulative Meta-Analysis. The Lancet 364:2021–29. Garnier, J.P. 2005. Advancing Enterprise. Conference Paper. February 4. Retrieved February 4, 2005, from http://www.hm-treasury.gov.uk/media/30C/C2/Dr_ JP_Garnier.pdf. Light, D. 2008. Reply to Dimasi, Hansen, and Grabowski. Journal of Health Politics, Policy and Law 33:325–27. Office of Inspector General (OIG), Department of Health and Human Services. 2001. The Globalization of Clinical Trials: A Growing Challenge in Protecting Human Subjects. Boston: Office of Evaluation and Inspections. ———. 2007. The Food and Drug Administration’s Oversight of Clinical Trials.

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Ortner, S. 1996. Making Gender: Towards a Feminist, Minority, Postcolonial, Subaltern, etc. Theory of Practice. In Making Gender: The Politics and Erotics of Culture, ed. S.B. Ortner, pp. 1–20. Boston: Beacon Press. Petryna, A. 2009. When Experiments Travel: Clinical Trials and the Global Search for Human Subjects. Princeton, NJ: Princeton University Press. Sim, I., and D.E. Detmer. 2005. Beyond Trial Registration: A Global Trial Bank for Clinical Trial Reporting. PLoS Medicine 2:1090–1092. Shuchman, M. 2007. Commercializing Clinical Trials—Risks and Benefits of the CRO Boom. New England Journal of Medicine 357:1365–1368. Zarin, D.A., N.C. Ide, T. Tse, W.R. Harlan, J.C. West, and D.A.B. Lindberg. 2007. Issues in the Registration of Clinical Trials. Journal of the American Medical Association 297:2112–2120. NOTES 11.1 This data derives from the “National Ambulatory Medical Care Survey 2005 Summary.” Division of Health Care Statistics, Centers for Disease Control and Prevention. See Cherry, Woodwell, and Rechtsteiner 2005:5. The findings of this essay are drawn from my book, When Experiments Travel: Clinical Trials and the Global Search for Human Subjects (2009). 11.2 See OECD Health Data 2010, http://www.oecd.org/dataoecd/43/24/40905081. pdf. 11.3 All personal names used in this essay are pseudonyms and do not refer to actual businesses, except in cases where information is drawn from published sources or where informants chose to be identified. 11.4 On the concept of serious games, see Ortner 1996. 11.5 The quote continues: “the inclusion of an independent endpoints committee should be the rule, and exceptions to this rule should be justified” (2004:2025). 11.6 Their policy went into effect in July 2005. 11.7 The mandate concerned intervention trials using drugs only. See Guidance for industry: information program on clinical trials for serious or life-threatening diseases and conditions (2002). ClinicalTrials.gov is one of the largest international clinical trials registries. Other significant registers include the European Clinical Trials Database (EudraCT) and the UK-based International Standard Randomised Controlled Trial Number Register. In fairness, the purpose of ClinicalTrials.gov is not to provide exhaustive index of globalized research, but to facilitate patient access to clinical research. By contrast, EudraCT, launched in 2005, does not make such data publicly available. Although it allows national monitors to gather data on trial-related,



Pharmaceuticals and the Competitive Logic of Global Clinical Trials 277 unexpected, serious adverse reactions, the rationale for the database is more administrative than medical. Its main purpose is to facilitate communications among national regulatory agencies over the content, commencement, and termination of trials in the European Union.

11.8 On problems in the registration of clinical trials, see Zarin et al. 2006. 11.9 This is true provided the mechanisms of action are similar. 11.10 See Centerwatch, State of the Clinical Trials Industry: A Sourcebook for Charts and Statistics, 2005:16, 131. 11.11 http://www.who.int/ictrp/consultation/en/index.html. Invitation for Open Comments. Pfizer response January 2006:5–6. 11.12 Ibid:6. 11.13 For example, when a pharmaceutical company registers a trial on ClinicalTrials.gov, it submits a code number which conceals a medicinal product’s identity but that should correspond to the code number as it appears on an investigational new drug (IND) application. ClinicalTrials.gov is similarly involved in such verification efforts. 11.14 Moreover, a recent study of drug trials registered in ClinicalTrials.gov found that those funded by industry were more likely to report positive outcomes than were trials funded by other sources (Bourgeois et al. 2010). 11.15 Some were also members of the country’s “Good Clinical Practice” inspection team, which was created in the wake of Poland’s acceptance of the European Union Clinical Trial Directive. 11.16 The ethics committee model for monitoring the conduct of research, as sociologists and anthropologists of bioethics have noted, turns the ethical universe in which researchers operate into an essentially procedural one. (See Bosk 2005; Bosk and de Vries 2004; de Vries 2004). 11.17 There is a parallel here with tobacco control as a public health strategy. (See Gostin 2007).

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12 Preparing Lawyers for Practice in an Era of Global Urbanization: A Proposal for Transnational Clinical Partnerships Sarah Paoletti

INTRODUCTION

I

t has become axiomatic that we live in a globalized world, and there are few aspects of life untouched by both globalization and the related phenomenon of world urbanization. That is as true in the practice of law, as it is in any other discipline: lawyers increasingly are called upon to operate within multiple legal systems, on behalf of or in partnership with clients and allies, and in opposition to adversaries from multiple countries and cultures. To be effective, lawyers must be able to navigate the legal and logistical complexities inherent to transnational practice with skill and facility. The legal academy has particular responsibility to adapt its curriculum in creative and innovative ways to prepare its students to practice in a world where almost every transaction—human, corporate, and otherwise—is transnational, has transnational implications, or is otherwise subject to the impact of globalization. In seeking to fulfill that responsibility, law schools have dramatically increased both the number and variety of opportunities aimed at preparing students for global practice. This proliferation is happening alongside, and sometimes more consciously in conjunction with,

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an increase in experiential learning programs, taking students out of the classroom and into the realities of legal practice. Law school clinical programs, in which students engage in the real-world practice of law under the supervision of faculty with legal practice experience, are recognized for their role in developing core lawyering competencies.1 This chapter argues the value of those clinical programs is enhanced when students are able to learn through cross-border peer-to-peer collaborations. In designing a pedagogical approach through which students from one country engage with students in a clinical program in another country, the legal academy can have a tremendous impact on the professional development of its students. To accomplish this requires engaging students in legal practice that is 1) truly transnational in its reliance on domestic, comparative, and international law, 2) grounded in the multiple legal systems and cultures in which norms and practices develop, and 3) that places students in positions of accountability to clients and constituencies from those legal systems and cultures. Those experiences will have an impact that will extend to the legal profession itself, as students enter into practice prepared to play a critical role alongside their peers from other countries in the evolution and development of legal norms and rules of practice responsive to the complexities of practice brought about by globalization (Grossman 2004; Carrillo 2004; Hurwitz 2003; Steiner 2002). This chapter sets forth rationale and guiding principles for developing law school clinical partnerships in which students engage in cross-border bi-national or multi-national collaborations as they prepare for practice in a globalized world, while providing specific case studies for exploring the promise and understanding the challenges of transnational clinical legal education.2 Part I addresses the impact of globalization on lawyering, and the ways in which the legal academy has begun to respond to the changes in legal practice necessitated by globalization. It then sets forth the underlying rationale for developing bi-national and transnational clinical collaborations. Part II looks specifically at lawyering at the intersection of migration, labor, and human rights, and notes the tremendous benefits to transnational advocacy models. It reviews specific examples from practice and the development of transnational advocacy models. Part III outlines potential models and opportunities for such collaborations among law school clinical programs, through an examination of cases and projects undertaken by the Transnational Legal Clinic at the University of Pennsylvania, which



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operates simultaneously at the local level within the immigrant rich city of Philadelphia, as well as at the national and international levels through dialogue and advocacy on policies and practices related to immigrant and migrant populations. The chapter concludes with an exploration of opportunities for expanding beyond law schools into other disciplines within the academy and proposes the development of multi-disciplinary collaborations that cross borders and cultures aimed at achieving the realization of human rights for all. Global cities such as Philadelphia provide rich and diverse opportunities to engage in collaborative interdisciplinary and transnational partnerships that bridge theory and practice in exciting and transformative ways.

I. THE CHANGING NATURE OF LAW AND LEGAL PRACTICE IN AN ERA OF GLOBALIZATION AND THE RESPONSE OF THE LEGAL ACADEMY In looking to build legal training models that will best prepare our students for practice, it is useful to examine how legal practice has evolved in the 21st Century as a result of globalization.3 In his article, The Internationalization of Public Interest Law, Professor Scott Cummings highlights ways in which public interest lawyers must adapt to the changes in legal practice brought about by globalization: Lawyering within the international arena is…notable for its tactical pluralism, embracing a broad range of nontraditional techniques such as lobbying, reporting, and organizing; its polycentrism, evident in the movement by lawyers into advocacy venues outside of the U.S.; and its connection to transnational alliances that operate to mobilize law across borders. Finally, internationalization has reframed issues of professional accountability, as public interest lawyers increasingly operate in international venues where the rules of lawyer-client relations are not well defined and the geographic scope of legal advocacy strains even the best attempts by lawyers to remain responsive to their clients’ interests.4 While Professor Cummings focuses on public interest law and practice, the impact of globalization extends equally into the private and public sphere.5 As globalization has taken hold over the past several decades, the

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legal academy has responded by seeking to internationalize, initially primarily through individual exchanges, but increasingly through bolder programmatic initiatives and curricular reform.

A. Responses of the Legal Academy to Globalization and an Introduction to International Human Rights Clinical Legal Education Law faculty have long had global interests, and have actively participated in the development of law and legal systems outside the United States through faculty exchanges, programs such as the Fulbright Fellowship, and through employment as experts or consultants in particular areas of law, legal practice, and pedagogy, exporting their professional expertise into the legal systems of other countries. While faculty exchanges contribute to a deeper understanding within the academy of the synergies among and the interdependence of legal and political systems, they are inherently limited in their ultimate impact on law students and ultimately the legal profession within the United States, due to their faculty-centric and often episodic nature. Furthermore, they are often focused outward on the promotion of law reform, democratization, and legal education in other counties, rather than inward. Legal scholarship has examined the impact—both positive and negative—that exportation has had on other countries; while the more critical examiners problematize the tension between providing valuable training and resources and “legal imperialism,” many share in the belief that faculty exchanges are incredibly enriching and rewarding for all who participate and have a durable impact on the ways in which legal academics think about, and therefore teach, the law (Genty 2008; Maisel 2008; Wilson 2004). Operating alongside and often on parallel tracks to the faculty exchanges has been an explosion of opportunities for students to explore international and comparative law and practice outside the United States. Within the physical confines of the law school are an expanded set of curricular offerings and lecture series in international and comparative law. Supplementing the internal offerings, students have an increasing number of opportunities to take their law school experience overseas, through exchange programs, summer fellowships, and related activities.6 These programs are often created at the initiation of and in response to student demand for educational and experiential learning opportunities that meet their interests in engaging in global practice. The student exchanges and fellowships provide tremendous opportunities for students to learn in context, and can provide trans-



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formative experiences for the students who participate. However, without systematic development of integrated programming their full potential may not be realized. These programs may also be susceptible to critiques that they fail to take into sufficient consideration the goals or the needs of the host schools or organizations. International human rights clinical programs—through which students engage in cases and projects that involve non-U.S. legal systems—have proliferated across the United States, as well as in other countries, and have become the site for seeking to develop more sustained student engagement, while bridging international and comparative law and practice. Core to their pedagogical mission is challenging a hegemonic approach to law and legal advocacy, and preparing students for the multinational, polycentric nature of legal practice in the 21st Century.7 It is worth noting that human rights clinical programs vary greatly in substantive practice areas, locus of work, and pedagogical approaches. Clinics may involve students in more traditional project-based human rights research, report drafting and related advocacy in the international arena, or may vest students with primary responsibility for the representation of individual clients seeking political asylum or other forms of immigration relief before domestic administrative law judges, while other clinics engage in a hybrid of activities.8 The varying clinical models tend to reflect the varied and evolving models of practice, and almost all human rights clinics employ domestic, international, and comparative law in their work. Through their participation in international human rights clinics, students are often at the forefront of the development of legal norms and practice, as they gain experience with and employ the full range of advocacy strategies in a manner reflective of the changing nature of human rights lawyering.9 As the substantive rights addressed through the U.S.-based human rights movement have expanded beyond traditional concepts of civil and political rights, and into the realm of social, economic, and cultural rights,10 the targets of human rights advocacy have also expanded to include not just government actors, but corporate and other private actors, and the general public. Human rights practitioners have therefore expanded their advocacy repertoire: in addition to pursuing the traditional approach of “naming and shaming” through the publication of written reports setting forth the violations of international law as informed by fact-finding in the target countries, and issuing a set of recommendations,11 advocates

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also undertake litigation in domestic and international courts,12 legislative advocacy,13 media campaigns,14 and increasingly are involved in community education and organizing.15 This shift in human rights practice and, by extension human rights clinical legal education, has resulted in legal training aimed at preparing students for legal practice wherein to be effective, they need to be adept in engaging across cultural and linguistic barriers to communicate with clients and partners, identify advocacy goals, and navigate the polycentric nature of law and practice, as they craft and implement a strategic plan for advancing the client goals.16 The clinical experiences create rich material for examining the role of lawyers in both constructing and advancing human rights norms, and opportunities for invigorating exchanges of ideas, ideals, and methodologies that help us improve our teaching, or students’ lawyering, and our collective understanding of human rights in context. Traditional models of human rights clinical education are not without inherent challenges. Programs are historically grounded in the tradition of American legal education, providing a Western hegemonic approach which risks failing to adequately account for or give voice to the persons on whose behalf they are purporting to work, and the complexities of the world in which we live.17 Critiques of human rights programs resonate with particular strength when law students assume the role of expert on particular matters in particular countries in which they have limited exposure, experience, and expertise, and where their contact is confined to the limited time during which they are enrolled in the clinic. International human rights clinicians have sought to respond to these critiques in the same way human rights practitioners operating in the United States and elsewhere in the Western-developed world have begun to respond (Bettinger-Lopez et al. 2011). In furtherance of the client-centered approach central to U.S. legal advocacy and clinical pedagogy, human rights clinics increasingly are engaging in direct lawyer-client relationships or are partnering with representative or membership organizations in the affected communities.18 In the traditional lawyer-client model, the students’ role is to identify the clients’ goals, and work with the client in developing and executing the legal and other strategies aimed at achieving those goals. Alternative relationship models may more closely resemble that of a cocounseling relationship, wherein the clinical program partners with an international or local non-governmental organization that works with or on



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behalf of a particular community or a particular set of human rights issues, and the students participate in the fact-finding and strategic planning, and contribute their legal research and writing skills to the advocacy efforts. These relationships lend legitimacy to the work of the international human rights clinic and ensure a level of accountability to the people at the heart of the advocacy, while providing students with a meaningful opportunity to engage in a collaborative practice of international human rights advocacy.19 Nonetheless, participants need to remain cognizant of the complex set of power dynamics that may be in operation between the lawyer-client or student-expert relationship, dynamics that are rendered more complex when viewed through the prism of transnational human rights lawyering. As a further response to critiques of U.S. legal imperialism and exceptionalism within the global human rights movement, and consistent with trends in human rights advocacy, an increasing number of human rights clinical programs have begun to engage in domestic, U.S.-based human rights advocacy.20 Domestic human rights advocacy serves both pedagogical and social justice goals in that it provides more opportunities to engage directly with the relevant actors, and allows for a critical engagement in a rights discourse less fraught with concerns of cultural relativism and legal imperialism than externally-focused advocacy is, while not absolved of the pedagogically rich issues of culture, language, custom, politics, history, and power that persist. Whether through participation in human rights advocacy at home or abroad, vesting students with primary responsibility for all aspects of client representation and strategic advocacy alongside a diverse constituency of partners provides essential learning opportunities that students will carry with them into their profession. The question answered below, however, is how those learning opportunities may be enhanced by the addition of another partner in the advocacy—that partner being law students enrolled in clinical programs outside of the United States.

B. Enhancing the Transnational Relationships for Pedagogy and Practice: What Bi-National Clinical Partnerships Add The proposal for bi-national or transnational legal clinical partnerships builds on the positive aspects of faculty and student exchanges, and existing international and comparative programming currently offered in law schools, particularly the proliferation and evolution of international human rights clinical programs, while systemically and intentionally bridging lit-

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eral and figurative borders through transnational legal practice. Under a bi-national clinical partnership model, students in a law school clinic in the United States would directly partner with students enrolled in a law school clinic in another country, supervised by law faculty who are also experienced practitioners within each respective country, providing transnational peerto-peer learning through joint client representations and legal advocacy. This model builds on a core component of clinical methodology—guided and reflective self-learning while engaged in the practice of law—enhanced by the shared input of fellow clinic students who bring with them multiple perspectives informed by their own lived and educational experiences. It provides a structurally pluralistic model for clinical legal education aimed at preparing our students for practice in the globalized world. Some examples of shared bi-national and even tri-national clinical projects exist within the field of human rights advocacy. The Human Rights Program at Harvard Law School has undertaken work in collaboration with human rights clinical programs in Colombia and Chile to address implementation of international human rights pertaining to indigenous peoples in those countries, in 2009–2010 (Human Rights Program, Harvard Law School, n.d.). The International Human Rights Clinic at Cornell Law School partnered with the Good Rural Governance and Citizen Participation Clinic at Jindal Global Law School in India from January to May 2012 to prepare a joint report, “Promoting Clinical Legal Education in India: A Case Study of the Citizen Participation Clinic (Cornell International Human Rights Clinic and Jindal Good Rural Governance and Citizen Participation Clinic, n.d.:4–6).” Both projects demonstrate the benefits and challenges of collaborative partnerships among clinical programs, students and faculty, and lay the groundwork for future shared learning and advocacy, as human rights clinicians increasingly look to partner with other law schools in the countries in which their advocacy is targeted. They also demonstrate ways in which such partnerships challenge students’ conceptions of the universality of human rights, as they wrestle with questions of cultural relativism. Students and law professors operating within the particular historical, political, cultural, and linguistic context of their respective legal systems have different understandings of how legal norms are developed and the short- and long-term consequences of a particular advocacy goal or strategy in their respective countries, informed by their own set of experiences and perspectives. Relatedly, they have different understandings of the role



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of lawyers in developing those norms. Providing a forum and a structure for engaging those differing perspectives serves both the pedagogical goals of clinical legal education and the ultimate legal services provided, not just on one case or with one client, but on an ongoing basis. Sustained bi-national or transnational clinical partnerships also provide a platform for faculty to interact with each other and with each other’s students about what we teach, why we teach it, and how we teach it, as we seek to improve our own teaching methodologies. Before setting forth specific models for transnational collaborations, particularly in the area of migration and migrant rights in the section that follows, it is important to acknowledge the challenges present in the implementation of bi-national clinical programs. In developing such programs, consideration must be given to the respective resources of each clinical program and the expectations arising out of the partnership. Partnerships are more likely to be successful when the respective programs benefit from similar levels of faculty and student resources and academic infrastructure, and a shared understanding as to what each partner can and will contribute. It is important to account for not just the respective financial limitations of the partner program, but also how many course credits the students are receiving for their time in the clinic, what is the compensation of the supervising faculty member (i.e., is she a full-time faculty member, or does she have to supplement her law school salary with other employment), how many students are in each clinic, what are their other obligations, and how is supervision conducted in each respective program. Working to ensure that the respective academic calendars allow the students to effectively work alongside each other is also useful. Most critical is ensuring adequate communication structures are in place. Technology has advanced to allow for relatively inexpensive video-conferencing and other modes of communication to allow students to work in a truly collaborative fashion, rather than independently along parallel tracks, but not all schools in all countries have access to the same level of technology, and, even if they do, differences in time zones may make it particularly difficult to find times when all parties can be online or otherwise connected via technology. Furthermore, particularly within the field of human rights, it is important for all parties to have a deep understanding of the political environment in which our colleagues work. We sometimes take for granted the protection that academic freedom affords us in our work in universities in

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the United States, but our colleagues in other countries often do not have equal protection, and we need to be mindful, just as our colleagues engaged in international human rights practice are, of the potential repercussions the joint undertaking may have. Additionally, partnerships developed between law schools in the United States and law schools in the global South carry the risk of North-South implicit bias and the baggage of colonial history and the United States’ direct and indirect exercise of power in the partner countries. Paying heed to these issues and thoughtful identification of program’s respective goals, roles and responsibilities is critical to effective collaboration. A successful clinic-to-clinic partnership, as with any collaborative relationship, is ultimately dependent upon open, honest, respectful, and reflective communication, and ongoing dialogue among the partners assessing the relationship, and a willingness to adapt to the challenges inherent in such an undertaking.

