Paul Pholeros: How to reduce poverty? Fix homes

80,917 views ・ 2013-06-20

TED


Please double-click on the English subtitles below to play the video.

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Translator: Joseph Geni Reviewer: Morton Bast
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The idea of eliminating poverty is a great goal.
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I don't think anyone in this room would disagree.
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What worries me is when politicians with money
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and charismatic rock stars --
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(Laughter)
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use the words,
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" ... it all just sounds so, so simple."
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Now, I've got no bucket of money today
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and I've got no policy to release,
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and I certainly haven't got a guitar.
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I'll leave that to others.
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But I do have an idea,
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and that idea is called Housing for Health.
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Housing for Health works with poor people.
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It works in the places where they live,
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and the work is done to improve their health.
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Over the last 28 years,
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this tough, grinding, dirty work
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has been done by literally thousands of people around Australia
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and, more recently, overseas,
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and their work has proven
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that focused design can improve even the poorest living environments.
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It can improve health
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and it can play a part in reducing, if not eliminating, poverty.
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I'm going to start where the story began --
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1985, in Central Australia.
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A man called Yami Lester, an Aboriginal man,
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was running a health service.
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Eighty percent of what walked in the door, in terms of illness,
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was infectious disease --
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third world, developing world infectious disease,
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caused by a poor living environment.
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Yami assembled a team in Alice Springs.
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He got a medical doctor.
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He got an environmental health guy.
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And he hand-selected a team of local Aboriginal people
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to work on this project.
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Yami told us at that first meeting,
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"There's no money," -- always a good start --
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" ... no money, you have six months,
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and I want you to start on a project --" which, in his language,
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he called "Uwankara Palyanku Kanyintjaku,"
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which, translated, is "a plan to stop people getting sick" --
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a profound brief.
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That was our task.
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First step, the medical doctor went away for about six months.
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And he worked on what were to become these nine health goals --
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what were we aiming at?
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After six months of work, he came to my office
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and presented me with those nine words on a piece of paper.
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[The 9 Healthy Living Practices: Washing, clothes, wastewater, nutrition, crowding,
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animals, dust, temperature, injury]
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I was very unimpressed. Big ideas need big words,
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and preferably a lot of them.
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This didn't fit the bill.
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What I didn't see and what you can't see
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was that he'd assembled thousands of pages
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of local, national and international health research
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that filled out the picture as to why these were the health targets.
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The pictures that came a bit later had a very simple reason.
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The Aboriginal people who were our bosses and the senior people
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were most commonly illiterate,
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so the story had to be told in pictures
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of what these goals were.
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We worked with the community,
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not telling them what was going to happen
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in a language they didn't understand.
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So we had the goals and each one of these goals --
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and I won't go through them all --
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puts at the center the person and their health issue,
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and it then connects them
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to the bits of the physical environment that are actually needed
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to keep their health good.
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And the highest priority, you see on the screen,
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is washing people once a day, particularly children.
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And I hope most of you are thinking,
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"What? That sounds simple."
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Now, I'm going to ask you all a very personal question.
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This morning before you came,
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who could have had a wash using a shower?
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I'm not going to ask if you had a shower, because I'm too polite.
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That's it.
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(Laughter)
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All right, I think it's fair to say
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most people here could have had a shower this morning.
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I'm going to ask you to do some more work.
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I want you all to select one of the houses
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of the 25 houses you see on the screen.
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I want you to select one of them and note the position of that house
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and keep that in your head.
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Have you all got a house?
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I'm going to ask you to live there for a few months,
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so make sure you've got it right.
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It's in the northwest of Western Australia, very pleasant place.
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OK. Let's see if your shower in that house is working.
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I hear some "Aw!" and I hear some "Ah!"
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If you get a green tick, your shower's working.
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You and your kids are fine.
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If you get a red cross,
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well, I've looked carefully around the room
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and it's not going to make much difference to this crew.
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Why? Because you're all too old.
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I know that's going to come as a shock to some of you, but you are.
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And before you get offended and leave,
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I've got to say that being too old,
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in this case, means that pretty much everyone in the room, I think,
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is over five years of age.
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We're really concerned with kids naught to five.
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And why?
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Washing is the antidote to the sort of bugs,
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the common infectious diseases of the eyes, the ears,
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the chest and the skin
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that, if they occur in the first five years of life,
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permanently damage those organs.
