Ken Banks, the founder of kiwanja.net, spoke about the importance of technology solutions that meet the needs of those working in the developing world and his own work in this area through FrontlineSMS.

While current excitement in the technology world may be focused on increasing centralization through cloud computing, this means little to people working in the developing world where internet connectivity is unavailable or unreliable.  Too little investment is going into building tools that will genuinely assist the work many non-profits are doing now.

Ken developed FrontlineSMS to tap into the potential of mobile phones, which are now widely available and used in the developing world. This is a two way communication system that can be used anywhere where there is a mobile phone signal.  FrontlineSMS is available as a free download and Ken's approach has been not to dictate implementation but rather to allow people to use this very general tool in whatever ways meet their particular needs. This has resulted in diverse applications, for example:

• Monitoring election practices in Nigeria in 2007
• Sending security alerts to humanitarian workers in conflict areas of Afghanistan
• Encouraging young people to take part in elections in Azerbaijan
• Updating local people on the location of speeches during President Obama's visit to Ghana

There is also great potential to combine FrontlineSMS with traditional media, such as radio, that is already widespread throughout Africa, to make this much more interactive.

Ken offered a number of points of guidance for those thinking about designing technology with social applications:

• Work with the equipment that people already have at their disposal
• Make equipment easy to assemble and intuitive
• Price it at a level people can afford
• Think about how use can be replicated - how will other NGOs find out about it?
• Assume a situation of no internet connectivity
• Where possible, give users an ability to connect with others - for example through a forum (this has been particularly successful at FrontlineSMS, with a third of those who download the software joining the online community)
• Don't let a social science approach dominate - it is much better to think in a multi-disciplinary way
• Use technology that is appropriate to the context - don't bring in tools that require knowledge and equipment not already held in the community
• Collaborate, don't compete. Sometimes NGOs can rush to do the same things; examples of genuine cooperation are hard to find

Looking ahead, Ken will be developing functionality for FrontlineSMS that makes use of internet connectivity where this is available. He is also working on finding additional funding to help organizations pay for text messages.

Global health disparities were the topic of a special event November 11th co-sponsored by the Asia Health Policy Program of the Shorenstein Asia-Pacific Research Center and the Center for Health Policy / Primary Care and Outcomes Research.

Sir Michael Marmot, internationally renowned Principal Investigator of the Whitehall Studies of British civil servants (investigating explanations for the striking inverse social gradient in morbidity and mortality), spoke about research on the social determinants of health and taking action to promote policy change. Pointing out the extreme disparities in life expectancy for peoples in different parts of the world – including the “haves” and “have-nots” within the high-income world – he presented an overview of “Closing the gap in a generation: Health equity through action on the social determinants of health” (http://www.who.int/social_determinants/en/). That report was commissioned by the World Health Organization (WHO) and released last year; Sir Marmot served as the Chair of the Commission on Social Determinants of Health.

Criticizing those who justify initiatives in global health solely on economic grounds, Sir Marmot argued that addressing the social determinants of health is a matter of social justice.

He presented data and discussed the report’s three primary recommendations: 1. Improve daily living conditions; 2. Tackle the inequitable distribution of power, money, and resources; and 3. Measure and understand the problem and assess the impact of action.
Stating that the World Health Assembly resolution on the social determinants of health was only meaningful as a first “baby step,” Marmot urged the audience to consider how research and policy advocacy can address the social determinants of health so that all individuals can lead flourishing lives.

Examples from Asia include

• the high risk of maternal mortality (1 in 8) in Afghanistan;
• the steep gradient in under-5 mortality in India (with the rate almost three times higher for the poorest quintile than for the wealthiest quintile);
• less than half of women in Bangladesh have a say in decision-making about their own health care;
• a large share of the world’s population living on less than US$2 a day reside in Asia;
• social protection systems like pensions are possible in lower and middle-income countries, with Thailand as an example;
• more can be done to address the millions impoverished by catastrophic health expenditures, such as in southeast Asia; and
• conflict-ridden areas and internally displaced people, such as in Pakistan and Myanmar, are among the most vulnerable.

He also responded to questions about the role of freedom and liberty in social development – contrasting India and China – and commented on the peculiar contours of the US health reform debate.

Professor Marmot closed by noting that, in exhorting everyone to strive for social justice and close the gaps in health inequalities all too apparent in our 21st century world, he hoped he was not too much like Don Quixote, going around “doing good deeds but with people all laughing at him.” 
Professor Sir Michael Marmot MBBS, MPH, PhD, FRCP, FFPHM, FMedSci, is Director of the International Institute for Society and Health and MRC Research Professor of Epidemiology and Public Health at University College, London. In 2000 he was knighted by Her Majesty The Queen for services to Epidemiology and understanding health inequalities.