II. BRIDGING THEORY AND PRACTICE: MIGRATION, HUMAN RIGHTS, AND TRANSNATIONAL LEGAL ADVOCACY This section seeks to concretize the concept of bi-national clinical partnerships by examining how issues pertaining to migration and human rights are particularly well-suited to the clinical partnerships proposed herein, and providing specific examples of transnational legal advocacy in the representation of migrant workers.

A. Lawyering at the Intersection of Migration and Human Rights Human migration has been called the face of globalization, and is a phenomenon that has local, national and global impact.21 Global urbanization and a complex series of push and pull factors have led to increased internal and transnational migration, as individuals move within their country’s borders and across State boundaries in search of physical safety and social and economic security, employment and educational opportunities. The greater-Philadelphia area, home to Penn Law’s Transnational Legal Clinic, reflects the trend towards global urbanization. It is rich in the national and ethnic diversity of its migrant and immigrant populations, and is also diverse in terms of socio-economic and legal status. Among Philadelphia’s foreign born are refugees, asylum seekers, students, individuals coming to join family members, and individuals coming for economic opportunities



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in all labor sectors from landscaping to health care to higher education and the technological and pharmaceutical industries (Singer et al. 2008). This diversity is not unique to Philadelphia, and is replicated in urban centers across the world. The increase of internal and cross-border migration brought about by globalization has resulted in an increase in legal regimes and policies at all levels of government aimed at regulating migration, governing the rights and responsibilities of migrants and their family members, and mediating their relationship with the State. But the legal regimes and policies themselves do not guarantee the legal rights of migrants, and in some cases, serve as a barrier to the realization of migrants’ recognized international human rights. Solely because of their status as non-citizens, migrants are subject to a series of legal vulnerabilities in countries of transit and ultimate residence.22 Without a means to enforce existing rights, and to push for the further development of laws, policies and practices that work towards the realization of the human rights of all migrants and their family members, even legally cognizable rights remain illusory in practice. Lawyers seeking to protect and promote the rights of migrant workers engage with clients at every stage of the migration stream in an effort to achieve respect for and enforcement of migrants’ individual and collective rights. Lawyers may provide direct representation in claims arising out of interactions with recruitment agents, employers or other private parties who exploit migratory or immigrant status in furtherance of other rights violations.23 They may provide representation before the government in seeking to obtain or protect lawful immigration status.24 And they may undertake advocacy before the State(s) with the legal authority and obligation to respect, protect, and fulfill the human rights of all persons within their jurisdiction.25 Direct representation is critical for ensuring migrants have access to justice in seeking realization of the full rights and remedies to which they are entitled under local, national, or international law. Domestic and international human rights advocacy complements the work of direct legal services through translation of those individual experiences into broader policy initiatives, particularly where the existing domestic legal regimes fail to guarantee the internationally recognized human rights of migrants.26 Law students enrolled in immigration, asylum, and international human rights clinics throughout the United States participate in domestic and international legal advocacy on behalf of (im)migrants, both in the United States

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and in countries across the world (Hurwitz 2003; Carrillo 2004).27 Advocacy undertaken on behalf of (im)migrants, both in an individual client representation capacity as well as in broader human rights advocacy initiatives, can present their own set of challenges, as is highlighted in greater detail below. Law students struggle—as do legal practitioners—to develop a clear theory of the case that satisfies the legal requirements while developing a narrative that does not essentialize the victim-subjects and accounts for the socio-economic, historical, and political determinants of human migration (Bettinger-Lopez et al. 2011; Bhabha 2002). They also have to confront the limitations of the law in responding to the needs of their clients, who often find themselves in an unsustainable legal and social limbo between the country of residence and their home country. Bi-national or transnational partnerships serve to provide legal representation to migrants throughout the migratory stream and can be structured to respond to pragmatic and logistical hurdles, while infusing the advocacy and representation with perspectives from each of the different systems migrants occupy. In working together to define the problem, identify the client goals, and assess and re-assess strategies available for advancing the rights at issue, conduct legal and factual research, identify experts, and locate essential resources, legal advocates can benefit from having co-counsel who are able to communicate directly with the client(s), whether they be in their place of migration, or home communities.

B. Transnational Responses to Transnational Labor Migration While all migration issues are ripe for bi-national representation, the situation of migrant workers specifically provides a useful platform for understanding the benefits offered through bi-national or transnational programmatic design. Globally, migrant workers—both with lawful status and without—engage in low-wage employment defined in the international dialogue by “3 D’s”—dirty, dangerous, and difficult. Their stories are of workplace discrimination and harassment, based on national origin, language, race, ethnicity, and gender; work environments that are inherently unsafe and violate health and safety standards; wage and hour violations; interference with their right to organize and collective bargaining; and retaliation for assertion of legal rights.28 But their stories of abuse and exploitation reach beyond the temporal, geographic, and legal confines of their immediate employment relationship. Instead, the stories begin in the country of



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origin, when workers undertake their journey in search of security and opportunities for themselves and their families, and continue throughout their migratory experience. From the moment they leave home, through job recruitment, employment, and possible termination of that employment, workers pass through a patchwork of international, national, and local regulatory frameworks that offer varying degrees of protection and redress.29 In seeking to ensure the fulfillment of the human rights of migrants, and in response to the abuses migrants face, advocates have historically engaged in advocacy on two parallel tracks: one operating in the domestic sphere; and, the other operating in the international sphere. Within the United States, for example, legal aid attorneys engage in state and federal court litigation to seek enforcement of domestic labor and employment laws.30 But the rights and remedies available through domestic litigation are incomplete and fail to meet the human rights standards set forth under international law.31 Employees in certain industries populated with high concentrations of migrants are excluded from the full panoply of labor and employment rights under U.S. state and federal law. In addition to statutory exclusions from protection applicable to specific labor sectors with high concentration of migrant workers,32 judicially enforced restrictions on the remedies based on immigration status have had a direct negative impact on the rights of all migrant workers. In 2002, for example, the U.S. Supreme Court ruled in a seminal case, Hoffman Plastics Compound, Inc. v. NLRB,33 that undocumented migrants are not entitled to the remedy of back-pay, the only individualized remedy available to a worker who has been unlawfully terminated for engaging in concerted protected activities under the National Labor Relations Act. Following the Hoffman decision, several state and federal courts have further restricted the remedies and therefore the rights to which undocumented migrant workers are entitled.34 In addition to legal hurdles, migrant workers must contend with the practical and sometimes more challenging barriers that arise from the fact that migrant workers, by definition, migrate; they lack access to legal services; and they are afraid.35 Workers fear being fired, deported, and blacklisted for deigning to ask questions or speak up about their rights—fears that are informed by experience. Workers also confront logistical barriers in their pursuit of access to justice—the biggest barrier being the lack of access to legal services. When migrant workers leave their place of employ-

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ment, they often return to their home country, particularly if they have been injured on the job or otherwise are unable to immediately find new employment. Workers who enter the United States as “guestworkers,” workers admitted to the United States on temporary work visas, lose their legal residency status upon termination of their employment, and are required to return to their home country. Once workers return home, they are not only hindered in their communication with lawyers in the United States, but they may also be foreclosed from opportunities to pursue claims in the United States, as their physical presence often is required by the adjudicatory body.36 While legal advocates struggle to ensure basic rights protection at the domestic level, migrant and labor rights advocates are coming together at the international level to advance the human rights norms applicable to migrant workers. At the United Nations (“U.N.”), conversations regarding the protection and promotion of migrant workers began in earnest with the drafting of an international instrument to govern the rights and responsibilities of individuals who migrate for work, a ten year process that led to the International Convention on the Rights of All Migrant Workers and Members of their Families (“Migrant Worker Convention”) that ultimately entered into force in 2003.37 The Migrant Worker Convention creates obligations on States-Parties to recognize labor and related socioeconomic rights as fundamental rights applicable to all migrant workers regardless of their migration status. It recognizes migrants as not merely fungible labor commodities, but rather human beings who—as such—are possessors of fundamental human rights, the most basic of which are the right to dignity and the right to be free from discrimination. It explicitly applies to migrant workers and their family members rights enumerated under the Universal Declaration on the Rights and Duties of Man, the International Covenant on Civil and Political Rights, the International Covenant on Economic, Social and Cultural Rights, and the International Convention on the Elimination of All Forms of Racial Discrimination.38 While the Migrant Worker Convention itself remains limited in effect due to the fact that not a single major receiving nation of migrants has ratified it,39 it provides a framework for engaged and ongoing debate at the international level on the rights and responsibilities of States in managing transnational migration. Within the Inter-American Human Rights System, the Inter-American Court on Human Rights set forth a statement of international human



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rights law that provides migrant workers, regardless of migration status, the full panoply of fundamental human rights in relation to their employment and rights arising out of employment. Following the U.S. Supreme Court ruling in Hoffman Plastics Compound, Inc. v. NLRB, and at the request of the government of Mexico, the Inter-American Court on Human Rights issued an Advisory Opinion on the juridical rights of undocumented migrants, in which it emphatically recognized the principle of equality and non-discrimination in the application of worker rights to all migrants.40 In so doing, it elaborated upon what it deemed the fundamental rights of all workers that unauthorized migrants should enjoy equally with nationals: In the case of migrant workers, there are certain rights that assume a fundamental importance and yet are frequently violated, such as: the prohibition of obligatory or forced labor; the prohibition and abolition of child labor; special care for women workers, and the rights corresponding to: freedom of association and to organize and join a trade union, collective negotiation, fair wages for work performed, social security, judicial and administrative guarantees, a working day of reasonable length with adequate working conditions (safety and health), rest and compensation.41 Advocates have celebrated the Inter-American Court’s Advisory Opinion as an important standard-bearer for the rights to which all migrant workers are entitled, and particularly the Court’s deft incorporation of economic, social, and cultural rights—historically unrecognized in the InterAmerican Human Rights system—through the civil right of equality and non-discrimination.42 But the disconnect between human rights in theory and practice persists, and international human rights advocates and domestic migrant and labor rights advocates recognize the need for more cross-fertilization between the international and local advocacy movements in working to overcome the gap between rights and realities.43 Domestic advocates working alongside and on behalf of migrant workers are increasingly presenting before international human rights mechanisms, as they explore alternatives to traditional litigation strategies.44 At the same time, there is a growing call from international law scholars and advocates for domestic implementation of international human rights norms through scholarship, submission

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of amicus briefs in state and federal court litigation, and other initiatives aimed at bringing international human rights principles into the domestic legal advocacy.45

C. Lessons from Practice Centro de los Derechos del Migrante, Inc. (“Center for Migrant Rights” or “CDM”) is a transnational worker rights organization with offices in Mexico City, Oaxaca, and Baltimore, Maryland, that provides intensive predeparture know-your-rights and capacity building training to people leaving Mexico to work in the United States. CDM also facilitates pursuit of legal claims in the United States for workers who have returned to Mexico, and engages in litigation and policy advocacy on behalf of clients on both sides of the U.S.-Mexico border. In partnership with Proyecto de los Derechos Economícos, Sociales y Culturales (“ProDESC”), CDM launched the Binational Labor Justice Initiative, designed to identify strategies and recommendations for rights advancement on a scale that reaches beyond individual client representation, recognizing that the “growing inter-connectedness of bi-national labor markets demand a new paradigm to view and defend migrant rights, and labor rights more generally….Working on both sides of the border provides new legal tools and safe spaces for workers to demand justice.”46 CDM has partnered with law school clinical programs within the United States, in furtherance of direct client representation, as well as policy and other advocacy initiatives arising out of their individual client representations.47 For example, CDM has collaborated with students in the Immigrant Justice Clinic at American University Washington College of Law in researching and producing a human rights report examining abuses in the crab-picking industry (American University Washington College of Law and Centro de los Derechos del Migrante, Inc. 2010). Through a more intensive collaborative model, CDM has partnered with the University of Maryland Law School, placing select students with CDM’s office in Mexico City, where they worked alongside the CDM staff based in Mexico and the United States and contributed to the advocacy undertaken by CDM.48 Students participating in that collaboration have opportunities to explore, engage in, and reflect on direct client representation and broader-based advocacy aimed at achieving the fulfillment of



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the human rights of migrant workers who literally and figuratively travel through multiple legal systems, and in that travel, often fall between the gaps of rights enforcement. While not diminishing the client services provided and the learning potential for students engaged in such exchanges, CDM’s law school partnerships have lacked the reciprocal educational partner in Mexico. While engaging students in explicitly transnational client representation facilitates the underlying goal of guiding them in their development as lawyers prepared to engage in practice that is necessarily substantively, procedurally, and strategically pluralistic, doing so in a manner that encompasses a sustained peer-to-peer bi-national manner provides the added lessons of crosscultural, cross-systemic teamwork and collaborative learning.49 Transnational clinical partnerships create an intentional space for students to engage in a shared inquiry. This allows all participants to build off of their own and each other’s learning experiences as they work collectively to bridge the persistent divide between international human rights and domestic realities. Bi-national or transnational client representations and shared classroom time provide law students, faculty, and client communities with unique opportunities to develop a more comprehensive knowledge base of the complex series of push and pull factors that lead to migration, contributing to a deeper understanding of law in context, and ultimately enhancing the nature of the legal representation they provide. Formal and informal communication structures built into the clinic design contribute to collectively enhancing the students’ legal skills and advocacy strategies, grounded in the different cultures, languages, history, and socio-economic realities of the legal regimes from which migrants come, through which they travel, and in which they ultimately find themselves. The ability to gain more direct access within the client communities facilitates students’ efforts to engage the client and client communities more directly in all aspects of the legal representation. Additionally, intentional transnational advocacy creates an opportunity to develop a set of successful and ethical practices on which to build while looking to enforce existing rights. It also highlights the shortcomings of other practices to achieve the realization of recognized rights and norms. At the same time, such partnerships could provide critical assistance in building the capacity of bi-national legal aid and other advocacy organizations.50

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III. EXPLORING THE POTENTIAL OF BI-NATIONAL AND MULTI-NATIONAL LAW SCHOOL CLINICAL PROGRAMS: CASE STUDIES IN THE AREA OF MIGRATION AND MIGRANT RIGHTS A brief review of four different cases and projects undertaken by Transnational Legal Clinic at the University of Pennsylvania Law School illustrates where bi-national or even multi-national clinical partnerships addressing different aspects of human migration can enhance student-learning and expand the legal advocacy opportunities. The cases and projects discussed herein are selected to illustrate the synergies that exist between direct individual legal representation and international human rights advocacy on behalf of a shared client community, in furtherance of providing students with multi-faceted lawyering experiences. They also provide opportunities to explore the intersection and divergence among and between the legal systems, cultures, socio-economic, political and historical contexts implicated, while designing and implementing an effective strategy for advancing the underlying advocacy goals of both the individual and the group. The first pair of examples looks at advocacy around migrant worker rights, building on the preceding discussion, and the intersection of rights vis-à-vis private parties and the obligations of the State to protect those rights. The second pair of examples looks at advocacy undertaken on behalf of refugees, the scope of rights afforded refugees, and the obligations that may or may not arise in countries of transit, host countries, or countries sought out for resettlement. All four examples call into question how best to serve the client and achieve the advocacy goals, while at the same time maximizing the pedagogical goals in training our students as future professionals in a global world.

A. Representation of Migrant Workers before Domestic Agencies and International Mechanisms The Transnational Legal Clinic was solicited to provide immigration legal services to more than twenty individuals from South East Asia who had been victims of human trafficking. Many of the men had prior experience as migrant laborers in the Gulf States, and were lured to jobs in the Gulf Coast of the United States with promises of high-paying employment and legal permanent residency for themselves and their family members.



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The labor contractors began extracting high fees from the workers at the very outset of what became a lengthy recruitment process, trapping them into extremely difficult and unsafe working and living conditions as they worked in vain to pay off their debts, because of fees and charges the employer deducted from their wages. Instead of the promised legal permanent residency status, the workers were laboring on temporary work visas that were set to expire after a limited period of time, afforded no rights to their family members, and tied them directly to their one employer. Their legal right to remain the United States was dependent on the maintenance of the employment relationship that brought them to the country. While a talented team of lawyers came together to bring a civil suit, and to file charges with various government oversight agencies, the Transnational Legal Clinic assisted the workers in gaining legal status and work authorization so that they could remain in the United States to pursue their legal claims and simultaneously work to earn the money needed to pay the debts incurred through the trafficking scheme. Therein, they tried to recover some piece of the promised opportunity that initially led them to leave their families to come to the United States. Through their individual client representations, students gained important lessons in cross-cultural interviewing, case theory development, and the role of narrative as they struggled to tell their clients’ stories in a manner that did not reduce them to duped and helpless victims. In the preparation of client affidavits and application materials, the students sought to put their clients’ stories within the broader context of labor trafficking. They witnessed through their own interactions with their clients, rather than merely a review of the relevant literature, that human trafficking is easily hidden, and not always readily identified or identifiable as trafficking.51 They recognized human trafficking as a transnational problem that requires transnational efforts at redress.52 Through their own efforts to craft applications for relief, they developed an understanding of the role legal advocates play in developing and translating the worker narrative from the time of recruitment through to workers’ experiences of forced or coerced labor. In this way, they were able to assist law enforcement and courts to see human trafficking for what it is, and achieve redress for those who had been trafficked. The workers patiently responded to students’ questions about the events that took place in their home country at the time of recruitment, explaining

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their conversations with their families, and the sacrifices they had made to come to the United States. However, the students would have been aided by the introduction of perspectives from the home country in putting these narratives into a broader context. Law students acting as co-counsel from the home country could have undertaken research and interviews to demonstrate the full arc of abuse and exploitation endured throughout the process, contributing to the evidence of fraudulent and coercive recruitment practices undertaken and the ensuing hardship. At a more meta-level, the addition of perspectives from the country of origin would have assisted in the broader advocacy agenda of demonstrating the ways in which temporary guestworker programs contribute to worker exploitation and labor trafficking, by providing a more complete understanding of employment and recruitment laws, policies and practices, and the realities and expectations prevalent within the communities from which these workers originated. In furtherance of the pedagogical goals associated with undertaking such client representations, a bi-national clinical partnership would have provided an opportunity for law students in the country of origin and the United States to undertake a collective examination of labor migration and human trafficking, informed by perspectives and experiences on both sides of the migration stream. While limited individualized relief can be obtained through direct representation in the host country, longer-term solutions and preventative efforts require multinational engagement. Sharing the experiences of the workers who are victims of human trafficking, grounded in the socio-economic and political realities of both the sending and receiving country, can play a pivotal role in legal advocates’ ability to craft both shortterm responses aimed at providing redress in individualized cases as well as longer-term responses aimed at combating the phenomenon and associated human rights violations. Such an examination contributes to a more nuanced understanding of the phenomenon of human trafficking, the multitude and complexity of factual and legal factors that contribute to the phenomenon, an understanding that could lead to new and innovative transnational legal advocacy strategies leading towards further collaboration. In working to develop broader human rights legal advocacy strategies that complement the individualized representation of migrant workers seeking immigration relief, the Transnational Legal Clinic has partnered with advocates across the United States in human rights advocacy on behalf of migrant workers before different U.N. human rights mechanisms and



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the Inter-American Commission on Human Rights.53 Law student representatives in the Transnational Legal Clinic took primary responsibility for drafting a report on migrant labor rights in the United States for submission to the U.N. Human Rights Council as part of the U.S. Universal Periodic Review, and articulating recommendations to the United States on measures to be taken to ensure compliance with its human rights obligations.54 The Universal Periodic Review is a process undertaken by States of States, and provides unique opportunities for engaging with national governments on the rights of migrants throughout the migratory process, and setting forth recommendations that fully account for the lived experiences of migrants. As with other U.N. human rights processes, the Universal Periodic Review is geared towards the obligations of the State to not only respect, but protect and fulfill the human rights at issue. The role of the lawyer is to translate the worker narrative into the human rights paradigm, framing the violations individuals endure—often at the hands of private actors—in light of the government’s failure to adequately protect and promote human rights, and failure to ensure redress when those rights are violated. To do so, the legal advocate must understand the relationship between existing domestic legal frameworks, and the ways in which the law, its implementation, and the ability to access judicial and administrative agencies with enforcement obligations, contributes to the rights violations committed by private parties. Advocates must also understand the impact of trade and other bi-lateral and multi-lateral agreements on labor migration, particularly as migrant workers increasingly assert rights not to migrate, but rather to human security and sustainable development in their home country. And ultimately, advocacy must be presented in a way that resonates with the countries of origin, transit and destination alike, as the questions asked, concerns expressed, and recommendations are made through the Universal Periodic Review process are ultimately between and among States.55 As highlighted in the example of the workers trafficked for labor to the Gulf Coast, bi-lateral and multi-lateral exploration in human rights advocacy contributes to a more robust understanding of the range of factors that contribute to the human rights abuses migrant workers endure, and facilitates the telling of the worker stories in a manner consistent with their own lived experience. Establishing relationships that allow for more direct communication with representatives from the migrant worker community, both those in the host country and those who have returned to their home

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country, ensures greater accountability to the community of workers on whose behalf the advocacy is undertaken, and facilitates their ability to participate in a forum that would otherwise be inaccessible to them. By bringing attention to rights abuses in the United States, advocates contribute to the development of human rights norms applicable to migrant workers, and the establishment of a set of best practices among all UN Member States. Engaging multiple constituencies and employing collaborative, coordinated, and pluralistic strategies becomes critical to ensuring the universality of the rights pursued. Furthermore, in order to enhance the likelihood of the implementation of principles into practice, complaints must be translated into proposals for reform that are realizable and can be converted into concrete initiatives that speak to the political and socio-economic realities at play within the different governing legal systems. Migrant worker advocacy at the international level provides important opportunities for not just North-South exchanges, as is typically the model within human rights clinical projects, but also North-North exchanges. While student representatives in the Transnational Legal Clinic benefited from their domestic collaborations in developing the report submitted for the U.S. Universal Periodic Review, they would have benefited as well from inputs and collaboration from countries of origin and transit, as well as other destination countries. The development of worker centers as a strategy for worker organizing and rights protection and promotion, for example, is not unique to the United States; worker centers have emerged in countries of all levels of economic development across the globe. Similarly, as advocates combat civil detention for immigrants in the United States, so too do advocates across the Western hemisphere. The synergies and differences for addressing migrant workers’ rights open opportunities for exploring new strategies, and for examining the role of the lawyer in worker organizing and human rights advocacy.

