How hateful rhetoric connects to real-world violence |
- Early lessons from India’s health insurance scheme, Pradhan Mantri Jan Arogya Yojana
- The death of Chadian President Idris Déby Itno threatens stability in the region
- How Black-owned businesses can make the most out of the Biden infrastructure plan
- Hutchins Roundup: Air pollution, computerization, and more
| Early lessons from India’s health insurance scheme, Pradhan Mantri Jan Arogya Yojana Posted: 29 Apr 2021 11:07 AM PDT By Shawin Vitsupakorn, Wenhui Mao, Ipchita Bharali As the coronavirus crisis continues, economic pressure and existing health systems challenges have aggravated disparities between the rich and poor in health care access and use. India's experience is especially instructive, and not just because of its current difficulties in managing the exigencies related to COVID-19-related immunization, infections, and hospitalization. Since 2005, over 270 million people in India have escaped poverty. However, COVID-19 and ongoing demographic and epidemiological transitions threaten to reverse this progress. While the government introduced major health reforms such as the National Health Mission (2005) and Rashtriya Swasthya Bima Yojana (RSBY, 2008) to cater to the needs of the poor, underfunded public health has struggled to meet the changing needs of people. Government health spending was only 1.17 percent of India's GDP in 2016, a lower share than the low-income country average (1.57 percent). By 2018, 62.8 percent of people did not have health insurance. Most households shoulder the burden of health care costs, with out-of-pocket expenses comprising 58.7 percent of total health spending. Furthermore, 1 in 5 households experiences catastrophic or impoverishing health expenses. Although RSBY—a publicly funded health insurance scheme for households below the poverty line—represented a big step toward universal health care, it grossly underperformed due to a low reimbursement ceiling, a limit of five enrollees per household, exclusion of outpatient care, and low enrollment. In addition, India's decentralized health governance gives rise to the fragmentation of insurance schemes, contributing to systemic inefficiency and inequity. The ambitious plans for the Pradhan Mantri Jan Arogya YojanaA decade after the launch of RSBY, the government unveiled Ayushman Bharat, a national health initiative with a two-pronged approach. First, it called for the operationalization of 150,000 health and wellness centers by the end of 2022; these would serve as hubs for comprehensive primary health care. Second, it established the Pradhan Mantri Jan Arogya Yojana (PM-JAY), an insurance scheme that would cover secondary and tertiary health services for poor and vulnerable communities. A recent review of PM-JAY by the Public Health Foundation of India and Center for Policy Impact in Global Health, Duke University found the following successes:
The implementation of PM-JAY marks the government's commitment to the well-being of the most vulnerable populations and more broadly, to advancing universal health care in India. Despite impressive achievements in its first two years, PM-JAY faces serious challenges in equity, quality, effectiveness, and sustainability:
What to do nowLooking ahead, the government of India has to consider further reforms to advance its universal health coverage ambitions. The most important areas are financing, costs, substitution, and quality.
