The Quotient: Recent Episodes
Usmaan M. Farooqui
Image: earth.com
I talk to Ethan Tupelo, a doctoral candidate at the University of Massachusetts-Amherst and part owner of the Pedal People worker cooperative in Northampton, MA, about waste management, human power, and the possible future of local trash collection.
If you live in the Northeast U.S., chances are your trash ends up in a 2,600-acre facility in New York State. The Seneca Meadows Landfill is one of the largest waste disposal sites in the country. It accepts trash from New York, Connecticut, Massachusetts, New Jersey, and Pennsylvania. In addition to solid waste management, the site recycles tires, produces methane gas for electricity, and offers a range of other services. It is one of Seneca County’s largest employers.
The Seneca Meadows Landfill is an example of growing consolidation in the waste management industry. In the last few decades, population growth and urbanization have turned garbage disposal into an industry worth billions of dollars, with large corporations like Waste Management and Republic Services, Inc. handling over half the trash in the U.S.
But in Northampton, MA, a small worker owned and run cooperative is changing how garbage is collected at the local level. In this historic settlement, it’s common to see bicyclist hauling 8-foot trailers filled with garbage bags all across town. Pedal People – a self-described “human-powered delivery and hauling service” – has been offering garbage disposal services to Northampton residents since its inception in 2002. In 2007, the organization entered a contract with the City of Northampton to collect public trash and recyclable materials.
Beyond simply using bicycles to haul things, the cooperative’s goal, according to its mission statement, is to “model the use of human power as a viable alternative to fossil fuels.”
What’s the current state of the garbage industry? Does the U.S. have a trash problem? And can human power help make waste management more efficient?
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Image: Cleveland Clinic - https://health.clevelandclinic.org/head-toe-benefits-cardio-workout-infographic/
I talk to Bri Cawley, a personal trainer based in Chicago, about health, how the pandemic has changed the fitness industry, and why it’s important to keep moving during lockdowns.
When COVID-19 restrictions went into effect early last year, the fitness industry took a massive hit. Gym closures and other limitations led to an estimated 480,000 jobs lost by Oct. 1, 2020, according to a report by the International Health, Racquet, and Sportsclub Association. Now, nearly a year after the lockdowns fundamentally changed how we interact with each other, the $94 billion fitness industry has reinvented itself by going online.
But, while Zoom sessions, fitness apps, and high-speed internet make it possible for people to remain in contact with trainers during the pandemic, online communication cannot reproduce the distinctiveness of face-to-face interaction – a defining feature of the fitness industry. Moreover, even though lockdowns are a necessary and scientifically proven way of stopping the spread of COVID-19, they come with their own set of non-virus related health risks. From weight-gain, increased blood pressure, and heart disease, to insomnia, depression, and anxiety, staying put for long periods – as we have all been doing – poses significant physical and mental health challenges.
How has the fitness industry changed? Will gyms ever be a thing again? And how are personal trainers reshaping both the nature and substance of their profession during the pandemic?
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Image: https://www.domo.com/learn/data-never-sleeps-7
Aoun Jafarey, a data analytics professional based in New York City, talks about the gray areas that exist in the enormous amounts of data we produce, consume, and utilize daily.
Imagine, if you can, stacks upon stacks of iPads stretching from the Earth’s surface all the way to the moon. Or, visualize 292 Great Pyramids filled with millions of external hard drives. As a final example, try to picture around 33 Empire State Buildings packed with billions of USB sticks. According to Domo, a cloud software company based in the United States, this would have been the physical representation of the amount of data produced per year, over five years ago.
The meaning of the word “big” in the term big data is so mind-boggling that it is hard to imagine what our collective digital footprint would look like if physicalized. Though big data has always referred to information that requires advanced techniques and software to process, the scale at which it is produced is exponentially trending towards the colossal. Indeed, with over 2.5 quintillion bytes produced daily (that’s 18 zeros), all the data in existence has been produced in the last 5 years.
This scale is fueled by the ease and speed with which professionals, public officials, and everyday people can conduct their business online. It is no surprise, then, that whether it is in designing algorithms for social media, conducting market research for a specific firm or industry, or formulating public policy, large volumes of data are integral to everything we do. Data science is therefore becoming increasingly central to how we describe, model, and even predict the future of a variety of human activities.
It makes sense that the quality of the data at our disposal goes a long way in the accuracy of data analytics. And the quality of our data invariably brings up questions of how we measure social phenomenon. What is the role of measurement in data science? And how can aspects of data science, like presentation for example, affect our ability to effectively describe and model the world?
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Source: “10 things to know about Sehat Sahulat Programme” https://dunyanews.tv/en/Pakistan/477223-things-know-about-Sehat-Sahulat-Programme
In this episode of The Quotient podcast, I talk to Fahad Khan, a program manager and healthcare delivery specialist with the Indus Health Network’s Global Health Directorate, about Pakistan’s healthcare delivery system and whether recent efforts by the government to achieve Universal Health Coverage are realistic.
Universal Health Coverage (UHC) by the year 2030 is a Sustainable Development Goal.
Despite this commitment, however, extending healthcare remains a challenge for national governments and public health officials. According to the World Health Organization, for instance, at least half of the world’s population lacks access to essential health services. Out of pocket health expenditures, meanwhile, are pushing as many as 100 million people into extreme poverty. In low-income countries particularly, there is a lack of quality and coverage when it comes to basic healthcare.
What kinds of policies, infrastructures, and actors will help achieve UHC? And can developing countries – with their resource constraints, complicated healthcare delivery systems, and disproportionate disease burdens – help lead the way in achieving UHC?
Pakistan on the forefront?
This is the question posed by the Government of Pakistan’s recent effort to extend healthcare throughout the South Asian nation.