B. Representation of Refugees at Home and Abroad The second set of cases and projects engaged in by the Transnational Legal Clinic that illustrate the contributions bi-national law school clinical partnerships make to both service and pedagogy arose out of the drawnout and brutal conflict that seized Liberia and led to a significant refugee population. Philadelphia is home to a high percentage of Liberian refugees, and in 2006, immigration legal service providers were overloaded with re-



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quests for assistance in submitting applications on behalf of family members seeking refugee resettlement into the United States after the United States announced it was closing its family-based resettlement program for Liberians. In the process of providing assistance in those cases, the Transnational Legal Clinic was contacted by a Liberian who had arrived in the United States more than ten years earlier as a refugee. Several years after his arrival in the United States, he learned that his son, whom he had not seen since the day the violent conflict in Liberia came to their doorstep, was still alive and living in West Africa. Because it was well outside the two-year filing deadline for bringing his son to the United States as the beneficiary of his own refugee status, he petitioned to bring his son through the familybased refugee resettlement program. As part of the process, our client’s son underwent an interview through which he had to demonstrate he qualified as a refugee. Without the benefit of legal representation, without any understanding as to the nature of the interview, and without any support structure in place, our client’s son was unprepared. When questioned about why he did not want to return to Liberia, he answered truthfully that he was afraid of the unknown: he did not know anyone in Liberia, had no family there, and did not know what he would find there or what he would do. He did not articulate a fear of persecution on account of one of five enumerated grounds required by the Refugee Convention’s definition of who is a “refugee” entitled to resettlement. Nor did he bring evidence of the past persecution he and his family endured during the Liberian conflict that resulted in the separation of his entire family, and the death of several family members. He was seventeen at the time of the interview. He was under the age of five when the rebels ransacked his house and his family scattered. Based on the students’ advocacy, our client’s son was granted a new interview for resettlement to the U.S. In granting him a new interview, the U.S. government explicitly recommended he bring legal representation with him to the interview. Unfortunately, our client son’s remoteness—both physically and figuratively—made it difficult for us to effectively communicate with both the client and his son, and we lost contact with our client’s son before achieving the ultimate goal of reunification and resettlement. Demonstrating the synergies between individual client representation and broader human rights advocacy, in the Fall of 2007, the Transnational Legal Clinic was invited to participate in statement taking of Liberian refu-

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gees residing in the Buduburam Refugee Settlement in Ghana as part of the Liberian Truth and Reconciliation Commission’s Diaspora Project.56 We returned to follow-up with the refugee population in March 2010, and were confronted with the numerous human rights issues that arise in protracted refugee situations. We met with individual refugees, students and teachers in the various training programs and schools created and staffed by the refugees themselves, foreign medical professionals staffing the hospital on the camp, the Ghanaian camp manager, representatives from UNHCR, and representatives of Ghanaian non-governmental organizations familiar with the Buduburam situation. Throughout, we struggled to identify a clear advocacy strategy that addressed the human rights of the remaining refugees, particularly in light of the persistent confusion among all actors, particularly the refugees, of the situation on the ground. The one point of clarity, however, was the critical importance of engaging all players in clear and consistent communication in working to understand and address the multitude of issues and challenges that refugees faced in their host community. Both our representation of our individual client, and our time with the Liberian refugees in Buduburam demonstrate the challenges endemic to remote representation and legal advocacy. The inability to have anything more than sporadic telephonic communications with our client’s son in West Africa undoubtedly hindered our relationship with him, and our ability assess his goals, and to effectively counsel him on the resettlement process and possible reunification with his father in the United States. Similarly, our lack of regular presence at Buduburam and our lack of a long-standing relationship alongside advocates in Buduburam and in Ghana, contributed to our inability to identify a clear role to play in the face the multitude of demands and the ongoing request for assistance on the part of the remaining refugees. In both cases, we were unable to overcome our outsider status. For our individual client, local legal representation would have allowed for more effective counseling of our client’s son and preparation for his interview. It also would have allowed for a more effective advocacy before the U.S. Department of State, the contracted organization conducting the interviews, and with the United Nations High Commissioner for Human Rights. It also would have contributed to more effective communication with our client’s son to ensure he understood the process, who we were, and our role in trying to advocate for his reunification with his father in the United States. In our work with the Liberian refugees remaining at Budu-



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buram, the participation of law students in Ghana, as well as Liberia, and perhaps also other countries of resettlement would have helped fill critical communication gaps and would have contributed to a more complete collective understanding of the complexity of the issues on the ground and a strategy for addressing the Liberian refugees’ rights. Protracted refugee situations present challenging questions about who owes what legal obligations towards whom, and absent those clear legal obligations, how to respond to create truly durable solutions. Inclusion of the multiple voices and stakeholder perspectives recognizes the multinational nature of the situation, helps in identification of assumptions made, and works to guard against unintended consequences that may arise in the course of the advocacy undertaken. Engaging students with lived and studied experiences in the legal, political, socio-economic, and cultural environments of the countries of residence, repatriation, and resettlement, directly in conversations through which, as peers they can challenge each other’s perceptions and assumptions, as they work collaboratively to develop proposals for moving forward, allows not only for rich pedagogical opportunities, but also clearer advocacy agendas arising out of the communities in which we operate.

IV: CONCLUSION: OPPORTUNITIES FOR EXPANDING TRANSNATIONAL LAW SCHOOL PARTNERSHIPS TO A NETWORK OF INTERDISCIPLINARY BI-NATIONAL AND MULTI-NATIONAL COLLABORATIONS As illustrated above, there are multiple opportunities for bi-national and multi-national engagement in direct legal services and international human rights advocacy, and law school clinical programs provide unique opportunities for engaging students in that advocacy. Law clinics provide an important space for critical reflection on the role of law and lawyering in human rights advocacy, reflection that is enhanced by peer-to-peer learning that provides truly multinational and multicultural perspectives. Bi-national migrant rights clinics also provide opportunities for interdisciplinary clinical work, reaching beyond traditional human rights advocacy. For example, Hometown Associations exist in multiple migrant communities, whereby members of a community working in the U.S. pool their earnings and send their remittances collectively to their hometown

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community for use in different development projects. Transactional clinics and business schools could engage with the client population working in the United States while partner clinical programs can engage with the organization in the home community to facilitate the development objectives of the Hometown Associations. Provision of health care and access to health care for migrants who return to their home country after suffering from pesticide exposure or other work-related health complications or injuries provides another area for interdisciplinary bi-national clinical collaboration. These interdisciplinary partnerships would provide unique opportunities for future professionals to engage with each other in developing strategies to address the needs of their clients operating in a world in which legal problems do not exist in isolation, but rather as part of a complex and global web of human existence. As with all human rights advocacy and international partnerships and exchanges, the development of bi-national and multi-national partnerships must be undertaken with care to guard against the perpetuation of legal and cultural imperialism, and to ensure a truly equal partnership in which the communities most directly impacted by the advocacy undertaken are central to the discussions about both the substantive rights undertaken and the strategies employed. But the opportunities to build approaches and develop strategies to serve the multitude of client and pedagogical goals through such partnerships ultimately are restricted only by our own limitations of creative planning and thought.

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Hidden Struggles of Migrant Worker Women in the Maryland Crab Industry. Available at: http://www.wcl.american.edu/clinical/documents/20100714_auwcl_ihrlc_ picked_apart.pdf. Amnesty International. 2006. Living in the Shadows: A Primer on the Human Rights of Migrants. Available at: http://www.amnesty.org/en/library/asset/ POL33/006/2006/en/f8aa4dfe-d3fd-11dd-8743-d305bea2b2c7/pol330062006en. html. Amnesty International n.d. a. Defending and Advancing Immigrants’ Human Rights. Available at: http://www.amnestyusa.org/our-work/campaigns/immigrantsrights-are-human-rights. ———. n.d. b. Organizing My City. Available at: http://www.amnestyusa.org/getinvolved/lead-in-your-community/organizing-a-community. ———. n.d. c. Take Action Now. Available at: http://www.amnestyusa.org/get-involved/take-action-now. ———. n.d. d. Urgent Action Network: A Rapid Response to Human Rights Threats Worldwide. Available at: http://www.amnestyusa.org/our-work/campaigns/individuals-at-risk/urgent-action-network. Balbuena v. IDR Realty LLC, 845 N.E.2d 1246 (N.Y. 2006). Bettinger-Lopez, C., D. Finger, M. Jain, J. Newman, S. Paoletti, and D. Weissman. 2011. Redefining human rights lawyering through the lens of critical theory: Lessons for pedagogy and practice. Georgetown Journal on Poverty Law and Policy 18:337–400. Bhabha, J. 2002. Internationalist Gatekeepers? The tension between asylum advocacy and human rights. Harvard Human Rights Journal 15:155–182. Blank, Y. 2006. The City and the World. Columbia Journal of Transnational Law 44:875– 939. Bryant, S. 2001. The Five Habits: Building cross-cultural competence in lawyers. Clinical Law Review 8:33–107. Bryant, S., and J.K. Peters. 2005. Five Habits for Cross-Cultural Lawyering. In Race, Culture, Psychology & Law, ed. K. Barrett and W. George, pp. 47–62. Thousand Oaks, CA: SAGE. Cahn, E.S. 1994. Reinventing Poverty Law. Yale Law Journal 103:2133–2156. Capps, R., M. Fix, and SY-Y Lin. 2010. Still An Hourglass? Immigrant Workers in MiddleSkilled Jobs, Migration Policy Institute. Available at: http://www.migrationpolicy. org/pubs/sectoralstudy-Sept2010.pdf. Carrillo, A.J. 2004. Bringing International Law Home: The innovative role of human rights clinics in the transnational legal process. Columbia Human Rights Law Review 35:527–587.

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Centre on Housing Rights and Evictions. n.d. a. About Us. Available at: http://www. cohre.org/about-us. ———. n.d. b. Achieving Housing for All. Available at: http://www.cohre.org/sites/ default/files/achieving_housing_rights_for_all_2005.pdf. Centro de los Derechos del Migrante, Inc. n.d. a. Binational Labor Justice Initiative. Available at: http://www.cdmigrante.org/The%20Binational%20Labor %20Justice%20Initiative.html. ———. n.d. b. Networks and Partnerships. Available at: http://www.cdmigrante.org/ networks-and-partnerships/. Chacón, J.M. 2006. Misery and Myopia: Understanding the failures of U.S. efforts to stop human trafficking. Fordham Law Review 74:2977–3040. Cmiel, K. 1999. The Emergence of Human Rights Politics in the United States. Journal of American History 86:1231–1250. Cohen, M. 2010. The Analogy Between Piracy and Human Trafficking: A theoretical framework for the application of universal jurisdiction. Buffalo Human Rights Law Review 16:201–236. Cole, D. 2006. The Idea of Humanity: Human rights and immigrant rights. Columbia Human Rights Law Review 37:627–658. Cornell International Human Rights Clinic and Jindal Good Rural Governance and Citizen Participation Clinic. n.d.. Promoting Clinical Legal Education in India: A Case Study of the Citizen Participation Clinic. Available at: http://www.lawschool.cornell.edu/academics/clinicalprogram/int-human-rights/upload/Cornell-JindalReport.pdf. Crespo v. Evergo Corp., 841 A.2d 471 (N.J. Super. App. Div. 2004), cert. denied, 180 N.J. 151 (2004). Cummings, S. 2008. The Internationalization of Public Interest Law. Duke Law Journal 57:891–1036. De La Vega, C. and C. Lozano-Batista. 2005. Advocates Should Use Applicable International Standards to Address Violations of Undocumented Migrant Workers’ Rights in the United States. Hastings Race and Poverty Law Journal 3:35–74. De Varennes, F. 2003. Strangers in Foreign Lands: Diversity, Vulnerability and the Rights of Migrants, Unesco. Available at: http://www.unesco.org/most/paper_devarennes.pdf. Friends of Farmworkers, Inc. n.d. a. Agency/Mission. Available at: http://mail. friendsfw.org/friendsfw.html. ———. n.d. b. Programs. Available at: http://mail.friendsfw.org/friendsfw.html. G8 Information Centre. 2005. Civil Society and Expanded Dialogue Unit: Interview with



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Mary Robinson, Executive Director, The Ethical Globalization Initiative. Available at: http://www.g8.utoronto.ca/evaluations/csed/CIVIL/robinson.html. Gavito, V. 2007. The Pursuit of Justice is without Borders: Binational strategies for defending migrants’ rights. Human Rights Brief 14:5–7. Genty, P.M. 2008. Overcoming Cultural Blindness in International Clinic Collaboration: The divide between civil and common law cultures and its implications for clinical education. Clinical Law Review 15:131–157. Grossman, C. 2004. Global Legal Education and Human Rights. Human Rights Brief 11:3–5. Haynes, D.F. 2006. Client-centered Human Rights Advocacy. Clinical Law Review 13:379–416. Hoffman Plastics Compound, Inc. v. NLRB, 535 U.S. 137 (2002). Human Rights Program, Harvard Law School. n.d. International Human Rights Clinic: Current Projects. Available at: http://www.law.harvard.edu/programs/hrp/ clinic/current%20projects/current_americas_projects.html. Human Rights Watch. 2012. Cultivating Fear: The Vulnerability of Immigrant Farmworkers in the US to Sexual Violence and Sexual Harassment. Available at: http://www. hrw.org/reports/2012/05/16/cultivating-fear-0. ———. n.d. Our Research Methodology. Available at: http://www.hrw.org/node/75141. Hurwitz, D.R. 2003. Lawyering for Justice and the Inevitability of International Human Rights Clinics. Yale Journal of International Law 28:505–550. ———. 2011. Teaching to the Paradoxes: Human rights practice in U.S. law school clinics. Maryland Journal of International Law 26:18–46. International Convention on the Protection of the Rights of All Migrant Workers and Members of their Families, Dec. 18, 1990, 2220 U.N.T.S. 3 (entered into force July 1, 2003). Janus, K.K., and D. Smythe. 2012. Navigating Culture in the Field: Cultural competency training lessons from the international human rights clinic. New York Law School Law Review 56:445–486. Juridical Condition and Rights of the Undocumented Migrants, Advisory Opinion OC-18, Inter-Am. Ct. H.R. (ser.A) No. 18 (Sept. 17, 2003). Keeley, B. 2009. International Migration: The Human Face of Globalisation, Organisation for Economic Co-Operation And Development. Available at: www.oecd.org/insights/migration. Kestenbaum, J.G., E. Hoyos-Ceballos, and M.C. Del Aguila Talvadkar. 2012. Catalysts for Change: A proposed framework for human rights clinical teaching and advocacy. Clinical Law Review 18:459–504. Koh, H.H. 1991. Transnational Public Law Litigation. Yale Law Journal 100:2347–2402.

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Lillich, R.B. 1993. International Human Rights Law in U.S. Courts. Journal of Transnational Law and Policy 2:1–22. Lopiccolo, J.M. 2009. Where are the Victims? The new trafficking victims protection act’s triumphs and failures in identifying and protecting victims of human trafficking. Whittier Law Review 30:851–886. Lyon, B. 2010. The Unsigned United Nations Migrant Worker Rights Convention: An overlooked opportunity to change the “brown collar” migration paradigm. New York University Journal of International Law and Politics 42:389–500. Lyon, B., and S. Paoletti. 2003. Inter-American Developments on Globalization’s Refugees: New rights for migrant workers and their families. European Yearbook of Minority Issues 2003:63–87. Maisel, P. 2008. The Role of U.S. Law Faculty in Developing Countries: Striving for effective cross-cultural collaboration. Clinical Law Review 14:465–508. McKee, K.A. 2005. Modern-day Slavery: Framing effective solutions for an age-old problem. Catholic University Law Review 55:141–192. Micah-Jones, R. 2011. From Pedagogy to Partnership: Leveraging the law clinic to institutionalize cutting edge strategies in transnational labor advocacy. Maryland Journal of International Law 26:113–134. Michaels, R., and N. Jansen. 2006. Private Law Beyond the State? Europeanization, globalization, privatization. American Journal of Comparative Law 54:843–890. National Immigrant Justice Center. n.d. Anti-Human Trafficking Services. Available at: http://www.immigrantjustice.org/anti-human-trafficking-services. Office of the United Nations, High Commissioner for Human Rights. 2006. The International Convention on Migrant Workers and its Committee: Fact Sheet No. 24 (Rev.1). Available at: http://www.unhcr.org/refworld/docid/479477420. Open Society Justice Initiative. 2009. Legal Clinics: Serving People, Improving Justice. Available at: http://www.soros.org/initiatives/justice/focus/legal_capacity/ articles_publications/publications/legalclinics_20090101/legalclinics_20090101. pdf. Paoletti, S. 2004. Human Rights for All Workers: The emergence of protections for unauthorized workers in the inter-American human rights system. Human Rights Brief 12:5–7. ———. 2007. Pursuit of a Rights-based Approach to Migration: Recent developments at the UN and the inter-American system. Human Rights Brief 14:14–16. ———. 2009. Transnational Approaches to Transnational Exploitation: A proposal for bi-national migrant rights clinics. University of Pennsylvania Journal of International Law 30:1171–1186.