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| The death of Chadian President Idris Déby Itno threatens stability in the region Posted: 29 Apr 2021 10:43 AM PDT By Alexandre Marc The sudden death on April 19, 2021 of Chadian President Idriss Déby Itno is creating a very dangerous vacuum in Central Africa and the Sahel. Déby, who ruled Chad for 30 years, was killed while fighting rebels trying to overthrow his government. Few sub-Saharan African countries have the regional reach of Chad, and this is due essentially to its army — an army Déby was visiting when he was killed in a firefight, as Chadian troops battled with rebels from Libya. Chad has one of the most effective armies in sub-Saharan Africa and has, over the last 20 years, appeared on all fronts of the war against jihadist groups in the Sahel. It has also been involved in some neighboring civil wars, notably those in Sudan and the Central African Republic (CAR), and more indirectly in Libya. Chad's powerful army gives it a formidable footprint in the regionDéby built Chad's powerful army for a few reasons: to protect his regime from the constant ethnic rivalries and ambitions of various warlords from the country's north; and also to achieve international recognition, credibility, and leverage in order to manage internal politics and use economic resources without interference. Déby always received strong backing from the West, particularly France and the U.S., despite his autocratic rule and rampant government corruption. Chad has been the strongest supporter of Barkhane, the French military operation to fight jihadist groups in the Sahel. It has repeatedly sent expeditionary forces into the region and has just positioned more than 1,000 troops in the tri-border region of Liptako-Gourma, where a bloody jihadist insurgency is wreaking havoc on the population and national armies. Chad is also widely recognized as an essential pillar of the G5 Sahel — a military alliance between Burkina Faso, Chad, Mali, Mauritania, and Niger, and heavily supported by France and the U.S. — to fight the region's powerful jihadist insurrection. The Chadian army is very familiar with the terrain, as its troops were critically involved in the 2013 French-led military operation to defend Mali from a takeover by well-organized Islamic armed groups. Chad is also one of the top troop contributors to the United Nations Multidimensional Integrated Stabilization Mission in Mali, the peacekeeping operation set up in 2013 in Mali in response to the insurrection. Chad's military presence in the region is not limited to the Sahel. In 2015, along with troops from neighboring Niger, it played a major role in dislodging Boko Haram from Northern Nigeria. It liberated some large Nigerian cities that had been under the terrorist organization's control for months, and struck a near-fatal blow to the organization. In doing so, it shamed the Nigerian army — one of the largest in Africa — that had been paralyzed by Boko Haram for years. Chad continues to fight Boko Haram in and around Lake Chad. Recently, it lost around 100 men in clashes with Boko Haram and one of its splinter groups, the Islamic State in the West Africa Province (ISWAP). In response, it mounted a massive offensive and destroyed the camps of these organizations, supposedly killing more than 1,000 militants. At that time, Déby complained bitterly that his army was the only one taking on militants in this region, and threatened to pause all support for the war against terrorist groups outside of his country. These threats were a recurrent strategy to remind the world of Chad's centrality and to gain support and recognition from Western nations. Chad also played a role in the conflict in CAR. A few years ago, it got involved with armed groups in CAR's northeast, assembled under a loose association called Seleka that occupied part of the country. Chad played a role in ending the conflict. Following the 2013 CAR civil war, Chad participated in the U.N. peacekeeping operation, contributing 850 troops, but left after being accused of human rights abuses and of being partial to the Muslim population. The situation was further complicated by members of the Chadian army having commercial interests in CAR linked to cattle raising and trading. In CAR, the Chadian army's role varies: Sometimes it plays a stabilizing role, and at others it clearly contributes to violence and exactions. Déby always kept an eye on Darfur, and more broadly on Sudan — mostly for internal security reasons, but Chad also had a strong impact on its neighbor at times. His Zaghawa ethnic group (and of some of his most trusted generals) represents less than 5% of the Chadian population, but is one of the most populous groups in Darfur. Some Chadian Zaghawa people based in Darfur had long been Déby's most vigorous armed opposition group. To manage his opponents, he made efforts to please Khartoum, while always showing that he could influence the civil war that was ravaging the west of the country through his ethnic and family connections. He did this with the Justice and Equality Movement (MJE), one of the main armed groups opposing President Omar al-Bashir. In 2005, tensions between the two countries became heated, with armed