In 2015, the government of Khyber-Pakhtunkhwa – one of Pakistan’s four provinces – launched the Sehat Sahulat Program (SSP), a publically-funded insurance plan that sought to provide free healthcare to poor families within the province. Fast forward to 2020, the federal government sees the SSP as a blue print to extent UHC across the country. Officials claim that over 7.1 million families have access to health coverage worth Rs.720,000 (roughly $4,500) per year under the program. Earlier this month, Prime Minister Imran extended coverage to the administrative territories of Azad Jammu and Kashmir and there are plans to expand the SSP in Punjab, Pakistan’s most populous province, in 2021.
Such an extension is ambitious, even if one ignores the already complex and multilayered healthcare delivery system in Pakistan where various private actors are de-facto providers.
A public health delivery perspective.
Here are three takeaways from my conversation with Fahad:
1) Private sector innovation remains not only widespread in delivering healthcare across income groups according to Fahad, but also necessary and currently irreplaceable when it comes to securing funding from international donors, public health messaging, door-to-door immunizations for diseases like tuberculosis, and identifying emerging areas of care such as mental health.*
2) Government programs like the SSP might do very little to take the burden off the private sector, at least in the short term. This is because such a program is unlikely to address the wide breath of healthcare services required in Pakistan.***
3) Fahad is hopeful, however, that the SSP might help in ways that don’t involve direct healthcare delivery. Specifically, the program may improve the quality and quantity of healthcare data, as well as underscore the need to collect taxes and devote public funds to providing healthcare.
Time will tell how effective Pakistan’s government healthcare programs will be. For now, healthcare delivery experts like Fahad remain skeptical about such large-scale initiatives.
- Reporting cited in this episode on the incidence of first time and drug resistant cases of tuberculosis per year is from the WHO’s Regional Office for the Eastern Mediterranean website.
** The WHO report cited in this episode regarding per capita mental health spending in Pakistan is the WHO Mental health Atlas country profile 2014.
* This podcast incorrectly states 175 doctors are registered with the public sector. The correct figure, according to the Journal of the Pakistan Medical Association, is 175,000.
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The coronavirus in Pakistan has public health experts stumped. At the end of May, the South Asian nation of over 220 million people faced disaster. With limited health services, widespread poverty, and a population that largely lives in crowded cities, global health officials feared Pakistan would be one of the countries worst hit by the deadly virus.
These fears seemingly came true in mid-June this year when the daily number of reported cases jumped to nearly 6,000. To make things worse, a study published by the Imperial College London predicted around 2.2 million deaths in the coming weeks. The federal government, in turn, was hesitant to impose a country wide lock-down despite this alarming forecast, proposing, instead a “smart lock-down” strategy which targeted virus hot spots in urban areas.
By the end of August, however, Pakistan’s active number of cases had fallen drastically with the number of new daily reported cases decreasing to around 500.
Source: World Health Organization “Pakistan: Coronavirus Pandemic Country Profile” (https://ourworldindata.org/coronavirus/country/pakistan?country=~PAK)
What do we know? What don’t we know?
There have been various explanations for Pakistan miraculously eluding the worst of the virus. They mention, to varying degrees, a preexisting public health infrastructure, natural immunity (due to “cross reactivity” stemming from exposure to previous coronavirus-like diseases), a coordinated and innovative government response, and environmental factors like climate and population age.
I spoke to Arman Majidullah, a public health expert based in Karachi, Pakistan to shed light on Pakistan’s COVID-19 conundrum:
The big picture.
Here are three main takeaways from my conversation with Arman:
There is little causal evidence of natural immunity in Pakistan either from genetic sources or exposure to similar viruses in the past. An anecdotal glance east to India shows a country that has a similar “disease burden” to Pakistan (setting aside polio) – hence a population that is likely to have the same immunological response to COVID-19. The rising rate of coronavirus infections in India suggests natural immunity might not be a large factor in Pakistan (though it is important to note that India is a far larger country and talk of cross-reactivity – given the lower than expected mortality rate – is common there as well).
Pakistan’s experience with previous diseases had little effect on COVID-19 preparedness. Perhaps the most shocking aspect of the pandemic is its disproportional effect on richer countries like the United States rather than poorer ones with limited resources. But, having experienced outbreaks of infectious diseases like Ebola, countries like Liberia have a preexisting infrastructure geared toward controlling virus outbreaks. The same is not so for Pakistan whose experience with polio – a disease that largely affects small children – cannot be scaled to address infectious diseases.
All that being said, coordinated public health interventions early on did work. Government bodies, NGOs, and hospital networks were quick to come together according to Arman. Two clear examples of this were
i) A sustained and consistent public messaging program, delivered through widely accessible technologies like cell phones, that warned people of the severity of the virus as well as information on testing and prevention.
ii) The centralization of virus monitoring and screening – two primary tools in a coordinated public health response. Decentralized data set collected by hospitals were synchronized and given to a federally-run virus cell which then identified hot spots and created policies, thus possibly enhancing the impact of smart lock-down strategies.
The way forward?
As Arman mentioned, the evidence public health experts have is anecdotal. In other words, the health sector cannot confidently say what did or didn’t cause the coronavirus trends we see in Pakistan. This has two humbling implications. First, explanations for a lower infection rate in Pakistan are incomplete and it is unlikely that the country’s experience can be replicated elsewhere until experts get a clearer picture of what happened. Second, it is difficult to predict whether Pakistan will face a second wave in the months that follow. This is more worrying given that the country has largely returned to normal, with social distancing becoming individualized to families and businesses. What is clear, however, is that with 315, 512 cases at the time of writing, the threat of a delayed public health catastrophe remains very real indeed. For now, Pakistan, like many other countries, is simply learning to live with the coronavirus.
This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thequotient.substack.com