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———. 2011. Using the Universal Periodic Review to Advance Human Rights: What happens in Geneva must not stay in Geneva. Clearinghouse Review 45:268–277. Paoletti, S., et al. 2006. Petition Alleging Violations of the Human Rights of Undocumented Workers by the United States of America, ACLU. Available at: www.aclu.org/images/ asset_upload_file946_27232.pdf. Platform for International Cooperation on Undocumented Migrants. 2003. Undocumented Migrant Workers in Europe. Available at: http://picum.org/picum.org/uploads/file_/UM_workers_in_europe_1.pdf. Reinforced Earth Co. v. Workers’ Compensation Appeal Board (Astudillo), 810 A.2d 99 (Pa. 2002). Rosa v. Partners in Progress, Inc., 868 A.2d 994 (N.H. 2005). Sanchez v. Eagle Alloy Inc., 254 Mich. App. 651 (Mich. Ct. App. 2003), cert. denied, 471 Mich. 851 (Mich. 2004). Singer, A., D. Vitiello, M. Katz, and D. Park. 2008. Recent Immigration to Philadelphia: Regional Change in A Re-Emerging Gateway, The Brookings Institution. Available at: http://www.brookings.edu/~/media/research/files/reports/2008/11/13%20 immigration%20singer/1113_immigration_singer. Southern Poverty Law Center. n.d. Southern Poverty Law Center: What We Do: Immigrant Justice. Available at: http://www.splcenter.org/what-we-do/immigrantjustice. Steiner, H.J. 2002. The University’s Critical Role in the Human Rights Movement. Harvard Human Rights Journal 15:317–328. Sullivan, W.M., A. Colby, J.W. Wegner, L. Bond, and L.S. Shulman. 2007. Educating Lawyers: Preparation for the Profession of Law. San Francisco: Jossey-Bass. The Advocates for Human Rights. 2013. Discover Human Rights: A Human Rights Approach to Social Justice Training. Available at: http://www.discoverhumanrights. org/training.html. The University of Texas at Austin School of Law. n.d. Clinical Education at UT Law: Transnational Worker Rights Clinic: Overview. Available at: http://www.utexas. edu/law/clinics/transnational/. U.S. Human Rights Network. 2008a. Labor and Employment Rights in The United States: A Critical Look at U.S. Compliance with the Convention on the Elimination of All Forms of Racial Discrimination. Available at: http://www.ushrnetwork.org/sites/default/files/23_LaborAndEmployment.pdf. ———. 2008b. Rights of Immigrants And Migrants to The United States: A Critical Look at the U.S. and Its Compliance under The Convention. Available at: http:// www.ushrnetwork.org/sites/default/files/declaration-treaty/2_Immigrant%20

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Rights-1.pdf. ———. 2010a. Migrant Labor Rights (UPR Joint Report, 2010). Available at: http://www. ushrnetwork.org/sites/default/files/declarationtreaty/Migrant%20Labor%20 Joint%20Report%20USA.pdf. ———. 2010b. Universal Periodic Review Joint Reports (UPR Joint Report, 2010). Available at http://www.ushrnetwork.org/UPRbook. Universal Declaration of Human Rights, G.A. Res. 217 (III) A, U.N. Doc. A/RES/217(III) (Dec. 10, 1948). University of Pennsylvania Law School. n.d. International. Available at: https://www. law.upenn.edu/international/. Wadley, J. n.d. Law School’s Human Trafficking Clinic to Open Site in Mexico, University Of Michigan Record Update. Available at: http://www.ur.umich.edu/update/ archives/101011/clinic. Wilson, R.J. 2004. Training for Justice: The global reach of clinical legal education. Penn State International Law Review 22:421–432. Zumbansen, P. 2012. Defining the Space of Transnational Law: Legal theory, global governance, and legal pluralism. Transnational Law and Contemporary Problems 21:305–336. NOTES 12.1 See Sullivan et al. (2007:120–121) (“The potential of clinical-legal education for bringing together the multiple aspects of legal knowledge, skill, and purpose has long been noted…[T]he student comes to understand that the cognitive and the practical are two complementary dimensions of meaningful professional activity that gets its point and intensity from its moral meaning.”); American Bar Association (1992:46) (“Both the law schools and the organized bar during the 1960s and 1970s greatly increased the profession’s commitment to providing legal services to the poor. A significant element in this increased commitment was the promotion at the law schools of clinical legal education with its focus on translating the needs of society for the profession’s services and skills into their educational equivalents”). As with many legal services programs across the country, clinical programs representing clients in domestic matters are finding they need to adapt their programs to include training in cross-cultural skills and working with interpreters as they begin representing a greater percentage of clients from immigrant communities. See, e.g., Ahmed (2007), Bryant and Peters (2005), and Bryant (2001). 12.2 This chapter builds on an essay written for the 30th Anniversary Symposium Issue of the University of Pennsylvania Journal of International Law, Transnational Ap-



Preparing Lawyers for Practice in an Era of Global Urbanization 311 proaches to Transnational Exploitation: A Proposal for Bi-National Migrant Rights Clinics, 30 U. Pa. J. Int’l L. 1171 (2009), and draws upon the author’s experiences as a professor teaching in an international human rights and immigration legal clinic, as well as her experiences as a former legal services attorney for migrant workers. The author is indebted to Noel León for her research assistance in bringing this project to completion.

12.3 See Koh (1991). See also, Zumbansen (2012) (discussing the evolving relationship between legal practice and globalization and arguing that the “advent of globalization” requires a new understanding of legal practice as a transnational endeavor); Blank (2006) (“[I]n many jurisdictions around the world, transnational entities, [international organizations], and international norms slowly begin to impact and reshape local government law.”). 12.4 Cummings (2008:897–898). David Cole has similarly noted “historic trends strongly suggest that we will see increasing incorporation of international norms in the domestic setting,” and setting forth his proposed approach for further engaging the international human rights framework in the domestic setting (Cole, 2006:629). 12.5 See Zumbansen (2012:319) (“[The] transformation [of legal systems in a globalized world] is perceived foremost as one of eroding boundaries…between public and private]”); Blank (2006:935) (discussing the ever-narrowing line between public and private legal entities as a result of globalization); Michaels and Jansen (2006:864–873) (examining the effects of globalization on private law through pressure exerted by new global organizations, treaties, and global competition, as well as the shift of power globally from public to private spheres). 12.6 See, e.g., University of Pennsylvania Law School (n.d.). 12.7 See Hurwitz (2003) (discussing the use and necessity of human rights clinics in law schools and providing a list of clinics currently active in the field); Carrillo (2004) (examining the role of human rights clinics in law schools and the ways in which that role can be expanded). 12.8 See Carrillo (2004:531) (“[T]here is no commonly accepted definition of ‘human rights clinic’ in circulation. Rather, the term is used broadly to refer to any law school program or clinic that incorporates some dimension of human rights-based experiential learning.”). See also, Janus and Smythe (2012:451) (describing the Stanford Law School International Human Rights Clinic’s South Africa site as using a hybrid between human rights advocacy research and training as well as direct client interaction); Kestenbaum, Hoyos-Ceballos, and Del Aguila Talvadkar (2012) (detailing the Cornell International Human Rights Clinic’s employment of multiple tools for human rights advocacy, including litigation, fact-finding missions, reports, and

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both national and international advocacy). 12.9 See Bettinger-Lopez et al. (2011:364) (describing how law school clinics began to develop in the 1970s to address poverty law issues in response to increased restraints on funding and activity of traditional legal services programs, and noting how clinics became important players in public interest law and are today “increasingly incorporating human rights language, strategies, and claims in their work with poor clients and community organizations.”). 12.10 For examples of U.S.-based human rights advocacy, see, e.g., U.S. Human Rights Network (2010b). 12.11 See, e.g., Human Rights Watch (n.d.) (“Human Rights Watch conducts regular, systematic investigations of human rights abuses around the world…determining who can and should take responsibility for stopping rights violations and providing redress, the detailed and specific steps they need to take, and who else can bring influence and leverage to bear.”); Cmiel (1999:1232) (describing the birth of international human rights politics and key organizations like Human Rights Watch and Amnesty International in the 1970s: “[H]uman rights activists…devised ways to collect accurate accounts of some of the vilest behavior on earth that no one had bothered to document before. They invented ways to move this information to wherever activists had some chance to shame and pressure the perpetrators.”). 12.12 See, e.g., Centre on Housing Rights and Evictions (n.d. a) (“COHRE applies a human rights approach to housing...through its research and documentation; public education, training and capacity building; and advocacy and litigation work before domestic, regional and international mechanisms and courts concerned with these rights.”); Centre for Housing Rights and Evictions (n.d. b) (describing litigation program). 12.13 See, e.g., Amnesty International (n.d. a) (outlining Amnesty International’s advocacy in federal and state legislatures for human rights to be incorporated into domestic legislation). 12.14 See, e.g., Amnesty International (n.d. c) (advertising human rights causes and galvanizing public support for human rights advocacy); Amnesty International (n.d. d) (describing Amnesty International’s Urgent Action Network of global volunteers who are notified of human rights abuses by Amnesty International and then collectively pressure local government officials into stopping their human rights violations). 12.15 See, e.g., Amnesty International (n.d. b) (“Together with individuals, groups and local organizations, we are organizing to build centers of human rights activism in cities and towns across the country that focus on growing the base of individual supporters for human rights.”). See also, The Advocates for Human Rights (2013).



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12.16 See Hurwitz (2003:521–522) (arguing that international human rights clinics develop students’ empathy, and, “drawing on multiple disciplines and legal systems, students also have an opportunity to deepen their understanding of legal pluralism); Carrillo (2004:544) (“[H]uman rights clinics...[train] law students to become skilled, ethical, and responsible advocates in the exercise of their profession...In this setting, other considerations are largely subjugated to the clinical goal of training lawyers to do well, while teaching them to do good.”). 12.17 These critiques are consonant with critiques levied against domestic poverty law practice that began in the 1970s and were primarily focused on poverty lawyers being out of touch with the realities in which their clients lived. Poverty law was led by lawyers who could not identify with their clients and condescended to them, using strategies that obscured the client community voice, victimizing clients rather than empowering them. See Bettinger-Lopez et. al. (2011:351). Critics asserted that the dissociation of lawyers from the communities they served severely limited the positive impact poverty lawyers could have on client communities. See Cahn (1994:2146 n.46) (noting for example that when the NAACP Legal Defense and Educational Fund severed its connection to the rest of the NAACP, the section of the organization that maintained contact with its constituency, the LDEF became “increasingly isolated from those it sought to help, only to discover somewhat belatedly the emergence of an underclass for whom most of its past victories were irrelevant”). 12.18 See Haynes (2006) (setting forth an approach to human rights lawyering that is grounded in client-centeredness as a response to critiques that human rights advocacy is imperialistic and essentializes the “victim subject.”). 12.19 International human rights clinic practitioners argue that through their clinic engagement, students learn skills of sensitivity to culture, difference, and privilege in international human rights settings that are transferrable to the domestic context, where such differences can be subtler and more difficult to detect. See Janus and Smythe (2012:479–482); Hurwitz (2011:21). 12.20 International human rights clinic practitioners argue that their clinic students learn skills of sensitivity to culture, difference, and privilege in international human rights settings that are transferrable to the domestic context, where such differences can be subtler and more difficult to detect. See Janus and Smythe (2012:479–82); Hurwitz (2011). 12.21 See, e.g., G8 Information Centre (2005); Keeley (2009). 12.22 See De La Vega and Lozano-Batista (2005:38) (“Because undocumented migration is illegal, [migrants] are often unprotected by domestic labor and employment laws, leaving them virtually defenseless against violations of basic rights. They often have

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no alternative but to accept low wages and appalling working conditions, exploited by those who profit from their illegal status. Moreover, where laws exist to protect migrant workers and control migration, such laws are often either not enforced or are used against the migrants they purport to protect.”). See also, Amnesty International (2006). Migrant workers are already vulnerable by virtue of being in a foreign land. They “may not master the official language(s), are unfamiliar with the workings of the legal system and administration, detached from traditional support and family networks, exposed to a society with ways of life or cultures which they may find at times alien, they may face trials that can leave them disoriented and disturbed” (De Varennes, 2003:8). 12.23 The mission statements of legal organizations representing migrant workers often expressly state that they are responding to exploitation in the workplace caused by workers’ immigrant status. See, e.g., Friends of Farmworkers (n.d. a); Southern Poverty Law Center (n.d.) (stating its use of litigation and advocacy on behalf of migrants, who are “routinely . . . denied basic protections in the workplace”). 12.24 See, e.g., National Immigrant Justice Center (n.d.) (describing its work to combat human trafficking, including providing representation to assist individual victims of trafficking obtain legal status). 12.25 See Paoletti (2011) (providing a case study for the ways in which U.S. advocates have employed the human rights mechanisms of the United Nations in seeking to advance low-wage worker rights in the United States). 12.26 De La Vega and Lozano-Batista (2005) (calling on attorneys to use international human rights law in migrant client cases in order to create support for legislative and policy change in the United States). See also, Paoletti (2011). 12.27 See also, Open Society Justice Initiative (2009). 12.28 See, e.g., Amnesty International (2006). 12.29 See, e.g., Platform for International Cooperation on Undocumented Migrants (2003); Capps, Fix, and Lin (2010). 12.30 State-wide and national legal aid, as well as international advocacy organizations identify federal and state litigation as principal strategies. See, e.g., Friends of Farmworkers (n.d. a, b); Southern Poverty Law Center (n.d.). 12.31 De La Vega and Lozano-Batista (2005:44) citing Hoffman Plastics Compounds, Inc. v. National Labor Relations Board, 535 U.S. 137, 140 (2002). Since that decision, which barred migrant workers from obtaining back pay relief from the NLRB, employers have been pushing to limit the availability of monetary compensation in other areas as well, with some efforts being successful and others not, at least as of yet. The prospects for litigation to further expand Hoffman are large. Id. at 49–58.



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12.32 For example, agricultural workers and domestic workers are specifically excluded from protection under the National Labor Relations Act, and certain provisions of the Fair Labor Standards Act, and numerical thresholds in our anti-discrimination statutes also leave many agricultural workers, domestic workers, and day laborers outside the jurisdiction of the Equal Employment Opportunity Commission. 12.33 Hoffman Plastics Compound, Inc. v. NLRB, 535 U.S. 137 (2002). 12.34 Following the Hoffman decision, a series of subsequent cases at the state level have limited, and in some cases foreclosed, remedies available to undocumented migrants when employers violate their labor and employment rights. See, e.g., Crespo v. Evergo Corp., 841 A.2d 471 (N.J. Super. App. Div. 2004), cert. denied, 180 N.J. 151 (2004) (holding that an undocumented worker suing for discriminatory termination could not recover either economic or non-economic damages absent egregious circumstances during the period of employment such as extreme sexual harassment); Sanchez v. Eagle Alloy Inc., 254 Mich. App. 651 (Mich. Ct. App. 2003), cert. denied, 471 Mich. 851 (Mich. 2004) (finding that undocumented workers are covered by Michigan workers compensation law and are entitled to full medical benefits if injured on the job but that their right to wage-loss benefits ends at the time that the employer “discovers” they are unauthorized to work); Reinforced Earth Co. v. Workers’ Compensation Appeal Board (Astudillo), 810 A.2d 99 (Pa. 2002) (holding that although undocumented worker is entitled to medical benefits after experiencing a workplace injury, illegal immigration status might justify terminating workers’ compensation benefits for temporary total disability); Rosa v. Partners in Progress, Inc., 868 A.2d 994 (N.H. 2005) (holding that undocumented worker asserting tort claim for workplace injury could only recover lost wages at the wage level of his country of origin unless he could prove his employer knew about his irregular immigration status at the time of hiring); Balbuena v. IDR Realty LLC, 845 N.E.2d 1246 (N.Y. 2006) (holding that immigration status can be a factor to reduce benefits received by an undocumented worker’s family in a wrongful workplace death claim). 12.35 See, e.g., Amnesty International (2006). See also, Human Rights Watch (2012). 12.36 For further discussion of the barriers to providing migrant workers with access to justice, see Gavito (2007). 12.37 International Convention on the Protection of the Rights of All Migrant Workers and Members of their Families, Dec. 18, 1990, 2220 U.N.T.S. 3 (entered into force July 1, 2003). See also, Office of the United Nations, High Commissioner for Human Rights (2006). 12.38 See Lyon (2010:397) (stating that a major accomplishment of the Migrant Workers Convention is that it “repeats and underscores existing human rights protection for

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unauthorized workers by guaranteeing fundamental rights for all migrant workers (including unauthorized immigrants”); Universal Declaration of Human Rights, G.A. Res. 217 (III) A, U.N. Doc. A/RES/217(III) (Dec. 10, 1948) (“[R]ecognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world.”). 12.39 See Lyon (2010:393-399) (contrasting the failure of countries to ratify the Migrant Workers Convention with the widespread ratification of other International Labour Organization Conventions). 12.40 Juridical Condition and Rights of the Undocumented Migrants, Advisory Opinion OC-18, Inter-Am. Ct. H.R. (ser.A) No. 18 (Sept. 17, 2003). 12.41 Id., para. 157. 12.42 For a full discussion of the development of the law in the Inter-American Human Rights system pertaining to migrant workers, and specifically OC-18, see Lyon and Paoletti (2003). See also, Paoletti (2004) (discussing the Inter-American Court’s Advisory Opinion on the Legal Status and Juridical Rights of Undocumented Migrants (OC-18), and the Inter-American Human Rights System’s inclusion of economic, social and cultural rights in its consideration of migrant workers and their family members). 12.43 E.g., the Transnational Workers Rights Clinic at the University of Texas Law School, directed by William H. Beardall, Jr., has participated in NAFTA Complaints as well as direct representation in state courts of day laborers, see The University of Texas at Austin School of Law (n.d.). The Immigrant Justice Clinic at American University Washington College of Law has recently begun supporting the work of Centro de los Derechos del Migrante, Inc. and Global Workers Justice Alliance, traveling to Guatemala and Mexico to provide litigation and settlement support services in major class action litigation in the U.S., co-authoring a report with Centro de los Derechos del Migrante, Inc., addressing the right of migrant workers employed in the crab-picking industry, see American University Washington College of Law International Human Rights Law Clinic and Centro de los Derechos del Migrante, Inc. (2010), while at the same time raising international human rights claims addressing the rights of the workers in question, see American University Washington College of Law (n.d.). 12.44 See, e.g., U.S. Human Rights Network (2008b). See also, U.S. Human Rights Network (2008a). For further discussion of the inter-State dialogues through both the United Nations and the Organization of American States, see Paoletti (2007) (discussing the rights-based approaches to migrant workers’ rights being discussed at that time and encouraging further global cooperation). 12.45 Lillich (1993) (giving an overview of the use of international human rights customs



Preparing Lawyers for Practice in an Era of Global Urbanization 317 in U.S. courts and advocating their continued use in domestic litigation to improve human rights law in this country and more fully integrate international norms). See also, American University Washington College of Law and Center for Human Rights and Humanitarian Law (n.d.).

12.46 See, Centro De Los Derechos Del Migrante, Inc. (n.d. a). 12.47 See, Centro De Los Derechos Del Migrante, Inc. (n.d. b). 12.48 Micah-Jones (2011) (describing the work of CDM and its collaborative partnership with the University of Maryland School of Law’s International and Comparative Law Clinic). 12.49 CDM had entered into a partnership with Universidad Autónoma de Zacatecas, Unidad Académica de Derecho and the University of Michigan Law School Human Trafficking Clinic for a bi-national partnership aimed at combatting human trafficking in both the United States and Mexico. See Wadley (n.d.). Unfortunately, because of security concerns, that project was never realized. 12.50 See Micah-Jones (2011:132–135). 12.51 See Lopiccolo (2009) (critiquing the TVPA’s failure to identify victims and offering suggestions: “implementing new training procedures for law enforcement to identify victims, lifting the burden of proof off adult victims and thereby facilitating the prosecution of traffickers, or changing the language of provisions that seem to categorize victims as criminals.”); Chacón (2006) (“Estimates on the number of individuals trafficked each year vary, and because they involve undocumented migration, are necessarily imprecise.”). 12.52 See Cohen (2010:233–234) (arguing that universal jurisdiction should be extended to the transnational problem of human trafficking because “any State would be able to prosecute traffickers, regardless of where the acts occurred or the nationality of the offender or the victim,” and because it would “provide additional political capital to combat the practice by underlining the international community’s strong desire to prevent and punish it,” hopefully prompting individual states to strengthen their human rights laws.); McKee (2005:164) (arguing that traditional anti-slavery and anti-trafficking doctrine relying on the Thirteenth Amendment, the Racketeer Influenced and Corrupt Organizations Act, and the Victims of Trafficking and Violence Protection Act are of limited use in combating international trafficking, largely because they are restricted in their applicability to countries of origin or transit: “Modern day slavery has become a transnational business; consequently, it demands a transnational solution.”). 12.53 The Transnational Legal Clinic serves as co-counsel in an effort make real the standards established in the Inter-American Court’s Advisory Opinion on the Juridical

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Sarah Paoletti Condition of Undocumented Migrants in the United States, mentioned above, in a Petition before the Inter-American Commission on Human Rights (“IACHR”) alleging Violations of the Rights of Undocumented Migrant Workers in the United States. Paoletti et al. (2006). Co-counsel include: American Civil Liberties Union’s Human Rights Program, Immigrants’ Rights Project, and Woman’s Rights Projects of the American Civil Liberties Union; and the National Employment Law Project.

12.54 See U.S. Human Rights Network (2010a). 12.55 See U.S. Human Rights Network (2010a); Paoletti (2011). 12.56 While this work was conducted in Ghana, there was also a local Philadelphia component in that the Transnational Legal Clinic was simultaneously engaged in outreach, education, and the taking statements from the Liberian community residing in the greater-Philadelphia area.

13 Towards a Comprehensive Response to Victims of Sex Trafficking Huiquan Zhou

INTRODUCTION

T

rafficking in human beings for economic or sexual purposes is considered a modern day form of slavery. Trafficking may take the form of voluntary participation on the part of adults, which later turns into exploitation (International Labor Office 2008). In the case of children, participation in trafficking may be (1) entirely involuntary (e.g., kidnapping, selling of new-born babies [Vermot-Mangold 2007]), (2) partially voluntary (e.g., if children are convinced by their caregivers that being trafficked for labor or sexual purposes will increase the economic well-being of the family as a whole [Bastia 2005; Taylor 2005]), or (3) voluntary (e.g., a juvenile chooses to participate in commercial sex acts, however the “voluntariness” of the action is not recognized by the law [Estes and Weiner 2001]). In all cases, human trafficking is illegal, and stringent laws and penalties have been established throughout the world to prohibit its occurrence. Even so, today, men, women and children are still being trafficked within and across international borders for the purpose of coerced labor, commercial sexual and other types of exploitation (e.g., begging, [Surtees, 2005]). In 2006 alone, over 21,400 victims were identified among the 111 countries reporting data to U.N. (United Nations Office on Drugs and Crime [UNDOC] 2009). This

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is likely just the tip of the iceberg.1 The United States is a source, transit, and destination country for trafficking. Thousands of men, women, and children are trafficked into the U.S. for sexual and labor exploitation; an unknown number of U.S. citizens and legal residents are also trafficked within the country, mainly for commercial sexual exploitation (U.S. Department of State 2009). To effectively reduce the incidence of human trafficking in the U.S., it is necessary that the federal, state, and local organizations charged with responding to the trafficking phenomenon work collaboratively with one another. Despite the critical nature of this need, objective data indicate that the level of inter-organizational and inter-agency cooperation between trafficking-focused organizations ranges from poor to very poor (Estes and Weiner 2001). Differing organizational histories, culture, and varying degrees of commitment to the anti-trafficking work account for these failures associated with organizational cooperation among different agencies on the human trafficking issue. Organizational competition and lack of experience also undermine the effectiveness of potential collaborations. This study uses sex trafficking to represent the larger trafficking phenomenon and seeks to: (1) review the history of anti-trafficking work in U.S.; (2) identify the primary federal and state organizations charged with responding to the issue of trafficking; (3) assess the degree of relative success experienced by these organizations in carrying out their mission; and (4) identify the major factors that impede more effective institutional responses to the problem. The paper will propose alternative approaches that can strengthen federal, state, and private responses to reduce the incidence of trafficking. Issues of both organizational structure and organizational culture figure prominently in this analysis.