clashes at the border. Twice, armed groups coming from Sudan to overthrow Déby nearly reached the capital, N'Djamena. In response, Déby sent his troops to track the rebels and reached the suburbs of Khartoum, clearly showing that he could bring Chad's military might to bear. By the same logic, Déby tried to manage his relations with Libyan groups, and it is understood that he had a good relationship with General Khalifa Haftar. Today, the most active military opposition to Déby's regime comes from southern Libya (the Fezan), where some Chadian rebels helped General Haftar and where the Goran tribe — which constitutes the majority of the rebels — are active in illicit trading activities. The group that entered Chad and ended up killing Déby last week came from southern Libya; they built up an impressive arsenal, probably through their involvement in the Libyan civil war. A well-financed, powerful, and unusually-structured armyDéby's powerful army is an interesting mix of rebel groups and a modern army, making it very powerful but also highly dependent on Déby's personal involvement. Most of the high-ranking officers and elite troops are recruited from the northern tribes — principally the Zaghawa, but also the Goran and other groups more broadly known as Toubous. They possess very old and solid combat traditions, excellent knowledge of the desert, an astonishing physical endurance, and a lot of courage. The elite units are often comprised of family and clan members who know each other well. At the same time, the army uses well-trained technicians such as helicopter and combat plane pilots who benefit from heavy support from France and other Western countries. Oil revenues fund generous salaries for officers and elite troops, as well as an impressive arsenal of relatively sophisticated equipment, including combat aircraft and helicopters. The International Crisis Group estimates that 40% to 50% of Chad's budget goes to the country's defense and security expenses. In 2000, Chad started to exploit relatively important oil reserves situated in the country's south. Worried about corruption, the World Bank and a number of development partners set up a complex mechanism by which they would finance an essential pipeline to export the oil to the coast, on the condition that the revenue would be channeled to a special fund monitored by donors. This mechanism was set up to ensure that resources would be used for development and poverty alleviation. At that time, this mechanism was hailed as a great innovation in good governance. But starting in 2006, Déby managed to change the original system to channel significant oil revenues to his army and to large public work programs of his choice, which did not always benefit the poor. Given the regional geopolitics, however, Western donors averted their eyes and accepted the situation. Many instability risks that need careful managementDespite its strength, the Chadian army also has significant weaknesses that could feed instability. First, the way the army acts toward the civilian population, with frequent exactions, limits its capacity to build up trust in ways that are essential for stability. Second, the army is marred by internal rivalry between commanders. Family rivalries or clan-based rivalries often extend inside the army. The fact that so many of the elite soldiers are northerners means that they also tend to have strong connections to some of the rebel movements based in Sudan or Libya, which are often comprised of former soldiers of the Chadian army. Also, Déby's strong involvement in the army — which he often commanded directly in the field — is probably the biggest risk. He kept the army's internal cohesion through personal negotiations, meaning that many loyalties are to him and not to other high-ranking officers. An additional source of instability is Chad's tense and fragmented political landscape. Just days before his death, Déby was reelected for a sixth consecutive term, with 80% of the vote; however, his hold on power was largely seen as a parody of democracy. His regime was autocratic, and while a decade ago he was making efforts to accommodate opponents and had some pretense of inclusiveness, his regime is now opaque, with most decisions made by a small group of friends and relatives. Just after his death, a Transitional Military Council was established, with 15 generals all very close to Déby; it is chaired by his son, a 37-year-old general.
The council has suspended the constitution and declared an 18-month transition period. One of the main reasons for the move is certainly the fear that the army could disintegrate, but it is also to ensure that the clan of Déby keeps control of the army and the country. The political opposition and civil society have called the move a military coup and called for protests, as did the African Union. Neither France nor the U.S. said anything immediately, but after protesters died during demonstrations, they weighed in with condemnation of the killing. These are very delicate times for Chad and the entire region. The personalization of Déby's regime has left the country with extremely weak institutions. There is a real risk of serious infighting inside the army and the circles of power, even