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They leave a lifelong remnant.
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That means that by the age of five,
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you can't see as well for the rest of your life.
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You can't hear as well for the rest of your life.
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You can't breathe as well.
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You've lost a third of your lung capacity by the age of five.
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And even skin infection,
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which we originally thought wasn't that big a problem,
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mild skin infections naught to five give you
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a greatly increased chance of renal failure,
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needing dialysis at age 40.
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This is a big deal, so the ticks and crosses on the screen
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are actually critical for young kids.
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Those ticks and crosses represent the 7,800 houses
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we've looked at nationally around Australia,
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the same proportion.
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What you see on the screen --
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35 percent of those not-so-famous houses
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lived in by 50,000 indigenous people --
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35 percent had a working shower.
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Ten percent of those same 7,800 houses had safe electrical systems.
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And 58 percent of those houses had a working toilet.
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These are by a simple, standard test.
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In the case of the shower:
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does it have hot and cold water, two taps that work,
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a shower rose to get water onto your head or onto your body,
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and a drain that takes the water away?
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Not well-designed, not beautiful, not elegant --
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just that they function.
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And the same tests for the electrical system
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and the toilets.
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Housing for Health projects aren't about measuring failure --
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they're actually about improving houses.
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We start on day one of every project.
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We've learned -- we don't make promises, we don't do reports.
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We arrive in the morning with tools, tons of equipment, trades,
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and we train up a local team on the first day to start work.
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By the evening of the first day,
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a few houses in that community are better than when we started in the morning.
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That work continues for six to 12 months,
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until all the houses are improved
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and we've spent our budget of 7,500 dollars total per house.
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That's our average budget.
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At the end of six months to a year, we test every house again.
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It's very easy to spend money.
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It's very difficult to improve
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the function of all those parts of the house.
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And for a whole house, the nine healthy living practices,
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we test, check and fix 250 items in every house.
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And these are the results we can get with our 7,500 dollars.
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We can get showers up to 86 percent working,
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we can get electrical systems up to 77 percent working
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and we can get 90 percent of toilets working
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in those 7,500 houses.
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(Applause)
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Thank you.
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(Applause)
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The teams do a great job, and that's their work.
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I think there's an obvious question
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that I hope you're thinking about.
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Why do we have to do this work?
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Why are the houses in such poor condition?
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Seventy percent of the work we do is due to lack of routine maintenance --
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the sort of things that happen in all our houses.
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Things wear out, should have been done by state government or local government,
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simply not done, the house doesn't work.
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Twenty-one percent of the things we fix are due to faulty construction --
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literally things that are built upside down and back to front.
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They don't work, we have to fix them.
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And if you've lived in Australia in the last 30 years, the final cause --
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you will have heard always that indigenous people trash houses.
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It's one of the almost rock-solid pieces of evidence
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which I've never seen evidence for,
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that's always reeled out as "That's the problem with indigenous housing."
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Well, nine percent of what we spend is damage,
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misuse or abuse of any sort.
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We argue strongly that the people living in the house
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are simply not the problem.
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And we'll go a lot further than that;
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the people living in the house are actually a major part of the solution.
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Seventy-five percent of our national team in Australia --
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over 75 at the minute --
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are actually local, indigenous people from the communities we work in.
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They do all aspects of the work.
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(Applause)
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In 2010, for example, there were 831,
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all over Australia, and the Torres Strait Islands,
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all states, working to improve the houses where they and their families live,
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and that's an important thing.
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Our work's always had a focus on health.
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That's the key.
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The developing world bug, trachoma, causes blindness.
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It's a developing-world illness,
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and yet, the picture you see behind
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is in an Aboriginal community in the late 1990s,
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where 95 percent of school-aged kids had active trachoma
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in their eyes, doing damage.
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OK, what do we do?
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Well, first thing we do, we get showers working.
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Why? Because that flushes the bug out.
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We put washing facilities in the school as well,
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so kids can wash their faces many times during the day.
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We wash the bug out.
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Second, the eye doctors tell us that dust scours the eye
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and lets the bug in quick.
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So what do we do?
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We call up the doctor of dust, and there is such a person.
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He was loaned to us by a mining company.
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He controls dust on mining company sites.
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And he came out and, within a day,
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it worked out that most dust in this community
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was within a meter of the ground, the wind-driven dust --
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so he suggested making mounds to catch the dust
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before it went into the house area and affected the eyes of kids.