SEX TRAFFICKING IN HISTORICAL PERSPECTIVE Although human trafficking is called the modern day slavery, its history in the U.S. is longer than that of the country itself. In addition to African slaves, people from many other countries were transported into the “new world” for the purposes of labor, sex, and other forms exploitation (e.g., Redemptioners, indentured servants, war prisoners, and coolies). Some forms of such exploitation continued even after 13th Amendment outlawed slavery in 1865. Sex trafficking, the particular form this paper focuses on,

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Table 13.1 Time line of the U.S. response to sex trafficking Time

Major Legislations

Major Trafficking-related Policy Changes

1st Wave Immigration and White Slavery Panic (Mid 19th Century to 1920s)

1875 Page Law 1903, 1907 and 1910 Immigration Law

 Sex Trafficking defined as an immigration issue  Ordered deportation of noncitizen prostitutes

1910 Mann Act

 Sex trafficking defined as a criminal justice issue  Ordered punishment of traffickers

2nd Wave Sexual Revolution and Child Abuse Revolution (1960s-1980s)

1974 Child Abuse Prevention and Treatment Act (CAPTA) 1974 Runaway Youth Act 1977 Protection of Children Against Sexual Exploitation Act 1978 Child Abuse Prevention and Treatment and 1978 and 1986 Mann Act (amendment)

 Sex trafficking of minors defined as a child abuse issue  Commercial sexual activities involving minors are prohibited  Ordered punishment of exploiters  Made grants available to child victims (including runaway youth)

3rd Wave

2000 Trafficking Victim Protection Act (and later reauthorizations)

 Human Trafficking officially defined  An attempt to re-organize existing institutions to respond to trafficking

Globalization (1990s-present)

has experienced at least three waves of discovery, rediscovery, definition and redefinition since the late 19th century. As shown in Table 13.1, the first wave of responses appeared during the late 19th and early 20th century. This time period was marked by rapid urbanization, industrialization, and a large influx of immigrants. Young people, especially young and single women went into the cities to seek paid employment, therefore, challenging the traditional patriarchal family and gender roles. New immigrants rapidly changed the demographic characteristics of the country; unlike the older immigrants from Protestant northern Europe and Britain, the new immigrants were primarily from southern and eastern Europe, consisting of the “unassimilable” Roman Catholics and Jews (Langum 1994; Zolberg 2008). The American middle class responded to such changes with fear (Higham 1963). Prostitution, one of the many social problems in urban America, was immediately associated with such

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changes in life. Reports came out claiming that the majority of prostitutes, brothel owners, and pimps were foreign-born (Langum 1994). It was also believed that thousands of innocent American girls were trafficked into prostitution every year (Connelly 1980). Thus, immigration control and criminal justice were charged with the responsibility to fight the problem. Immigration laws ordered the deportation of any non-U.S. citizen involved in prostitution. The Mann Act, for example, criminalized the transportation of women and girls across state borders for prostitution, debauchery, or any other immoral purpose. The second wave of responses appeared during the 1960s and 1970s, when the “sexual revolution” gave rise to a startling increase in juvenile prostitution and pornography (Stetson 2004). During this time, views about the role of children in society changed, eventually leading to the institutionalization of substantial child protection legislation (Ellett and Leighninger 2007). Child protection responded to juvenile prostitution and child pornography, defining them as child abuse and exploitation. Funding was made available to provide child victims and potential victims (e.g., runaway youth) with a comprehensive range of preventative and protective services. It should be noted that debates about commercial sexual activities of adult women also existed during this time period. Some groups (e.g., radical feminists) argued that that all forms of pornography and prostitution exploited and degraded women and should therefore be banned (Barry 1979). Other groups (e.g., organized prostitutes and supporters for free speech) called for the decriminalization, and even legalization, of prostitution and pornography because these activities involved consenting adults (for more discussion, see Stetson 2004). These debates, however, did not result in significant policy changes. The same debates are ongoing today. Partly because of the lack of consensus among different groups, the U.S. still does not have a definition for sex trafficking, particularly with regard to the distinctions among sex trafficking, prostitution and sex work (for some debates on the terminology, see for example Butcher 2003; Davidson 2006; Doezema 2001; Limoncelli 2009). The third wave of responses to sex trafficking started in the 1990s. Globalization and unequal levels of development among different regions gave rise to massive international migration. Willingly or unwillingly, many people entered the global sex trade (Stetson 2004). The international society was alarmed. In 1994, the U.N. General Assembly issued a resolution



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on the “traffic in women and girls.” In 1995, The Fourth World Conference on Women furthered the discussion of the issue. To implement the recommendation of the Beijing Plan of Action in the U.S., the President’s Interagency Council for Women (IAC) was created. The IAC proposed a three-part framework: prevention through funding research, protection through provision of various social services, and prosecution of the traffickers (Stetson 2004). This framework later became the Trafficking Victim Protection Act of 2000 (hereafter, TVPA 2000), which officially recognized labor trafficking and sex trafficking, ordered prosecution and punishment of traffickers, and authorized services for victims. This is the first instance in which the U.S. attempted to view trafficking as a single phenomenon as opposed to the discrete problems of immigration, child protection, and criminal justice. However, it should be noted that unlike the first wave and second wave of legislation, which created new institutions (e.g., Federal Immigration Control2 and child protection) or significantly empowered existing institutions (e.g., federal law enforcement3), the TVPA did not create new institutions. Instead, it attempted to achieve a comprehensive solution by integrating existing institutions under a shared administrative umbrella. This effort will be introduced in detail in the next section.

THE CONTEMPORARY ORGANIZATIONAL MIX IN RESPONDING TO SEX TRAFFICKING Even though the field has not reached any agreement regarding the definition of sex trafficking, researchers, policymakers, service providers and the advocates tend to agree that (1) children cannot consent to participating in commercial sexual activities; (2) whoever profits/benefits from the exploitation of others should be punished; and (3) individuals that have suffered from exploitation should be compensated in some way. Based on these agreements, one can easily conclude that a comprehensive anti-sextrafficking system needs to have three missions: (1) protecting all minors involved in commercial sexual activities; (2) prosecuting and punishing all exploiters; and (3) providing services to victims, however defined. Theoretically, the TVPA has organized enough federal, state, local, public and private organizations to carry out all three of the missions outlined above. These organizations can be categorized into four major groups, which will be referred to as the four “actors” of the U.S. anti-trafficking

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system. They are: (1) child protection (and to some extent juvenile justice), which focuses on underage individuals, (2) criminal justice, which prosecutes and punishes offenders, (3) victim assistance (and other human service agencies), which provides compensation and other types of services to the victims/survivors, and (4) immigration control, which deals with cases involving victims/offenders that have crossed national borders (Table 13.2). All of the four actors are quite well-established, and each had various experiences with human trafficking before the TVPA was enacted. The TVPA empowered some actors with more policy tools and more funding, and redefined the role of some actors in anti-trafficking work.

Child Protection: Serving Minor Victims Before the enactment of the TVPA, the child protection (and sometimes juvenile justice) system had served sexually-exploited minors as victims of child (sexual) abuse or sometimes as juvenile delinquents that needed discipline. Even after passage of the TVPA, public and private actors in the field still utilize child protection laws to identify and serve minor victims (for review of available services from various public and private agencies, see Estes and Weiner 2001). For example, the Innocence Lost Initiative, a joint effort of the FBI, Department of Justice Child Exploitation and Obscenity Section, and the National Center for Missing and Exploited Children, rescued nearly 900 children from 2003 to 2009 (Federal Bureau of Investigation 2009). With the enactment of the TVPA and its subsequent reauthorizations, sexually-exploited minors, particularly domestic juveniles involved in prostitution, are recognized as victims of sex trafficking. Efforts have been made to improve the availability and accessibility of services for both alien and domestic minors. For example, the reauthorization of the TVPA in 2005 set aside $5,000,000 for each of the fiscal years 2006 and 2007 to implement a “pilot program to establish residential treatment facilities in the U.S. for juveniles subjected to trafficking” (42 U.S.C. § 14044b). Reauthorization of the TVPA in 2008 (The William Wilberforce Trafficking Victims Protection Reauthorization Act) ordered the provision of interim assistance to alien minor victims of trafficking for up to 120 days, while eligibility determinations are made for longer-term assistance. If determined eligible for longer-term assistance, alien minors can receive various types of services, such as legal immigration status, and public assistance programs. Those who do not have a suitable family care-giver in the U.S.

Table 13.2 Core Institutions and Legislations of the Anti-Sex-Trafficking System in U.S. Child Protection Juvenile Justice

Criminal Justice

Victim Assistance

Immigration C

Cases involve individuals under 18

Prosecution and punishment of offenders

Services and compensation for eligible victims/survivors

Transnational

Department of Health and Human Services (HHS) Office of Juvenile Justice and Delinquency Prevention (OJJDP) State child welfare agencies

Department of Justice (DOJ) Federal and law enforcement agencies

Office for Victims of Crime (OVC)

Federal Immig

Mann Act Child Abuse Prevention and Treatment Act (CAPTA) Protection of Children Against Sexual Exploitation Act State prostitution laws

Mann Act State prostitution laws Child Abuse Prevention and Treatment Act (CAPTA) Protection of Children Against Sexual Exploitation Ac

Victims Of Crime Act (VOCA)

Mann Act Immigration a

Offer the child victim with relevant services or detain the juvenile as an offender

Prosecute the case with existing laws

Services and compensation using the Crime Victims Fund

Deportation o U-visa for the

Office of Refugee Re-Settlement (ORR) Department of Health and Human Services (HHS)

Department o (DHS)

tners

TVPA Prosecutorial Remedies and Tools Against the Exploitation of Children Today Act State anti-trafficking legislations

TVPA Prosecutorial Remedies and Tools Against the Exploitation of Children Today Act State anti-trafficking legislations

TVPA

TVPA

Minors are all recognized as trafficking victims

Prosecute the case with available laws

OVC - “Services for Trafficking Victims Discretionary Grant Program Comprehensive Services Sites” Refugee benefits from ORR, including working permit Section 1595 for civil relief

Continued pre trafficking vict witnesses duri prosecution, a victims as wel members.

ave carried out the duties of Federal Immigration Control. The Bureau of Immigration was established under the Treasury Department to federally administe ncy’s function was transferred to the Department of Commerce and Labor, and in 1933, the agency was changed into the Immigration and Naturalization S mmigration issues is the Department of Homeland Security, which was created in 2002.

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can enter the “Unaccompanied Refugee Minor Program”, which puts them in federal foster care and provides them with a wide range of services, including mental health treatment, medical care, educational services, legal representation, intensive case management, and independent living (Fong and Berger Cardoso 2010).

Criminal Justice: Investigation, Prosecution, and Punishment The U.S. Department of Justice (DOJ) is the federal agency responsible for coordinating investigation and prosecution of suspected trafficking cases. Before the enactment of the TVPA, federal and local law enforcement could use the Mann Act, Child Abuse Prevention and Treatment Act, and state criminal codes to bring charges to individuals and groups that sexually exploit others. The TVPA makes the punishment even harsher and has provided funding to train law enforcement officers to efficiently recognize signs of trafficking. The TVPA also inspired many states to propose their own anti-trafficking legislations. As of April 2009, 42 states had passed criminal anti-trafficking legislation.4 This type of state legislation enables the local prosecution of traffickers and other offenders when a case is not severe enough to reach the federal level. They are especially helpful in terms of prosecuting pimps and patrons who exploit local juveniles. Furthermore, the Prosecutorial Remedies and Tools Against the Exploitation of Children Today Act of 2003 amended scattered sections of the Unites States Code and made it a crime for a U.S. citizen or permanent resident to engage in sex tourism or to organize, assist, or facilitate sex tours. The maximum penalty for sex tourism was increased to 30 years imprisonment. This legislation, although not a part of the TVPA, can be regarded as an anti-sex-trafficking policy that attacks the demand side of the global sex market. Victim Assistance (and Other Partner Agencies): Service Provision for Victims Services of various kinds are available to all qualified victims, foreign or domestic, adults or minors. Before the TVPA, it was possible for victims to receive refugee benefits if they were recognized by immigration control, child welfare services if they were recognized by child protection or juvenile justice, or victim compensation if they were recognized by victim assistance within the justice system.



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The TVPA tried to integrate these different service systems. Although so far there is no “one-stop shop” for trafficking victims, the TVPA certainly enhances the existing systems and has made available a broad range of protective and treatment services. The Office for Victims of Crime (OVC) administers the “Services for Trafficking Victims Discretionary Grant Program—Comprehensive Services Sites”, which provides direct services, such as shelter, medical care, crisis counseling, legal assistance, and advocacy to assist victims after they are identified by law enforcement. By 2003, the OVC had awarded twelve grants totaling more than $9.5 million to nongovernmental organizations to provide trafficking victims with specialized services; in 2004, 10 more grants totaling over $5.5 million were awarded to expand these services (U.S. Department of State 2005). When victims are certified by Department of Health and Human Services (HHS), they are eligible for services from the Office of Refugee Re-Settlement (ORR). Furthermore, the reauthorization of the TVPA in 2003 created a civil rights action for human trafficking victims codified under 18 U.S.C. § 1595 (section 1595). It allows victims to seek civil relief against their traffickers in a U.S. district court for damages and reasonable attorney fees. This has a potential to give victims more monetary relief (Nam 2007).

Immigration Control: Immigration Relief for International Trafficking Victims Deportation is no longer the fate of victims of international trafficking. It is still true that according to the Immigration and Nationality Act (INA), an individual who came to the U.S. “solely, principally, or incidentally to engage in prostitution, or has engaged in prostitution” may be denied entrance (INA, §212(a)(2)(D)). However, through the authorization of the TVPA, the Department of Homeland Security (DHS) now provides two types of immigration relief to trafficking victims: (1) continued presence (CP) to human trafficking victims who are potential witnesses during investigation or prosecution, and (2) “T-visas” for trafficking victims and their immediate family members. In short, the TVPA did not create a new anti-trafficking system but instead attempted to re-organize existing systems under this “new umbrella”, revising unproductive approaches (such as deporting the victims) and enhancing constructive practices (such as enforcing harsher punishment and authorizing more services). Figure 13.1 summarizes the organizational mix of the U.S. contemporary anti-trafficking system.

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13.1 Contemporary Organizational Mix for Handling Trafficking Cases

Now the TVPA and the new anti-trafficking system are about to celebrate their 10-year anniversary. Most existing studies agree that the TVPA has achieved undeniable success in prosecuting traffickers (Bishop 2003; Chacon 2006). The number of cases prosecuted as well as the number of traffickers convicted has increased exponentially since 2000 (UNODC 2009). However, the achievements in victim protection seem less impressive. For example, the TVPA authorized DHS to give out 5,000 T-visas every year. However, cumulatively, through fiscal year 2008, Department of Homeland Security (DHS) had only issued 1,255 T-visas to trafficking victims and 1,077 T-visas to their family members (U.S. Department of State 2007, 2008, 2009). This is only a small fraction of the total number of T-visas available. In terms of the comprehensive service packages, which include cash assistance, medical care, food stamps, and housing, from fiscal years 2001 to 2006, the Department of Health and Human Services (HHS) only certified an annual average of 179 trafficking victims to receive federally funded or administered benefits and services (U.S. Department of Justice 2007). This stands in stark contrast to the number of estimated victims trafficked into the U.S.



Towards a Comprehensive Response to Victims of Sex Trafficking 329

Based on these statistics, researchers and advocates criticized the TVPA for failing to provide sufficient services and protection to victims (Chacon 2006; Nam 2007) and for sometimes subjecting victims to punishment (Chapkis 2003; Srikantiah 2007). What has contributed to such unbalanced achievements in the TVPA’s two major missions? The next section will attempt to provide some insight to this dilemma.

Emerging Dilemmas in Coordinating the Federal Response to Human Trafficking As mentioned earlier, all four of the major U.S. anti-trafficking actors were well-established before the enactment of the TVPA. Some actors, such as the Federal Immigration Control, have existed for longer than a century. All four actors have developed their own values, beliefs, practices, languages, and structures. Re-organizing them under the TVPA, or asking them to adopt the TVPA-defined way of responding to sex trafficking, was akin to introducing an innovation into these old systems. Previous research on various systems’ adoption of new ideas/practices/technologies suggested that when the innovation was compatible with the values, beliefs, practices, languages and structures in the old system, the adoption would be easier (Katz, Levin, and Hamilton 1963). The values, beliefs, practices, languages, and structures of an institution are shaped by its institutional environment, both historical and current. These values and structures influence the behaviors of the individuals working in the institution, who in turn produce and reproduce the values, beliefs, practices, languages and structures of the institution (Friedland and Alford 1991; Thornton and Ocasio 1999). To understand how the different actors react to the TVPA’s re-organizing efforts, it is important to identify: (1) how respective institutional environment has shaped these different actors; (2) what their values, beliefs, practices, languages, and structures are; and (3) the compatibility between the TVPA and these existing values, beliefs, practices, languages, and structures. Child Protection: Searching for The Innocent Victims Child protection has a mission to prevent child maltreatment. Although the bulk of child protection laws in the U.S. were passed in the 1970s, various public and private agencies had been responding to abused and neglected minors since the late 19th century (Myers 2008). Juveniles involved

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in prostitution were among the groups of young people with whom child protection was involved. However, from the very beginning, child protection agencies were preoccupied with the image of a perfectly innocent child victim. The reasons were that when progressive reformers campaigned for Age of Consent Laws as well as the Mann Act, they framed the complicated problem of urban prostitution as an issue of child exploitation because putting emphasis on the young women’s youthfulness and virginity had more sentimental appeal (Connelly 1980). In reality, the majority of the “fallen women” were young adults or at least juveniles in their late teens rather than young children (Fernald 1914; Sumner et al. 1911). As a result, when child protection was equipped with new policies to rescue child prostitutes, they found few. Most of the statutory rape or trafficking cases that were brought to court involved girls who willingly engaged in sex. In fact, many cases were initiated by angry parents trying to regain control over their rebellious daughters (Odem 1995). Unfit for the child protection system, these girls were processed by the juvenile justice system, put on probation or confined to state reformatory schools on sexual delinquency charges. Some youth were also checked into private asylums for wayward girls (Tice 1998). Mounting the campaign on the back of the most innocent and then using the policy for other purposes, including punishing the less innocent victims, became a set strategy the U.S. used to respond to sex trafficking of minors. In the 1960s and 1970s juvenile prostitution and pornography was again framed as a child abuse problem. Despite problems in methodology, researchers and advocates described juveniles involved in commercial sexual activities as victims of childhood sexual, physical, and psychological abuse who had to run away from home and were forced to exchange sex for survival (see for example, James and Meyerding 1977; Seng 1989). Those juveniles who were not abused but were merely exchanging sex for luxury items were left out of the discussion (Estes and Weiner 2005). Framed by such discourse, police officers, who were usually the first to encounter these juveniles, kept their eyes open for traumatized and blameless child victim of sexual exploitation. In reality, they often met rebellious adolescents who caused trouble. Researchers found that police officers only treated about 60% of juveniles involved in prostitution as victims; a juvenile was more likely to be handled as a victim if he/she came to the officer’s attention through a report (rather than through the officer’s own actions),



Towards a Comprehensive Response to Victims of Sex Trafficking 331

had no prior record, was willing to cooperate with the police, and if the exploiter was known (Halter 2010). The rest of the juveniles whose cases did not have these characteristics were handled as general offenders. They were often “caught in a revolving door circling between prostitution and an institution that is outmoded as well as ineffective in practice, and to a large extent in judicial philosophy as well” (Friedman 2005:8). Furthermore, it was believed that if a juvenile pretended to be an adult, police often lacked the incentive to do more investigation and would simply pass him/her on to the adult system (Friedman 2005). Although the TVPA’s view of minor victims and its proposed solutions for the problem are compatible with the existing system, it failed to create systematic change in the stakeholder organizations to challenge the stereotype of the completely innocent child victim. To the contrary, the public awareness campaign for sex trafficking created another image of ideal child victims like that of the innocent girl from a Thai village or the naïve teenager from Ukraine. This reinforced the misperception of the problem, leaving juveniles who have a history of delinquency, who are involved in street crimes, who are drug addicts, or who dream of becoming wealthy through prostitution out of the system of care.