inside Déby's own family. Also, tensions with the political opposition are rapidly increasing. It seems clear that suspending the constitution will only make things worse. France, the European Union, and the U.S. — the main donors to Chad — should put strong pressure on the Transitional Military Council so that it engages in a more substantive dialogue with political factions and civil society than it has done so far. The council should also show that it is serious about organizing elections, as it said it would, much earlier than in 18 months, as announced. Under pressure, the council has just nominated a civilian prime minister. This is a good step. It should also nominate a government sufficiently representative of the country's different social groups, particularly ethnic groups from the south and center that have been marginalized. It would also be important for Western nations to pressure the new Libyan authorities, particularly General Haftar, to rapidly improve their control of various militias and armed groups in Libya. The ceasefire in this country has created opportunities for highly armed groups to look for opportunities abroad, as was the case when the Gadhafi regime fell.  This posting includes an audio/video/photo media file: Download Now | ||||||||||||||||||||||||||
| How Black-owned businesses can make the most out of the Biden infrastructure plan Posted: 29 Apr 2021 09:45 AM PDT By Andre M. Perry, Tynesia Boyea-Robinson, Carl Romer Alongside much-needed investments in the nation's roads, bridges, and water systems, President Joe Biden's $2 trillion infrastructure proposal, the American Jobs Plan, promises to create more opportunities for small businesses and advance racial equity. One way to accomplish both of these goals, as we have written previously, is to invest in Black-owned businesses, allowing them to play a role in the plan's revitalization of our infrastructure. Black businesses do not lack for quality or service compared to their white-owned counterparts. What Black businesses lack is investment, which is reflected in their size and revenue. According to our analysis, roughly 96% of Black-owned businesses are sole proprietorships (unincorporated businesses owned and operated by one individual) compared to 79.9% of non-Black-owned businesses. Employer businesses (firms with more than one employee) are much more likely to participate in multifaceted infrastructure projects like those proposed in the Biden plan. Sole proprietorships need significant investment and growth before they can do the same. Black business owners know too well what happens when government fails to recognize the composition of their businesses. The first round of Paycheck Protection Program funding in the 2020 CARES Act restricted COVID-19 relief subsidies to employer firms, which largely shut out Black entrepreneurs. The geographic coverage of the subsidy also showed bias; according to a Bloomberg analysis, 27% of businesses in white-majority congressional districts received relief loans, compared with 17% of businesses in districts where minorities made up more than half the population. For Black businesses to truly benefit from the Biden infrastructure plan, its investments must reach the sectors and places where those businesses operate. The 3 million Black sole proprietorships make up 11.7% of all such businesses in the country. (Meanwhile, Black-owned employer businesses make up only 2.2% of the total.) To participate in infrastructure projects, sole proprietorships need to be in the industries that will be in demand. Table 1 shows that Black sole proprietorships operate in different sectors than their non-Black counterparts. Table 1. Black sole proprietorships operate in different sectors
The average revenue for Black sole proprietorships is $22,223, while the average revenue for non-Black sole proprietorships is $50,050. Table 2 shows that the sectors in which most Black sole proprietors operate earn less revenue than the sectors for non-Black sole proprietors. Table 2. Black sole proprietorship sectors have less revenue than non-Black sole proprietorship sectors
On a geographic level, we calculated the share of Black-owned sole proprietorships relative to the local Black population in their respective metropolitan areas to get a sense of how regional ecosystems generally support firms. A ratio of 1 means that the Black population is well reflected in the business community. By examining the sectors those firms are in, we can also get a sense of the degree to which firms can grow to take on infrastructure projects. There are several micropolitan areas (particularly in Texas) where the ratio of Black sole proprietorships to the Black population percentage is significantly greater than 1, meaning that the Black population is overrepresented in sole proprietorships. The high ratio may be skewed by sole proprietorships that participate in the "gig economy"—and, as such, are not traditional businesses, but rather a consequence of discriminatory labor markets and a lack of quality jobs. Whether the higher ratios in these micropolitan areas are due to a supportive local ecosystem or to discrimination and poor job quality is to be determined and should be further studied.