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So we used dirt to stop dust.
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We did it. He provided us dust monitors.
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We tested and we reduced the dust.
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Then we wanted to get rid of the bug generally.
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So how do we do that?
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Well, we call up the doctor of flies -- and, yes, there is a doctor of flies.
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As our Aboriginal mate said,
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"You white fellows ought to get out more."
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(Laughter)
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And the doctor of flies very quickly determined
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that there was one fly that carried the bug.
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He could give school kids in this community
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the beautiful fly trap you see above in the slide.
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They could trap the flies, send them to him in Perth.
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When the bug was in the gut,
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he'd send back by return post some dung beetles.
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The dung beetles ate the camel dung,
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the flies died through lack of food,
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and trachoma dropped.
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And over the year, trachoma dropped radically in this place, and stayed low.
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We changed the environment, not just treated the eyes.
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And finally, you get a good eye.
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All these small health gains
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and small pieces of the puzzle make a big difference.
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The New South Wales Department of Health,
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that radical organization,
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did an independent trial over three years
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to look at 10 years of the work we've been doing
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in these sorts of projects in New South Wales.
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And they found a 40 percent reduction in hospital admissions
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for the illnesses that you could attribute to the poor environment --
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a 40 percent reduction.
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(Applause)
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Just to show that the principles we've used in Australia
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can be used in other places,
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I'm just going to go to one other place, and that's Nepal.
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And what a beautiful place to go.
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We were asked by a small village of 600 people
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to go in and make toilets where none existed.
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Health was poor.
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We went in with no grand plan,
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no grand promises of a great program,
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just the offer to build two toilets for two families.
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It was during the design of the first toilet
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that I went for lunch,
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invited by the family into their main room of the house.
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It was choking with smoke.
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People were cooking on their only fuel source, green timber.
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The smoke coming off that timber is choking,
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and in an enclosed house, you simply can't breathe.
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Later we found the leading cause of illness and death
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in this particular region is through respiratory failure.
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So all of a sudden, we had two problems.
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We were there originally to look at toilets
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and get human waste off the ground, that's fine.
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But all of a sudden now there was a second problem:
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How do we actually get the smoke down?
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So two problems, and design should be about more than one thing.
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Solution: Take human waste, take animal waste,
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put it into a chamber, out of that, extract biogas,
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methane gas.
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The gas gives three to four hours cooking a day --
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clean, smokeless and free for the family.
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(Applause)
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I put it to you: is this eliminating poverty?
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And the answer from the Nepali team who's working at the minute would say,
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don't be ridiculous --
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we have three million more toilets to build
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before we can even make a stab at that claim.
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And I don't pretend anything else.
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But as we all sit here today,
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there are now over 100 toilets built
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in this village and a couple nearby.
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Well over 1,000 people use those toilets.
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Yami Lama, he's a young boy.
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He's got significantly less gut infection because he's now got toilets,
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and there isn't human waste on the ground.
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Kanji Maya, she's a mother, and a proud one.
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She's probably right now cooking lunch for her family
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on biogas, smokeless fuel.
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Her lungs have got better,
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and they'll get better as time increases,
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because she's not cooking in the same smoke.
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Surya takes the waste out of the biogas chamber
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when it's shed the gas, he puts it on his crops.
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He's trebled his crop income,
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more food for the family and more money for the family.
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And finally Bishnu, the leader of the team,
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has now understood that not only have we built toilets,
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we've also built a team,
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and that team is now working in two villages
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where they're training up the next two villages
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to keep the work expanding.
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And that, to me, is the key.
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(Applause)
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People are not the problem.
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We've never found that.
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The problem: poor living environment,
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poor housing and the bugs that do people harm.
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None of those are limited by geography, by skin color or by religion.
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None of them.
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The common link between all the work we've had to do
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is one thing, and that's poverty.
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Nelson Mandela said, in the mid-2000s, not too far from here,
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he said that like slavery and apartheid, "Poverty is not natural.
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It is man-made and can be overcome and eradicated
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by the actions of human beings."
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I want to end by saying
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it's been the actions of thousands of ordinary human beings
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doing -- I think -- extraordinary work,
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that have actually improved health,
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and, maybe only in a small way, reduced poverty.
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Thank you very much for your time.
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(Applause)
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