Criminal Justice: Prosecution of Offenders The criminal justice system’s role is to find the criminals and to exact retribution for what the criminals have done. From the beginning, this goal has been clear and simple. In the Progressive Era, law enforcement faithfully investigated all alleged Mann Act violations (Langum 1994). Not willing to let one single trafficker walk away, the Mann Act’s aggressive prosecution tendencies sometimes went to extremes, and the officials charged with its implementation prosecuted women and girls who were supposed to have been trafficked, and further blamed them for conspiring with traffickers to arrange their own transportation (Chacon 2006). Furthermore, often prosecutors in the justice system would threaten a woman with charges of conspiracy to force her to testify against her trafficker. This approach of emphasizing prosecution is completely compatible with the TVPA’s mission “to ensure just and effective punishment of traffickers.” Thus, the criminal justice system adopted the solution prescribed by the TVPA and incorporated it into their existing practice. Although prosecutors no longer coerce the victim into testifying, under the TVPA, victims of traf-

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ficking (with the exception of children) are still asked to comply with “any reasonable request for assistance in the investigation or prosecution of acts of trafficking” before they can get their T-visa for continuous presence. The language of the TVPA does not prohibit issuance of a T-visa to victims whose cooperation is not sought. For example, T-visas can be extended to someone who “has not attained 18 years of age” or “would suffer extreme hardship involving unusual and severe harm upon removal” (INA, §1101(a)(15)(T)). However, in practice, DHS is “strongly encouraged to obtain the formal endorsement of law enforcement prior to issuing a T-visa” (Chacon 2006:3025). Any outright refusal to assist in an investigation, as stated in the text of the TVPA, would result in a denial of a T-visa application (Chacon 2006). To assist in investigation and prosecution, a victim will need to think clearly, remember many details, and tell a consistent story (Chacon 2006). Failure in any of these elements might label a victim as useless, and make him/her unqualified for a T-visa. Many researchers criticized this provision, pointing out that many victims might be too traumatized to take on the responsibility of being a witness (Sadruddin, Walter, and Hidalgo 2005). The reauthorization of the TVPA in 2008 amended this provision by granting relief and assistance to victims who are unable to cooperate with the criminal justice system due to physical or psychological trauma. This certainly helps more victims to access services and may reduce the re-victimization associated with the investigation/prosecution process or deportation process. However, this provision still does not protect victims and their family (many times, in another county) from the threats of traffickers and organized crime groups. Fearing for the safety of themselves and their family, victims may be too frightened to speak up and thus become ineligible for immigration relief and other services. By not recognizing the vulnerability of trafficking victims, the TVPA reinforces the criminal justice system’s emphasis on prosecution. It gives the criminal justice system more power to push prosecution and punish traffickers. Success in prosecution is undeniable. Harsher punishment may serve to deter future crimes. However, prioritizing prosecution over service may backfire and harm victims.

Victim Assistance: A Dependent of the Criminal Justice System The victim assistance system is dependent on the criminal justice system. The system itself has the mission to help victims gain control over



Towards a Comprehensive Response to Victims of Sex Trafficking 333

their cases and to receive compensation for their loss; and during the process of institutionalization it received support from the criminal justice system. This was the case, however, primarily because it was believed that assistance to victims would increase their cooperation in prosecution, leading to improved rates of conviction. The criminal justice system initiated and funded many victim assistance programs, which set standards for services and trained professionals in the field (Weed 1995). Therefore, from the very beginning, victim assistance was reliant on the criminal justice system. The Office for Victims of Crime (OVC) resided in the Department of Justice. The Crime Victims Fund, the crucial funding source for state victim compensation and local victim service programs, comes from federal criminal fines, penalties and bond forfeitures, which are collected through the criminal justice system. Because of its dependence on the criminal justice system, the victim assistance system helps the criminal justice system to push for victims’ cooperation in prosecution rather than protecting victims from the potential backlash of cooperating with the prosecution. The TVPA reinforced this approach rather than challenging it by conditioning the receipt of T-visas and other services on assistance in prosecution. Because of its compatibility with the old system, the approach was adopted and implemented. Section 1595, the civil relief for trafficking victims, seems to provide a mechanism for private enforcement of the anti-trafficking laws that frees victims from the prosecutor and increases victims’ control over the case. The approach has a low compatibility with the existing system. It was adopted, but trafficking victims are not provided with sufficient support to utilize it. To file a section 1595 claim trafficking victims will need to be in a relatively stable situation. They will need to find legal aid and obtain immigration status and social benefits before they file (Nam 2007). Thus, section 1595 is still not freed from its dependence on the prosecution process.

Immigration Control: Keeping Out the Unwanted The U.S. immigration system has a mission to select person who may reside or become citizens of the country and who should be kept out (Neuman 1993; Pierson 2007; Zolberg 2008). Even before independence was gained, the colonies tried to keep out criminals, paupers, people with contagious diseases, and people with racial/ethnic/religious backgrounds that were different from those of the early settlers (Abrams 2005; Garis

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1928; Neuman 1993). Foreign prostitutes have always been an unwelcome group. However, our hostility toward them went beyond moral purity. Historical evidence suggests that there were women who came to the U.S. “for the purpose of prostitution”, either willingly or unwillingly (Hobson 1990; Rosen 1982). However, the evidence also suggests that the majority of immigrant women involved in prostitution did not come for such a purpose. Scholars believed that many of these were lower class immigrant women who lacked the skills and the social network to get a wellpaying job; they had to exchange sex for money to support themselves and their children, especially if their husbands died (Hobson 1990). Thus, foreign prostitutes merely represented a group of poor immigrant women. Deporting them more or less reflected the will to keep out lower class immigrants. Since the 14th Amendment granted U.S. citizenship to all U.S.born children of immigrants, the easiest way to prevent the accumulation of unwanted people in the U.S. was to keep the women out so the unwanted aliens could not start a family (Abrams 2005; Zolberg 2008). Today, the intention to keep out lower class immigrant women has not changed. Although for humanitarian purposes certain groups of “blameless” unfortunate people (e.g., refugees, victims of domestic violence, and victims of human trafficking) were singled-out and made eligible for relief, the immigration system as a whole remains hostile to lower class immigrants. In terms of policy, a few years before the TVPA was enacted, Congress passed the Personal Responsibility and Work Opportunity Reconciliation Act and the Illegal immigration and Immigrant Responsibility Act. These legislations denied immigrants many welfare benefits, which further deteriorated poor immigrants’ living conditions in the U.S. (Srikantiah 2007). Of course, if an immigrant woman voluntarily chooses to make money through sex work, then she will not be considered a sex trafficking victim. It is very likely that she will be deported upon identification by authorities, just as she would have been a hundred years ago. Although the TVPA shows sympathy towards trafficking victims, during its implementation much effort was put into determining who deserve a T-visa to remain in America and who should be deported. As a result, among all trafficking victims who applied for T-visa, only a few received it; the majority of the applications were denied or are still pending (Chacon 2006).



Towards a Comprehensive Response to Victims of Sex Trafficking 335

In short, because of the low compatibility between its core mission and the TVPA’s goals, immigration control only reluctantly adopted the TVPA’s policy recommendations for sex trafficking. These policy recommendations were not integrated into the immigration system and did not result in any structural changes in the system. U.S. immigration policy remains hostile to the undesirable immigrants, making it easier for traffickers to threaten or to mislead the victims.

CONCLUSION: PROMOTING MORE EFFECTIVE RESPONSES TO HALTING HUMAN TRAFFICKING IN THE U.S. As the preceding discussion has demonstrated, the TVPA’s efforts to reorganize the existing systems of child protection, criminal justice, victim assistance, and immigration control to respond to sex trafficking include both new ideas that challenge the old practices and other efforts that reinforce existing approaches. When new ideas are incompatible with the old systems (e.g., T-visa vs. immigration control, and section 1595 vs. victim assistance), the new approaches were adopted reluctantly and typically implemented through the old systems. When approaches are compatible with the old systems, they were adopted to reinforce the existing practices despite the fact that they might be less effective or even counter-productive in anti-trafficking work. Many commentators have suggested that some incremental changes can be made to improve the TVPA and the U.S. anti-trafficking system. Some call for a loosening of the requirements that victims must meet to receive protection and benefits (Sadruddin, Walter, and Hidalgo 2005); some have suggested that the government should dedicate greater funding to civil rights lawyers working on behalf of trafficking victims (Nam 2007); and still others believe that expanding investigative efforts and educating more federal and state local officials will help recognize and rescue victims (Clawson Dutch, and Cummings 2006). All of these suggestions have the potential to help a larger number and broader range of trafficked people. However, whether they can be adopted and fully integrated into the existing system remains questionable. As the earlier discussion shows, responding more effectively and efficiently to trafficking victims may require significant changes in the existing institutions’ values, beliefs, practices, languages, and structures. These kinds of changes

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are always the most difficult to bring about. As creating a completely new system is probably impractical, it is crucial to explore alternative strategies to change existing systems. Previous research has found that institutional changes could result from competition between organizations and/or pressures from outside (upper level) institutions (DiMaggio and Powell 1983; Hannan and Freeman 1977). It could happen through a coercive way either formally (e.g., government mandate, laws, regulatory agencies) or informally (i.e., societal and cultural expectations of the environment); it could also happen through a mimetic way, with one institution trying to learn from other institutions that appear to be more successful; and it could happen in a normative way, as a result of higher levels of professionalization (DiMaggio and Powell 1983). Not all of these strategies can be applied to every stakeholder system involved in the anti-trafficking work in the U.S. Some actors might be more resistant to change. For example, immigration control has a mission that is highly incompatible with serving trafficking victims. Modifying agencies’ missions to be more responsive to the needs of trafficking victims is a challenging task and will take considerable time. Outside pressure such as changing societal values and demands from larger international societies may facilitate the process. Public education that aims to change people’s perceptions of lower class immigrants also may help to create a change in societal values. Other actors may view changes more positively. For example, the child protection and juvenile justice systems already have a mission to offer assistance to minors involved in commercial sexual activities. Their performance in anti-trafficking work can be improved by reframing the problem and deflating the myth of the perfect child victim. High performing programs and agencies can be identified and rewarded to encourage evidencebased practices (Estes and Weiner, 2005). Professionals, such as law enforcement officers and outreach workers also can be trained to better recognize real survivors rather than looking fruitlessly for ideal victims. The criminal justice system is already very powerful, if not too powerful. The system is faithfully carrying out its duty, which is to prosecute offenders. However, coercing victims to assist in the apprehension of their victimizers not only harms the victims but may also harm the system because victims may be too frightened to cooperate. To improve the current practices, the TVPA can be amended to remove the requirement for assistance in prosecution as a prerequisite for T-visa.



Towards a Comprehensive Response to Victims of Sex Trafficking 337

Victim assistance programs need to be empowered to be independent of criminal justice. Amending the TVPA to loosen the requirements that victims must meet to receive services can give victim assistance more autonomy. Providing funding support for civil rights attorneys to represent trafficking victims may help victims to better utilize section 1595. Identifying model programs to encourage service improvement and facilitating networking to share effective strategies also can both help improve the victim assistance programs. Changing existing institutions’ values, beliefs, practices, structures, and ways of communication is a process that requires much time and effort. Table 13.3 Improving the U.S. Anti-trafficking System Child Protection Juvenile Justice

Criminal Justice

Victim Assistance

Immigration Control

Coercive Strategies

- Public awareness campaign and public education on the reality of commercial sexual exploitation of minors rather than stereotypical stories of ideal victims

- Amending TVPA and remove the requirement for assistance in prosecution as the prerequisite for T-visa

- Amending TVPA and remove the requirement for assistance in prosecution as the prerequisite for services

- Public awareness campaign and public education aiming to change the perception of lower class immigrants

Mimetic Strategies

- Learning from other countries that are more effective in anti-trafficking work - Identifying high performing programs within the country and make them model practice

- Encouraging civil rights attorneys to represent trafficking victims by providing funding support - Identifying high performing programs within the country and make them model practice

Normative Strategies

- Training for professionals to recognize real survivors as opposed to looking for ideal victims

- Networking to share best practices

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Some researchers argue that institutions are products of the collective myths of the institutional environment, so they paid little attention to the real needs of victims (Meyer and Rowan 1977; Thornton and Ocasio 1999, 2008; Tolbert and Zucker 1983). However, this does not mean that changes are impossible. Through collaborations with various sectors, including the general public, international society, the government, and professionals, it is possible to change institutional environments. Furthermore, through training and education, it is possible to help institutions to implement ideas and practices new to them into their constituent elements, thus facilitating the adoption of the ones that are compatible with their existing values and characteristics. With these collaborative efforts, the U.S. anti-trafficking system can be improved to provide more comprehensive and more effective responses to human trafficking victims.

REFERENCES Abrams, K. 2005. Polygamy, Prostitution, and the Federalization of Immigration Law. Columbia Law Review, 105:641–716. Barry, K. 1979. Female Sexual Slavery. New York: New York University Press. Bastia, T. 2005. Child Traficking or Teenage Migration? Bolivian migrants in Argentina. International Migration 43:57–89. Bishop, C. 2003. The Trafficking Victims Protection Act of 2000: Three years later. International Migration 4:219–231. Butcher, K. 2003. Confusion Between Prostitution and Sex Trafficking. Lancet 361:1983. Chacon, J.M. 2006. Misery and Myopia: Understanding the failures of US efforts to stop human trafficking. Fordham Law Review 74:2977–3040. Chapkis, W. 2003. Trafficking, Migration, and the Law—Protecting innocents, punishing immigrants. Gender and Society 17:923–937. Clawson, H.J., N. Dutch, and M. Cummings. 2006. Law Enforcement Response to Human Trafficking and the Implications for Victims: Current practices and lessons learned. Washington, DC: National Institute of Justice (NIJ), U.S. Department of Justice. Connelly, M.T. 1980. The Response to Prostitution in the Progressive Era. Chapel Hill, NC: University of North Carolina Press. Davidson, J.O. 2006. Will the Real Sex Slave Please Stand Up? Feminist Review 83:4–22. DiMaggio, P.J., and Powell, W.W. 1983. The Iron Cage Revisited: Isomorphism and collective rationality in organizational fields. American Sociological Review 4:147–160.



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Doezema, J. 2001. Ouch! Western feminists’ ‘wounded attachment’ to the ‘third world prostitute’. Feminist Review 67:16–38. Ellett, A.J., and Leighninger, L. 2007. What Happened? An historical perspective of the deprofessionalization of child welfare practice with implications for policy and practice. Journal of Public Child Welfare, 1:3–24. Estes, R.J., and Weiner, N. 2001. The Commercial Sexual Exploitation of Children in the U.S., Canada and Mexico. Philadelphia: University of Pennsylvania, School of Social Work, Center for the Study of Youth Policy. ———. (2005). The Commercial Sexual Exploitation of Children in the United States. In Medical, legal, and social science aspects of child sexual exploitation: A comprehensive review of pornography, prostitution, and Internet crimes, ed. S.W. Cooper, R.J. Estes, A.P. Giardino, N.D. Kellogg and V.I. Vieth, pp. 95–128. St. Louis, MO: GW Medical Publishing. Federal Bureau of Investigation. 2009. Innocence Lost National Initiative, http://www. fbi.gov/innolost/innolost.htm Fernald, W.E. 1914. Report of the Commission for the Investigation of the White Slave Traffic, so called. Boston, MA: Wright and Potter Print. Co., State printers. Fong, R., and J. Berger Cardoso. 2010. Child Human Trafficking Victims: Challenges for the child welfare system. Evaluation and Program Planning 33:311–316. Friedland, R., and R.R. Alford. 1991. Bringing Society Back in: Symbols, practices, and institutional contradictions. In The New Institutionalism in Organizational Analysis, ed. W.W. Powell and P.J. Dimaggio, pp. 232–263. Chicago: University of Chicago Press. Friedman, S.A. 2005. Who Is There to Help Us: How the system fails sexually exploited girls in the U.S. New York: ECPAT_USA, Inc. Garis, R.L. 1928. Immigration Restriction: A study of the opposition to and regulation of immigration into the United States. New York: The MacMillan Company. Halter, S. 2010. Factors That Influence Police Conceptualizations of Girls Involved in Prostitution in Six US Cities: Child Sexual Exploitation Victims or Delinquents? Child Maltreatment 15:152–160. Hannan, M.T., and J. Freeman. 1977. The Population Ecology of Organizations. American Journal of Sociology 82:929–964. Higham, J. 1963. Strangers in the Land: Patterns of American nativism, 1860–1925, 2nd ed. New York: Atheneum. Hobson, B.M. 1990. Uneasy Virtue: The politics of prostitution and the American reform tradition. Chicago: University of Chicago Press. International Labor Office. 2008. ILO Action Against Trafficking in Human Beings.

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Geneva, Switzerland: International Labour Organization. James, J., and J. Meyerding. 1977. Early Sexual Experience and Prostitution. American Journal of Psychiatry 134:1381–1385. Katz, E., M.L. Levin, and H. Hamilton. 1963. Traditions of Research on the Diffusion of Innovation. American Sociological Review 28:237–252. Langum, D.J. 1994. Crossing Over the Line: Legislating morality and the Mann Act. Chicago: University of Chicago Press. Limoncelli, S.A. 2009. The Trouble with Trafficking: Conceptualizing women’s sexual labor and economic human rights. Womens Studies International Forum 32:261–269. doi: 10.1016/j.wsif.2009.05.002 Meyer, J.W., and B. Rowan. 1977. Institutionalized Organizations: Formal structures as myth and ceremony. American Journal of Sociology 83:340–363. Myers, J.E.B. 2008. A Short History of Child Protection in America. Family Law Quarterly 42:449–463. Nam, J.S. 2007. The Case of the Missing Case: Examining the civil right of action for human trafficking victims. Columbia Law Review 107:1655–1703. Neuman, G.L. 1993. The Lost Century of American Immigration Law (1776–1875). Columbia Law Review 93:1833–1901. Odem, M.E. 1995. Delinquent Daughters: Protecting and policing adolescent female sexuality in the United States, 1885–1920. Chapel Hill, NC: The University of North Carolina Press. Pierson, P. 2007. The Costs of Marginalization—Qualitative methods in the study of American politics. Comparative Political Studies 40:145–169. Rosen, R. 1982. The Lost Sisterhood: Prostitution in America, 1900–1918. Baltimore, MD: The Johns Hopkins University Press. Sadruddin, H., N. Walter, and J. Hidalgo. 2005. Human Trafficking in the United States: Expanding victim protection beyond prosecution witnesses. Stanford Law and Policy Review, 16:379–416. Seng, M. 1989. Child Sexual Abuse and Adolescent Prostitution. Adolescence 24:665– 675. Srikantiah, J. 2007. Perfect Victims and Real Survivors: The iconic victim in domestic human trafficking law. Boston University Law Review 87:157–211. Stetson, D.M. 2004. The Invisible Issue: Prostitution and trafficking of women and girls in the United States. In The politics of prostitution: Women’s movements, democratic states and the globalization of sex commerce, ed. J. Outshoorn, pp. 245–264. New York: Cambridge University Press. Sumner, W.T., E.W. Sims, W.L. Baum, D.L. Blaustein, J.F. Callaghan, A. Dwyer, et



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al. 1911. Social Evil in Chicago: A study of existing conditions with recommendations by The Vice Commission of Chicago. Chicago, IL: Gunthorp-Warren Printing Company. Surtees, R. 2005. Other Forms of Trafficking in Minors: Articulating victim profiles and conceptualizing interventions. Geneva, Switzerland: NEXUS Institute to Combat Human Trafficking and International Organization for Migration (IOM). Taylor, L.R. 2005. Dangerous Trade-offs—The Behavioral ecology of child labor and prostitution in rural northern Thailand. Current Anthropology 46:411–431. Thornton, P., and W. Ocasio. 1999. Institutional Logics and the Historical Contingency of Power in Organizations: Executive succession in the higher education publishing Industry, 1958–1990. American Journal of Sociology 105:801–843. ———. 2008. Institutional Logics. In Handbook of Organizational Institutionalism, ed. R. Greenwood, C. Oliver, R. Suddaby, and K. Sahlin-Andersson, pp. 99–129. London: Sage. Tice, K.W. 1998. Tales of Wayward Girls and Immoral Women: Case records and the professionalization of social work. Urbana, IL: University of Illinois Press. Tolbert, P. S., and L.G. Zucker. 1983. Institutional Sources of Change in the Formal Structure of Organizations: The diffusion of civil service reform, 1880–1935. Administration of Science Quarterly 28:22–39. U.S. Department of State. 2004. Trafficking in Persons Report 2004. Washington, DC: U.S. Department of State, Office to Monitor and Combat Trafficking in Persons. ———. 2005. Trafficking in Persons Report 2005. Washington, DC: U.S. Department of State, Office to Monitor and Combat Trafficking in Persons. ———. 2007. Trafficking in Persons Report 2007. Washington, DC: U.S. Department of State, Office to Monitor and Combat Trafficking in Persons. ———. 2008. Trafficking in Persons Report 2008. Washington, DC: U.S. Department of State, Office to Monitor and Combat Trafficking in Persons. ———. 2009. Trafficking in Persons Report 2009. Washington, DC: U.S. Department of State, Office to Monitor and Combat Trafficking in Persons. U.S. Department of Justice. 2007. Attorney General’s Annual Report to Congress on U.S. Government Activities to Combat Trafficking in Persons Fiscal Year 2006. Washington, D.C.: U.S. Department of Justice. United Nations Office on Drugs and Crime. 2009. Global Report on Trafficking in Persons. Vienna, Austria: United Nations Office on Drugs and Crime. Vermot-Mangold, R-G. 2007. Disappearance of Newborn Babies for Illegal Adoption in Europe. Parliamentary Assembly, Council of Europe. Weed, F.J. 1995. Certainty of Justice: Reform in the crime victim movement. New York:

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Aldine De Gruyter. Zolberg, A.R. 2008. A Nation by Design: Immigration policy in the fashioning of America. Cambridge, MA: Harvard University Press. NOTES 13.1 In the past 10–15 years, many organizations have put out various estimates of the number of victims of human trafficking. Most of the numbers were not derived from sound scientific methods. In recent years, most prominent institutions and organizations stopped putting out estimates. The United Nations now only reports the number of identified victims. International Labor Organization estimated that Out of 12.3 million forced labor victims worldwide, around 2.4 million were trafficked, including 1.2 million children (International Labour Organization 2008). The latest estimate for victims in the U.S. came from Department of State in 2004, claiming 14,500 to 17,500 are trafficked into the United States (U.S. Department of State, 2004). Additionally, about 300,000 minors in the U.S. are at risk of commercial sexual exploitation (Estes and Weiner 2005). 13.2 The first restrictive federal immigration law was the 1875 Page Law, which prohibited the importation of Chinese women for the purpose of prostitution. 13.3 Some researchers pointed out that the vague language of Mann Act criminalized many non-trafficking behaviors involving no commercial gain nor any exploitation of an innocent victim (Chacon 2006). Investigating all alleged Mann Act cases provided the take-off for federal law enforcement, transforming FBI from a team of only 23 agents to a nationally recognized institution with agents in every state and every large city (Langum 1994). 13.4 Polaris Project keeps the most updated list of the states with anti-trafficking legislation http://www.trendtrack.com/texis/cq/viewrpt?event=49ec754b1314.