Our research shows that to equitably represent the Black population share, we need to create 806,218 new Black employer businesses. The corresponding labor market reality is that if 806,218 sole proprietorships became employer businesses, that would create at least as many jobs. According to the Economic Policy Institute, as of April 2021, the U.S. was down 8.4 million jobs from where it was before the COVID-19 pandemic. Adding more than 800,000 new jobs would lower the overall unemployment rate and disproportionately help the Black unemployment rate. While many sole proprietorships function as they are designed and their owners are happy with the state of their businesses, many others would like to expand but lack the capital to grow. There are organizations and firms in different cities that have created some simple but concrete ways to increase capital to this class of firms. Some of these efforts include:
President Biden's jobs plan intends to "reconnect neighborhoods cut off by historic investments" and "redress historic inequities." It can do this by building capacity in Black businesses and Black communities. By investing in the development of Black firms and employing them in infrastructure projects, the plan will enable the Black community to participate in its own recovery. Growing Black sole proprietorships and converting them to employer businesses is a key first step before this vision can be realized.  This posting includes an audio/video/photo media file: Download Now | ||||||||||||||||||||||||||
| Hutchins Roundup: Air pollution, computerization, and more Posted: 29 Apr 2021 08:00 AM PDT By Sophia Campbell Studies in this week's Hutchins Roundup find almost all fine-particle air pollution sources affect people of color disproportionately, the computer knowledge gap that once drove older workers out of their jobs has largely closed, and more. Want to receive the Hutchins Roundup as an email? Sign up here to get it in your inbox every Thursday. Nearly all sources of fine-particle air pollution disproportionately affect people of colorPeople of color are disproportionately exposed to harmful PM2.5 air pollution (tiny particles less than 2.5 micrometers in diameter—more than 100 times thinner than a human hair—that are emitted from burning fuel). Christopher Tessum of the University of Illinois Urbana-Champaign and co-authors show that this racial disparity is present for nearly all emissions sources—representing about 75% of total PM2.5 exposure in the US—rather than for just a few. The problem is systemic, the authors say— consistent across major sectors, urban and rural areas, income, and exposure levels. Black communities in particular are exposed to above average concentrations in all sectors, while white communities face below average exposure in all sectors except for coal-fired electricity generation. Among the largest sources of the disparity are industry, construction, light-duty gasoline vehicles, and heavy-duty diesel vehicles. A computer knowledge gap that once pushed older workers out of the workforce has largely closedUsing survey data on computerization and labor market outcomes for older workers between 1984 and 2017, Péter Hudomiet of the RAND Corporation and Robert J. Willis of the University of Michigan find that as occupations were computerized, older workers faced a computer knowledge gap relative to their younger peers—but that differences in computer use across age groups largely disappeared by the early 2010s. Older workers likely felt pressure to adopt the new technology in order to meet the competition from younger workers, the authors say. In the meantime, however, the authors find that this knowledge gap pushed many older workers out of the labor force or into part-time jobs and lowered their wages. These effects were largest for women and middle-skilled workers, whose occupations saw greater replacement of workers by computers. Fostering the talent of disadvantaged children important to innovation and long-run growthPursuing public investment in research and development only through subsidies and tax breaks for companies, institutions, and individual scientists may not increase the number of inventors and so may be ineffective at increasing innovation. Instead, John Van Reenen of the London School of Economics suggests that policies aimed at young, disadvantaged children who show early promise in academics could be particularly effective at boosting innovation and long-run growth by leading to an increase in the number of innovators in the economy. Despite similar measures of early ability, only 0.5 out of 1,000 Black children become inventors compared to 1.6 out of 1,000 white children. Targeting programs, such as tracking students into gifted and talented programs have been shown to push more talented students into innovation. In the shorter-term, immigration of highly–educated workers can also boost innovation. While immigrants are 17-18% of the U.S. labor force, they earn 52% of STEM doctorates and about 25% of patents. Chart of the week: US population growth from 2010 to 2020 lowest since 1930s
Quote of the week:"I’ve referred to an economy on crutches; one fiscal crutch, one monetary crutch… [economies] have to go across the bridge of the pandemic and have to be on solid and sustainable ground in order to walk on a self-sustained basis… Clearly the use of debt in the first few months of the pandemic had to do with keeping the economy afloat, making sure that businesses were not going down the tube, making sure that people were not left without income," says Christine Lagarde, President of the European Central Bank. The real question now is: what use is made of debt? Is the public spending targeted and temporary in order to cross the bridge of the pandemic, as I have indicated earlier in the first instance? Second, is this public financing going to be spent on productivity-enhancing reforms that will actually improve the growth potential of those economies? If that is the case and financing terms remain attractive relative to the growth that can be developed as a result of those targeted temporary measures and productivity-enhancing measures, then this is debt put to good use."  |
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