14 Globalization and the University: A Relationship Worth Studying? Alan Ruby

INTRODUCTION

T

he purpose of this chapter is to show that globalization affects universities and that there is a lot about the phenomena of globalization and its interaction with institutions of higher learning that merits study, not least of which is the way those institutions can contribute to and shape globalization. I begin with a definition of globalization and how it affects some of the constituent parts and populations of institutions of higher education. Then I examine those in more detail before going on to suggest three ways in which scholars and researchers might add to our knowledge about globalization. I will give one example of how systematic inquiry would increase our understanding of the market for international higher education students and then suggest some other approaches of inquiry and finally offer some suggestions about future research in this area.

A WORKING DEFINITION BASED ON THE MOVEMENT OF FORMS OF CAPITAL Despite the avalanche of literature about globalization in the last twenty years there is still some debate about how it is defined as scholars from dif-

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ferent disciplines have written about the current wave of closer technological, economic and demographic integration between nations and communities. Others can debate the various attempts at definitions. Here the focus is on one common element: the ease or freedom of movement between economies of three forms of capital, financial capital, intellectual capital, and human capital. As “globalization” occurs through technological advances, changes in the laws and treaties governing cross- national trade, and the recognition of qualifications, national boundaries become more permeable to the movement of money, ideas, and people. As a consequence all three forms of capital move more quickly and easily between nations and markets. Universities as institutions involved in the creation of knowledge and the development of human capacity contribute to the stock of capital that can and does move and facilitate that movement through actions, policies and processes of scholarship and teaching. Of course things other than capital move more easily because of globalization: goods, services other than education, and disease are ready examples. These movements also attract the interests of scholars and educators. They offer opportunities for study, present new cross-national problems for researchers, and influence curricula for health professionals and so on.

GLOBALIZATION AND EDUCATION THROUGH THE LENS OF TRADE IN SERVICES Education is included in the agreements between nations brokered under the GATS framework (General Agreement on Trade in Services). This allows governments to recognize education as a trade “good” and to enter into arrangements with other nations about market access. Over 50 nations have treaties or agreements that cover aspects of education and many of them cover higher education. These legal provisions make it easier for institutions to sell educational services to students from other sovereign nations. The trade in educational services can be classified into four modes of delivery (cf. Suave 2002). The first is cross-border supply, where an institution domiciled in one nation provides education to a student in another. The most obvious example of this is distance or virtual education where the instructor and the student are in different locations or time zones. Delivery and consumption do not have to be simultaneous. There are no



Globalization and the University: A Relationship Worth Studying? 345

real constraints on the scale of provision, and the legal framework governing the arrangement is usually that of the provider’s nation. This sector is relatively small but growing quickly. The second mode is “consumption abroad” where the student moves to the location of the provider. International students are a ready example and the numbers have grown rapidly in the last 20 years and continue to grow. There are now more than 4.1 million people studying at the post-secondary level outside their country of citizenship (OECD 2012:24) and while growth is difficult to predict, as demand is shaped by aspiration, economic realities, and the availability of high quality domestic opportunities, it is likely to continue to grow. The third mode is usually referred to as “a commercial presence” where the provider has established a revenue attracting entity in another nation. Usually this would be a branch campus offering a small range of courses or degrees rather than a full academic program. There are examples like Nottingham in Ningbo and New York University in the Arab Emirates where the “branch” is a complete institution or in New York University jargon a “portal.” The final mode of trade in educational services is described as “the movement of natural persons.” Essentially this is mobile faculty: people from the home campus physically present and teaching in another sovereign nation. There is no reliable data on this partly because definitions are not set and because people move using different visa classes for different periods of time. Some argue that faculty mobility is constrained by the customs and mores of a tenure path academic culture that offers no incentive for international service. Others observe that tenure is not open to or indeed the aspiration of all and that other constraints on mobility like family and personal responsibility are more telling. All four forms of delivery of educational services are facilitated by and contribute to globalization.

STUDYING THE INTERACTION BETWEEN GLOBALIZATION AND THE UNIVERSITY A simple beginning would be to look systematically at how higher education institutions contribute to “globalization” and how they are affected by it as illuminated by the actions of universities as “providers” of human and intellectual capital and at the behavior of the consumers of university teaching—students. Then we can look at how the products of universities—credentials and the people who hold them—are affected by globaliza-

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tion and how different modes of university teaching or knowledge transfer contributes to “globalization.” One way in which higher education institutions have responded to globalization is to become more “international.” Some have sought to do that by opening up courses and content to students in other locations through various forms of distance education or by making course materials freely available. MIT’s Open Course Ware is a leading example. However, the big distance education universities, located in Turkey, Indonesia and China are still focused on domestic markets and extending access to citizens rather than meeting global demand.The rapid growth of massive on line courses (MOOCs) beginning in mid-2012 may broaden access to higher education, but data from the first year of six MOOCs at Edinburgh University shows that most users were from developed nations with strong domestic higher education systems (Edinburgh University 2013). This may change as MOOCs evolve and the take up from currently underserved populations increases but more evidence is needed to support claims that MOOCs will be an effective tool to increase access to higher education (Perna and Ruby 2013). Most universities have endeavored to become more international by changing the composition of the undergraduate population. Institutions have become less homogenous in terms of country of origin, nationality, and cultural identity as they have opened up to the “cross border supply” of students. Table 14.1 shows the ten U.S. Universities with the largest populations of international students, ranked in numerical order. The order would change if the ranking was based on the proportion of international students in the total student population. At Columbia University for example almost 1 in 4 of the total student population is an international student and in Fall 2012 they came from 139 countries (Columbia University 2012). A more diverse student population presents challenges to university leaders. It could be simply the influence on student life where suddenly the range of interests, activities and religions has expanded. Should cricket join lacrosse as an intervarsity sport? Do we offer space for worship for Russian Orthodox and Episcopalian congregations and does the university finance student clubs for the multiplicity of ethnic groups within the Vietnamese community? All become time consuming questions for administrators. Teaching becomes more complex and more demanding as the diversity of the student population increases. Over the past 40 years as higher education became a “mass” institution—to use Martin Trow’s taxonomy—



Globalization and the University: A Relationship Worth Studying? 347 Table 14.1 U.S. Institutions with largest numbers of International Students 2011/2012 (IIE Open Doors 2012) Rank

Institution

Number of Students

1

University of Southern California

9269

2

University of Illinois- UC

8997

3

New York University

8660

4

Purdue University- Main Campus

8563

5

Columbia University

8024

6

UCLA

6703

7

North Eastern

6486

8

University of Michigan

6382

9

Michigan State University

6209

10

Ohio State University- Main Campus

6142

teachers were confronted with the challenges of dealing with a student population that came with very different forms of cultural capital and very different vocational aspirations. They were no longer dealing just with the children of the elite and they had to adjust programs and teaching methods accordingly. Yet, they were, by and large, dealing with a majority culture. Since the mid-1980s the challenges of mass higher education have deepened as domestic student participation levels have increased but especially as the international student body has increased in size. International students bring very different histories and experiences of academic life and often have different expectations about classroom practice and behavior. Student motivations are sometimes more intensely focused on vocational preparation and achievement. These differences can be as simple as unquestioning and passive participation in graduate seminars that are being conducted in a Socratic mode to as complicated as ignorance of academic integrity codes. While these are important institutional matters, the focus here is more on the broader policy issues involved in globalization and its interrelationship with universities. One of those issues is how a university responds to its more global environment when it wishes to do more than simply enroll a number of international students or to diversify where those students come from. Some institutions have pursued the third mode of trade in educational services

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by creating branches or franchises in other economies or nations. By some counts there are over 200 degree awarding branch campuses (Lawton and Katsomitros 2012). American institutions operate in more than 40 economies that vary in size from Bermuda to China and in political system from parliamentary democracy (Australia) to state Communism (Vietnam). Institutions in many other nations, like Britain, are also setting up branch campuses. Some of the branches and programs aim to increase the revenue and reputation of the home college, while others seek to maximize the institution’s international character. Still others are driven by institutional altruism and a desire to help less-fortunate communities. The for-profit sector has also been active abroad. The Apollo Group has been buying degree-awarding entities in Britain and Chile; Laureate Education is expanding in Central and Latin America, and DeVry operates programs in the Caribbean and Brazil. They are but three of more than 70 well-capitalized investors looking at the global market. Branch campuses are not new. The religious orders opened branches in India for example in the 1800s and there was a wave of U.S. branch campuses in Japan starting in the 1970s when its economy was booming and the U.S. was stagnant. Few of the branches in Japan were successful and only Temple University’s campus in Japan still operates, and it finally “broke even” financially in 2009. Many of those that failed simply overestimated demand or did not foresee economic or cultural barriers to success. In 2007, Australia’s University of New South Wales had to abandon its Singapore outpost during the first semester of operation. The enrollments just weren’t there, with less than half the projected 300 students attending. The local market was saturated, and one-third of Singapore’s college students were already attending institutions abroad. The fiscal incentive—a wage premium for a Western education—was eroding, as the supply of graduates increased and growth in the economy slowed. The social incentive of a “Western lifestyle” that had attracted 400 or more students to the home campus in Sydney was not transferable to the planned Changi campus. Some branch campuses offered too many programs, some chose illogical locations and some selected partners looking for more immediate profits than a university could provide. Carnegie Mellon University, on entering Japan, sought to apply lessons from the efforts of others. Setting modest goals, it is offering programs for niche markets in which demand is strong



Globalization and the University: A Relationship Worth Studying? 349

and there is no competition, like the master’s program in entertainment technology that it began in Osaka in 2008. Some institutions have created partnerships rather than branches. This can range from shared programs where courses are designed by faculty at one institution and delivered by them and local instructors at another institution to arrangements where short courses at one school are recognized by another as counting towards a degree. There are seemingly endless variations involving distance education, faculty and student exchanges, certificates of participation, transfer requirements, and course credits. Some are ephemeral—flowering and fading with the interests of particular faculty or students and others endure. An example of the later is Oberlin College’s fascinating history in China which began with the Oberlin Mission in the 1880’s which created an educational institution in Shansi province. The massacre of Christian missionaries during the Boxer uprising closed the school and it was revived a few years later and endured to the late 1940’s and was revived again after the Korean war. It continues as an educational exchange and support program—a 130 years since its inception. While these partnerships have been around for a long time, while the sums of money involved are significant investments, and while the numbers of campuses and students involved has increased dramatically, there is little systematic analysis of these developments. The Observatory of Borderless Higher Education’s surveys are a good beginning but there is no detailed study of the business success and failure of branch campuses and only the beginnings of a systematic study of the due diligence process that should precede the creation of a campus in another nation. (See Box 1 below which first appeared in The Chronicle of Higher Education [Ruby 2010].)

DIVERSIFYING THE SERVICE Rather than look externally—new locations and new markets—some universities have sought to increase the international or global character of the educational experience they offer. They seek to diversify the course offerings, broaden or change the languages and area studies offered, open service opportunities in other countries and introduce courses and degree programs called “global studies” (see Appalachian State University for one of many examples). In U.S. institutions the most prominent change in the last 15 years has been the growth of study abroad programs. While still

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Box 1: Questions to Ask Before Setting Up A Branch Campus • Does a branch campus align with the institution’s mission and values? • Are you offering a broad liberal education or a low-cost, high-demand program like business and information technology? • Who is putting up the capital? Is there an escrow payment to protect students from institutional default? • Who owns the land? Is there anything already on the land? • Whose “brand” is at risk? If the branch fails, how much impact would that have on the home institution’s or host nation’s name or the perceived reliability of the latter’s education system? • How will revenues be allocated, both among the parties and across operations? • How much demand is there? Who else might be trying to serve the market? • Will the tuition be set solely in terms of the local market, or will it reflect the global value of the service—the education received—and any subsequent globally recognized credential? • Can any profits be repatriated to the home institution or foreign investors? • Will there be differential tax treatment or taxes and levies on international commercial exchanges? • What will be the language of instruction, and who will teach? Will certain courses be mandatory, and who will teach them? • Are domestic institutions subsidized directly, or indirectly through scholarships? Can you get either form of subsidy? If so, at what cost in terms of regulatory oversight or admissions requirements? • Can you build on existing academic or study-abroad partnerships? On an alumni base? • How do you plan to attract and retain top faculty members? (Offering salary premiums and housing incentives has usually not attracted significant numbers of home-campus professors to serve on branch campuses. And there may be restrictions on the number of visas and length of stay. Finding well-credentialed local faculty members can be difficult as well.) • How long a commitment can you make? Sometimes that question is best asked as, “How much money can you afford to lose?”



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less than 2% of four year degree students study abroad each year the total number of students studying abroad for academic credit increased to over 270,000 in 2010/2011 (International Institute for Education 2012). There has been steady growth of study abroad student numbers for the last 10 years. This growth has been partly matched by a diversification of destinations and a broadening of the disciplines that these students come from. Some schools have designed thoughtful programs that allow students from engineering and nursing to pursue study abroad opportunities. There is a small but growing body of research on the motivation to study abroad, on what constitutes good practice, and on the academic and vocational benefits of study abroad (see Vande Berg, Paige and Hemming Lou [2012] for a survey).

AN EXAMPLE OF A PRESSING RESEARCH NEED: THE INTERNATIONAL STUDENT MARKET The area most in need of systematic research is the international student market. How big is it? What is its economic value? Can we forecast its scale accurately or reliably? What factors are shaping demand and what factors may slow growth? Why are these questions worth considering? First it is always desirable to test conventional wisdom. For example “It is good for the economy” has been the dominant public policy maxim to justify government’s supporting inflows of international students since the 1980s. There are other reasons. At the national level, international students are important strategically and diplomatically. Their presence has various benefits—fostering global engagement and cross-cultural understanding, promoting freedom and democracy, and easing tensions between nations. International students have become elements in the “soft power” approach to international relations (Atkinson 2010). Institutionally, students from other cultures and economies diversified the student body and symbolized the international mission of colleges and universities. They also brought fee revenue, an important factor, as state support was reduced by economic circumstances and shifts in ideology. For national policy-makers looking for economic growth in a knowledge economy, selling services to international students was an opportunity to diversify the industrial base of a nation. Education could become an

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‘export’ industry bringing foreign capital to domestic institutions. Australia, New Zealand, Canada, and the United Kingdom were the most aggressive in pursuing revenue. By 2009, one in five university students in Australian universities was an international student and most were “full fee” paying, making them a vital part of an institution’s operating budget. And in 2011 a few provincial universities, like the University of Ballarat, seventy miles inland from Melbourne, had populations were two in five students were international students. At the national level, international students were seen to create jobs, pay taxes, consume locally produced goods and services, and create other indirect benefits that would multiply the value of each student’s expenditure on themselves and their dependents. It was a “good thing” for the universities and the economy. In some countries such as the U.K. and Australia these benefits justified state expenditures on marketing and promotion to increase demand and hence revenue. Growth in revenue generating, cross-border students was rapid from 800,000 in 1999 to around four million in 2012. This is separate from the numbers of students involved in the other three “modes” of international education, where academics move, where the service crosses national boundaries and when programs cross borders. Political and institutional leaders promoted and defended the international student market with claims about the “value” of the industry. The economic value was often referred to in terms of “export” income and the education and training industry was favorably compared with other big export earners. Popular comparisons in Australia were to claim that education was second to iron ore and coal as an export earner and was worth more than tourism(Australian Education International 2011). In British Columbia, foreign students are compared with fishing and trapping and the Vancouver film industry as contributors to the provincial economy. The most recent analysis for Canada compares international students’ spending in Canada with the value of aluminum exports (Kunin and Associates 2012:iii). Positioning higher education as an export industry was rational but it begs the question: just how valuable is this industry? As the numbers of international students grew so did the estimates of the value of the market for particular nations. Recent public estimates (in U.S. dollars at current exchange rates) range from $22.7 billion for the U.S., $16 billion for Australia, $21.1 billion for the U.K., $8 billion for Canada (Kunin and Associates 2012:9) to $1.5 billion or more for New Zealand. The estimates appear pe-



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riodically and were largely unchallenged until late 2009 when Birrell (2009), an Australian demographer with a long-time interest in immigration and international students, claimed that the estimates for Australia numbers were wrong and wrong by as much as 50%. The sources of error were allegedly buried in the statistical methods used, out-dated expenditure data, and incorrect assumptions about the spending power of the international student population. Birrell challenged the emphasis on export earnings, arguing the total revenue needed to be discounted for local wages earned by international students. The industry leaders were quick to respond, pointing out mistakes in the analysis and flawed logic including omitting some of the non-educational expenditures of students and overlooking the downstream economic benefits of students’ work earnings (Withers 2009). Five years ago this little disagreement would probably have passed unnoticed or been dismissed as a nerdish spat. Today, however, the stakes are assumed to be substantial, because the numbers for the national markets have continued to grow and because some institutions depend on the revenue from international students for financial stability. Universities in the U.K., Australia and New Zealand draw more than 10% of their revenue from international students. In some markets and some sectors within individual national markets—such as English language training and vocational skills courses—private for-profit providers have opened colleges and programs almost solely for foreign students. They need good, timely, and reliable market intelligence to do business planning and attract investors. At a more macro level economic planners and strategists are trying to monitor and predict capital flows between economies and, while the numbers are below an airline or bank bail out, they are significant in smaller economies. So why not simply add the national figures? Well, the popular estimates fail the ‘eyeball’ test. If the U.S. has 750,000 international students worth $21.8 billion, how can Australia with around 470,000 students get an economic impact of $16 billion? Australia is a slightly lower cost destination and it does sell education at lower price than the U.S. but the per capita differences seem too wide ($28.5 thousand per student in the U.S. versus $34.2 thousand per student in Australia). It just does not “add up” because the estimates are derived using different methods and by different types of actors, ranging from national statistical agencies to a private consulting firm to a team led by a very dedicated international admissions director officer

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on behalf of a non-profit international education and training organization. Unfortunately, there is no agreed global standard for estimating the economic worth of an individual international student to industrialized economies. The methods of estimation range from the addition of average tuition and direct living costs to the use of course specific costs and different assumptions about family size for graduate students to more sophisticated econometric modeling that takes into account the indirect impact through job creation in other sectors and tax revenue. Even if there was agreement about the methodology, there is also variance in the way the multiplier— the number of ‘international students’—is calculated in different nations. So, there are plenty of sources of error. Domestic policy makers and institutions have no real motivation to make these estimates more reliable. Estimates of national market size and value do not need to be internationally comparable for annual business planning and sources of error at least remain constant and do not confound cross year monitoring and trend analysis. Even these shortcomings can be problematic for domestic providers as the U.K. found when it underestimated its international student population by 20% because of how it treated resident foreign nationals. Concentrating on the domestic market numbers overlooks the fact that the international student industry operates in a global market with institutions in different nations competing for volume, market share, and revenue against each other. Between 2012 and 2013, three of the biggest providers of education services, U.K., Canada, and Australia released international student market forecasts for the next ten or more years underscoring the idea that the market is “global” and that students seeking education through English language programs have a range of choices. It also underscored the existence of competition between nations for the best students. (See Ruby [2013] for a discussion of all three forecasts.) The nations providing students and seeing an outflow of domestic capital are also interested in the current and future size of at least their portion of the industry—both in terms of currency flows and controls and in terms of skill formation and human capital creation. The sending and the receiving nations need global market intelligence to value demand and supply of educational services to guide policy-makers and providers.The individual purchasers also need better information about costs and supply. This will help them make choices about country of destination, of institution and



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of program of study. It will also help them make assessments of country and institutional supply and selectivity, relative costs and potential return on investment. Returns are not solely a function of price of tuition but are also influenced by living costs and by income on graduation for holders of particular qualifications. Some markets have seen a decline in demand and compensation for students with international qualifications. Transparency and reliability of information are very important when the provider and the purchaser are geographically separated at the time of choice of product and payment. For the five big Anglophone providing nations and in Japan, around 90% of international students are ‘self -financing’ and are risking their own resources by making choices with little information. They often are forced to rely on ‘commission agents,’ whose incentives are to maximize enrolments in institutions that pay the agent the most, or on anecdote, rumor or commercial publications such as U.S. News and World Report rankings. None of these are interested in cross-national comparisons or global comparisons and none are interested in protecting the consumer. In summary, national policy-makers, institutional providers and investors, and potential students would all benefit from more reliable and more readily available data about the size and value of the international student market. It all sounds nice and logical, but is it really worth the effort? If the numbers involved were still less than one million it might be debatable. If we take the ‘best’ estimate of four million students as the current year multiplier and assume unfairly and simplistically that the total unit value is $35,000 (the sum of average U.S. tuition for an international student of $16,000 plus U.S. average living expenses of $18,000 and $1,000 in other costs such as immigration and processing fees), the global market has a potential value of $140 billion. Arbitrarily discounting the unit value by 15,000 for lower cost destinations and less costly programs produces an estimated global market value of $90+ billion. This is still a number that commands attention. Of course, the global demand for post-secondary school education is expected to continue to grow and the number of international students could increase to five million—a conservative prediction—by 2025. Using the lower unit value of $20,000 the potential global value is $100 billion in today’s monetary values (Ruby 2009). Both the current value and possible future value justify serious work on monitoring the global market and getting a better grip on both the numbers and the economic benefits involved. There is a case for some sustained

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research in this area. The challenges are significant: there is no agreement among national agencies or international interest groups like the OECD and the Institute for International Education on the number of international students now or the likely growth or decline in the numbers for the next five or ten years. There is no agreed formula for estimating the economic value of international students and there is not even agreement about the definition of who is an international student. Thus, there is real work to be done to determine if this is $100 billion dollar industry.

OTHER LENS OF ANALYSIS Not everyone finds the human capital or economic approach to international students and globalization acceptable or comfortable. It is too materialist or too instrumental. It overlooks the importance of the individual and social benefit that comes from a world-class education. It tends to over value the vocational preparation programs in universities at the expense of a broad liberal arts education that “creates knowledge” and opens the mind of students—to paraphrase the mission of the Harvard undergraduate college. There is room for such criticisms and there are other ways of looking at international student flows between nations and at other aspects of globalization and its interrelationship with universities. For example, there is a rich literature on the ethical and moral dimensions of “brain drain” and “brain circulation” especially in the medical occupations (Chen et al. 2004; Clemens 2009). Others look at the legal dimensions and the recognition of qualifications across borders and the accreditation of institutions that market services in other nations through commission agents. These and others are legitimate perspectives on a complex and under studied phenomenon. There is also scope for work on identifying predictors of demand for cross-border education. Is it largely driven by the growth of the middle class in nations with limited supply of high quality post-secondary school education? Is it simply a mismatch between demographic change—a rapidly growing youth population that outstrips the available or affordable infrastructure? Or is demand linked to economic diversification which increases the demand for skill and hence vocationally oriented further education? How we do factor in increased individual and family aspirations and social changes in attitudes towards the education of girls? There are many profitable avenues for work as we try to understand the interconnection of universities and globalization.



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CONCLUSION In summary, there is a clear case that globalization has an effect on universities and that the actions of universities contributes to increased globalization by promoting movement of people and ideas across national borders. The movement of people for short or longer periods of time is increasing but the numbers involved and the economic value of this movement is poorly quantified and merits continued study.

REFERENCES Atkinson, C. 2010. Does Soft Power matter? A comparative analysis of student exchange programs 1980–2006). Foreign Policy Analysis 6:1–22. Australian Education International. 2011. Export Income to Australia from Education Services in 2010–11, Research Snapshot, November 2011. www.aei.gov.au/research Birrell, B. 2009. Exports of Educational Services Attributable to the Overseas Students Industry in Australia. University World News, August 2009. Chen, L., et al. 2004. Human Resources for Health: Overcoming the crisis. Lancet 364:1984–1990. Clemens, M. 2009. Skill Flow: A fundamental Reconsideration of Skilled-Worker Mobility and development. Center for Global Development, Working paper 180, August 2009. Columbia University. 2012. International Students at Columbia University, Fall 2012. www.columbia .edu/cu/isso/fallreport/Fall_Report_2012.pdf Edinburgh University. 2013. MOOCs@ Edinburgh 2013-Report #1. 10 May 2013. www. era.lib.ed.ac.uk International Institute for Education. 2012. Open Doors Report on International Education Exchange, 2009. Available through the IIE website, http://www.iie.org. Kunin and Associates. 2012. Economic Impact of International Education in Canada— an Update. Final Report. May 2012. http://www.international.gc.ca/education/ assets/pdfs/economic_impact_en.pdf. Lawton, W., and A. Kasomitros. 2012. International Branch Campuses: Data and developments. The Observatory on Borderless Higher 2102. www.obhe.ac.uk . OECD. 2012. Education at a Glance 2012:Highlights. Paris: OECD. www.oecd.org/edu/ highlights.pdf. Perna, L., and A. Ruby. 2013. The Silver Bullet of Education? ScienceGuide 21 May 2013. www.scienceguide.nl/201305.

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Ruby, A. 2009. International Students: A $100 Billion dollar industry? University World News, September 27, 2009. ———. 2010. Thinking About a Branch Campus? Think Twice. Chronicle of Higher Education March 21, 2010. ———. 2013. Where Will International Students Go? ScienceGuide 10 June 2013. www.scienceguide.nl/201306. Suave, P. 2002. Trade, Education and GATS. What’s in, What’s out and What’s all the fuss about? Paris: OECD. Vande Berg, M., R.M. Paige, and K. Hemming Lou, eds. 2012. Student Learning Abroad: What Our Students Are learning, What They’re Not, and What We can Do About It. Sterling: Stylus Publishing. Withers, G. 2009. Sector’s $15 Billion—plus export figures really stack up. The Australian August 2009.

15 Academically Based Global Service Learning Joseph S. Sun, John D. Keenan, Megan Doherty, and Christina Catanese

M

any of today’s students want a practical hands-on experience both cross-culturally and technically as part of their education. Educational institutions want to prepare students for global engagement. Communities around the world are seeking financial and technical assistance to improve their access to adequate health care, improved water and sanitation, and digital technology. An experienced local Non-governmental organization (NGO) wants to see community development projects completed in a manner that will insure long-term sustainability and may not have the finances or the technical staff to complete it on their own. One obvious way to satisfy all of these needs is to marshal the energy of young people and direct them to these problems requiring resolution. If such a program is poorly designed, students will receive an invigorating but very short-term exposure with a limited understanding of the unique challenges of community development projects; the community and the local NGO will receive an exciting exchange with a group of students that they may not see again. On the other hand, if the local NGO is well versed in development strategies, the U.S. based institution is committed to a long term relationship, the students are appropriately trained, and the community is willing to take ownership of the project, then effective and sustainable development is possible (Rosen and Sauder 2007).

360 Joseph S. Sun, John D. Keenan, Megan Doherty, and Christina Catanese We face enormous global challenges that must be addressed over the next generation. Many of the key issues are those of access. As an example, with nearly a billion people in the world still without improved water sources and more than a billion without adequate sanitation facilities, the challenge to address these needs is truly global (Howard 2002). Bringing service learning and a community development focus to bear on these issues together provides an opportunity to engage students globally and for a community to benefit from shared resources. Service learning has become an important part of education at many institutions with textbooks appearing recently on the market (for example, see Lima and Oakes [2006]). Speaking from experiences in both long-term community development in Sudan, Chad, Mali, and Honduras and in short-term service learning projects in Cameroon, China, India, Ghana, and Honduras, we describe a service learning program at the University of Pennsylvania which is mutually beneficial to holistic learning for visiting students and sustainable development for the host community (Sun and Keenan 2008). In brief, it is the strong link to the University’s core academic mission that makes this program successful. Without this link, service learning programs tend to fail or survive solely as an extra-curricular appendage.

MISSION AND OBJECTIVES The ultimate objectives of our community service and outreach efforts are to improve the quality of life for individuals and communities in the developing world through sustainable technology and engineering, and through engaging students in learning about and service to civil society. The focus is on teaching students about the challenges in the developing world and the role that appropriate technology and sustainable engineering play in this setting. An important element in this program is that we work closely with local communities to responsibly provide useful technical solutions to individuals and communities in the developing world. This typically means close involvement with an NGO and a long-term relationship with the community, which entails repeated visits over a number of years (Rosen and Sauder 2007). We have been involved in a variety of engineering-oriented community service projects for about a decade (somewhat longer with local projects).



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Our primary objective has been to involve our students in global projects that stress sustainability through the application of appropriate technologies and assistance in local community organizing.

ORGANIZATION A key factor in our success has been the buy-in and support at the student, school, and faculty levels. All three are necessary. We need faculty to be involved as instructors and as mentors. The support of the school is critical because of the complexity and detail of the arrangements necessary to undertake projects involving a dozen or more students in an international setting. This organization structure that characterizes our approach to service learning is represented in Figure 15.1, which indicates that successful programs involve a partnership of the students, faculty, and school administration. The fundamental building block is support of the school, which is the best positioned partner to provide oversight, coordination, and administration of these efforts. Within Penn Engineering this effort is housed within the school’s Office of Academic Programs, which provides oversight for both local and global initiatives.

15.1 Implementation of service learning depends on committed students working under the supervision of dedicated faculty in an environment supported by the school’s administration.

362 Joseph S. Sun, John D. Keenan, Megan Doherty, and Christina Catanese Student organizations are integral to our learning and projects model. The projects are typically undertaken in partnership with these organizations. This model is a particularly effective one because it provides extensive student leadership experiences. We have organized with several student organizations—most notably the Penn Chapter of Engineers without Borders (Penn-EWB) and another Penn student group, called CommuniTech. These organizations come under the responsibility of the SEAS Office of Academic Programs. Departmental and faculty involvement is essential with respect to fulfilling the academic mission central to our approach to service learning, and to leading and mentoring the field projects. Using Penn-EWB as an example, the narrative for a typical service learning project is as follows. The students develop a list of potential projects each academic year and then present the list to a group including the representatives of the Penn Engineering Office of Academic Programs, and faculty and professional mentors. The list is culled to a manageable number and at least one faculty mentor and at least one professional mentor are identified. (In the case of an EWB project, there are a number of EWB-USA level approvals that are needed. These are not detailed here.) For the projects actually undertaken, the faculty mentor is responsible for developing the academic component; the professional mentor and the faculty mentor collaborate on overseeing the engineering design involved in the project; the students are responsible for fund-raising and organizing the project trip; and the Office of Academic Programs oversees, coordinates, and facilitates the entire effort.

METRICS Our active global service/engagement program began in 1999. Since then we have completed over 50 projects involving over one thousand students; of these, nearly 500 have participated in field projects. Roughly 85 faculty, staff, and outside consultants have served as project mentors; this group has been responsible for the teaching component. In carrying out these projects, we have developed partnerships with around 50 NGOs, GOs, and universities abroad and with multiple corporate and foundation partners. By any measure, and certainly by these standards, it is clear that we have been successful in implementing global service learning projects.



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PROJECTS The efforts we report here have focused on three areas: community technology centers, water and sanitation projects, and clinical prosthetics and orthotics. The vehicle for the community technology centers and networks has been a Penn student organization called CommuniTech. The aim of this group has been bridging the digital divide and their projects have included installing community computer centers, and training systems administrators, computer users and trainers. Projects have been completed in Ecuador (1999), India (2000–06), Pakistan (2004–06), Mali (2000–01), Ghana (2001–05, 2008), and Cameroon (2005–07). The installation of clean water delivery and sanitation systems has been the purview of Penn-EWB. Projects have been carried out in Honduras (2006–07) and Cameroon (2007–present) and initiated in Guatemala (2010). In addition, another (non-EWB) project addressing arsenic in drinking water has been underway in India since 2009. The third focus area has been the Global Biomedical Service program, which has included a clinical prosthetic and orthotic service in China each summer since 2006 (Figure 15.2).

15.2 The Global Biomedical Service program includes a hands-on clinical experience focusing on prosthetics and orthotics.

364 Joseph S. Sun, John D. Keenan, Megan Doherty, and Christina Catanese

ACADEMIC COMPONENT It is through the second two programs above, Engineers without Borders and Global Biomedical Service, that we have honed the academic component of our service learning program. In order to link global service with academics, we have all students on the EWB and GBS projects enroll in two classes—they sign up for one in the semester before travel and the other in the semester after travel. We believe that the academic component of the program is an absolutely essential part of the entire experience (Figure 15.3) and is an important contributor to success.

15.3 Paradigm for Service Learning. In addition to the Service Learning project itself, successful implementation includes academic work and cultural immersion as interlocking components.

The thrust on the academic side has been on problem solving and learning. The basic pattern is similar in all cases. For the purpose of illustration, we’ll consider the two-course sequence used for the group who worked in Cameroon. This was an Engineers without Borders project in which a clean, reliable source of drinking water was provided for a village of several hundred people. The projects typically occur in the summer. Students participating in this project signed up for EAS 296, Sustainable Development in Cameroon during the spring semester before travel (Figure 15.4). The group met in as a class for six three-hour sessions, the purpose of which was to prepare for the trip. One part of the preparation focused on engineering.



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15.4 Hands-on projects are an important part of service learning, but sustainability considerations demand community partnership and ownership.

In these classes, we studied a variety of topics (with extensive readings from Jordan [1984] and Mihelcic et al. [2009]) including engineering for rural water and sanitation, water demand and supply, public health, spring development and protection, engineering for sustainable development (World Bank 2003; Dodds and Venables 2005), appropriate technology and international development, and practical field engineering. This classroom work is conducted in a lecture/discussion format. The academic deliverables include homework assignments and the project system design. The classroom preparation also includes a presentation by the university’s Travel Medicine clinical personnel, and sessions on a review of Cameroon history and culture with a focus on the Kob-Tudig region, the Meta language, and team work in a cross-cultural setting. The literature on working in other cultures includes many good sources including Airhihenbuwa (2007). The speakers include personnel from Student Health and from the African Studies program at Penn. The second part of the academic component is the on-the-ground experience. This includes the hands-on project itself (Figure 15.5). Invaluable lessons are learned about the nature of engineering design because we

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15.5 Students learn to implement their design and make the transition theory to practice.

15.6 The iterative of engineering design is never as clear as it is in the middle of the night revising plans based on what was learned earlier that day in the field.



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always learn more about the problem as we progress and this inevitably results in changes to the original design (Figure 15.6). Of course, the students learn much about another language and culture while in country. Students are required to maintain a daily journal as part of the academic deliverables, reflecting on their daily experiences and capturing salient lessons learned. In the semester following the project, typically the fall, students are required to complete a capstone project. This consists of a term paper on an approved topic of the student’s own choosing. Interestingly, the paper topics more often focus on a social, cultural, or historical aspect of the country visited—anecdotally, there are very few engineering-focused papers. Perhaps the immersion in the local culture makes the non-technical part of the experience more significant in the minds of most students.

STUDENT IMPACT These projects have been evaluated using surveys to solicit student opinion. It is apparent that the projects have had a very positive impact on our students. The projects are viewed as a “transition from theory to practice” in which the students “learned to solve unexpected problems”. The programs have been viewed as eye-opening, unique educational experiences integrating technical learning with cultural awareness. An “increased appreciation for other cultures” is the most commonly repeated reaction expressed by participants. From the perspective of an educator, one of the most important features has been the influence on future goals. As a result of participating in these projects, students have joined the Peace Corps in such places as Mali and the Dominican Republic. Students are pursuing medical and health research careers in developing country contexts, medical school, graduate school in policy and planning for international development, and technology solutions to aid the poor.

COMMUNITY IMPACT The projects have also had a positive impact on the recipient communities. In terms of infrastructure, there has been a dramatic increase in clean water availability (Figure 15.7), perceivably decreased soil erosion and in-

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15.7 The availability of a clean, reliable supply of drinking water means less time is spent carrying water each day from a distant source.

15.8 Improved access to information and educational resources translates to a greater desire to complete education.



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creased quality of environment, and improved communication capabilities and access to information. In the education sector, we have seen increased access to information and educational resources. This in turn has resulted in a greater desire to complete education and to advance to senior secondary schooling and beyond (Figure 15.8). Finally, in terms of health and livelihood, there has been a reduction in the time used for water hauling, increasing time available for productive tasks; presumably a reduced incidence of waterborne diseases in the impacted communities; and an increase in ambulatory abilities leading to happier and more productive living.

SUMMARY We describe a framework for service learning in a global context. The skeleton of this framework is close linkage to the academic mission of the university: students receive academic credit from the service learning projects. There are a number of academic deliverables that are used in the evaluation of the student’s work. These include classroom work during the semester before the project; the engineering design associated with the project; journal writing and cultural immersion during the project; and, finally, a capstone term paper written the semester following the servicelearning project. This model (or variants of it) has been applied a number of times to improve access to drinking water and sanitation (through Engineers without Borders); to IT infrastructure (CommuniTech); and providing prosthetic and orthotic clinical service (Global Biomedical Service). Successful, sustainable implementation of these projects depends in large part on a close working relationship with the community through a non-governmental organization so that the community takes ownership.

REFERENCES Airhihenbuwa, C.O. 2007. 2007 SOPHE Presidential Address: On Being Comfortable with being Uncomfortable: Centering an Africanist Vision in our Gateway to Global Health. Health Education and Behavior 34:31–42. Dodds, R. and R. Venables, eds. 2005. Engineering for Sustainable Development: Guiding Principles. The Royal Academy of Engineering, London.

370 Joseph S. Sun, John D. Keenan, Megan Doherty, and Christina Catanese Howard, G. 2002. Healthy Villages: A Guide for Communities and Community Health Workers. Geneva: World Health Organization. Jordan, T.D. 1984. A Handbook of Gravity-Flow Water Systems for Small Communities. Warwickshire, UK: Intermediate Technology Publications, Ltd. Lima, M. and W. Oakes. 2006. Service-Learning. Wildwood, MO: Great Lakes Press. Mihelcic, J.R., L.M. Fry, E.A. Myre, L.D. Phillips, and B.D. Barkdoll. 2009. Field Guide to Environmental Engineering for Development Workers. Reston, VA: Water, Sanitation, and Indoor Air. ASCE Press. Rosen, R., and J.A. Sauder. 2007. Appropriate Technology: Approach, Selection and Evaluation—What will our community project look like in 5 years. Presented at the East Coast Engineers without Borders Annual Workshop held at Rowan University, NJ. October 15, 2007. Sun, J., and J.D. Keenan. 2008. Global Technology Service. Service Learning for Engineering Students in Developing Countries. Presented at the 2008 Wharton Africa Business Forum. The Wharton School, University of Pennsylvania. December 5, 2008. The World Bank. 2003. Sustainable Development in a Dynamic World: Transforming Institutions, Growth and Quality of Life. World Development Report 2003. New York: Oxford University Press.