Dismantle the Poverty Trap by Nurturing Community Trust

Would you rather receive $100 today or wait for a year and then receive $150? The ability to delay immediate gratification for a potentially greater payout in the future is associated with greater wealth. Several studies have shown that the poor tend to opt for immediate rewards even if they are lower, whereas the wealthy are willing to wait for greater rewards. One obvious reason for this difference is the immediate need for money. If food has to be purchased and electricity or water bills have to be paid, then the instant “reward” is a matter of necessity. Wealthier people can easily delay the reward because their basic needs for food, shelter and clothing are already met.

Unfortunately, escaping from poverty often requires the ability to delay gratification for a greater payout in the future. Classic examples are the pursuit of higher education and the acquisition of specialized professional skills which can lead to better-paying jobs in the future. Attending vocational school, trade school or college paves the way for higher future wages, but one has to forego income during the educational period and even incur additional debt by taking out educational loans. Another example is of delayed gratification is to invest capital – whether it is purchasing a farming tool that increases productivity or investing in the stock market – which in turn can yield greater pay-out. However, if the poor are unable to pursue more education or make other investments that will increase their income, they remain stuck in a vicious cycle of increasing poverty.

Understanding the precise reasons for why people living in poverty often make decisions that seem short-sighted, such as foregoing more education or taking on high-interest short-term loans, is the first step to help them escape poverty. The obvious common-sense fix is to ensure that the basic needs of all citizens – food, shelter, clothing, health and personal safety – are met, so that they no longer have to use all new funds for survival. This is obviously easier in the developed world, but it is not a trivial matter considering that the USA – supposedly the richest country in the world – has an alarmingly high poverty rate. It is estimated that more than 40 million people in the US live in poverty, fearing hunger and eviction from their homes. But just taking care of these basic needs may not be enough to help citizens escape poverty. A recent research study by Jon Jachimowicz at Columbia University and his colleagues investigated “myopic” (short-sighted) decision-making of people with lower income and identified an important new factor: community trust.

The researchers first used an online questionnaire (647 participants) to assess trust and asked participants to choose between a payoff in the near future that is smaller and a larger pay-off in the distant future. They also measured community trust by asking participants to agree or disagree with statements such as “There are advantages to living in my neighborhood” or I would like my child(ren) to be raised in the neighborhood I currently live in”. They found that lower income participants were more likely to act in a short-sighted manner if they had low levels of trust in their communities. In a second online experiment, the researchers recruited roughly 100 participants from each state in the US and assessed their community trust levels. They then obtained real-world data on payday loans – a sign of very short-sighted financial decision-making because people take out cash advances at extraordinarily high interest rates that have to be paid back when they get their paycheck – for each state. They found that the average community trust for each state was related to the use of payday loans. In states with high average community trust ratings, people were less likely to take out these payday loans, and this trend remained even when the researchers took into account unemployment rates and savings rates for each state.

Even though these findings all pointed to a clear relationship between community trust and sound financial decision-making, the results did not prove that increased community trust is an underlying cause that helps improve the soundness of financial decisions. To test this relationship in a real-world setting, the researchers conducted a study in rural Bangladesh by collaborating with an international development organization based in Bangladesh. The vast majority of participants in this study were poor even by Bangladeshi standards, earning less than $1/day per household member. The researchers adapted the community trust questionnaire and the assessment of financial decision-making for the rural population, with live interviewers asking the questions and filling out the responses for the participants. After assessing community trust and the willingness to delay financial rewards for greater payouts in the future, half of the participants received a two year intervention to increase community trust. This intervention involved volunteers from the community that acted as intermediaries between the local government and the rural population, providing input into local governance and community-level decisions (for example in the distribution of social benefits and the allocation of funds for development projects).

At the end of the two year period, participants who had received the community intervention showed significant increases in their community trust levels and they also improved their financial decision-making. They were more likely to forego immediate lower financial rewards for greater future rewards when compared to the villagers who did not receive any special intervention.

By combining correlational data from the United States with an actual real-world intervention to build community trust, the researchers show how important it is to build trust when we want to help fellow humans escape the “poverty trap“. This is just an initial study with a limited group of participants and a narrow intervention that needs to be replicated in other societies and with long-term observation of the results to see how persistent the effects are. But the results should make all of us realize that just creating “jobs, jobs, jobs” is not enough. We need to invest in the infrastructures of communities and help citizens realize that they are respected members of society with a voice. Empowering individuals and ensuring their safety, dignity and human rights are necessary steps if we are serious about battling poverty.

Reference

Jachimowicz, J. M., Chafik, S., Munrat, S., Prabhu, J. C., & Weber, E. U. (2017). Community trust reduces myopic decisions of low-income individuals. Proceedings of the National Academy of Sciences, 201617395.

Note: An earlier version of this post was first published on the 3Quarksdaily blog.

ResearchBlogging.org

Jachimowicz, J., Chafik, S., Munrat, S., Prabhu, J., & Weber, E. (2017). Community trust reduces myopic decisions of low-income individuals Proceedings of the National Academy of Sciences DOI: 10.1073/pnas.1617395114

Let Them Make My Cake: Exporting Burden, Importing Convenience in the Externalization Society

On 5 November 2015, an iron ore tailings dam burst in Bento Rodrigues near the Brazilian city of Mariana, releasing 60 million cubic meters of a reddish-brown mud-flood. This toxic flood buried neighboring villages and flowed into the Rio Doce, contaminating the river with several hazardous metals including mercury, arsenic and chromium as well as potentially harmful bacteria. The devastating and perhaps irreparable damage to the ecosystem and human health caused by this incident are the reason why it is seen as one of the biggest environmental disasters in the history of Brazil. The German sociologist Stephan Lessenich uses this catastrophe as a starting point to introduce the concept of the Externalisierungsgesellschaft(externalization society) in his book Neben uns die Sintflut: Die Externalisierungsgesellschaft und ihr Preis (“Around us, the deluge: The externalization society and its cost”).

What is the externalization society? According to Lessenich, this expression describes how developed countries such as the United States, Japan and Germany transfer or externalize risks and burdens to developing countries in South America, Africa and Asia. The Bento Rodrigues disaster is an example of the environmental risk that is externalized. Extracting metals that are predominantly used by technology-hungry consumers in developed countries invariably generates toxic waste which poses a great risk for the indigenous population of many developing countries. The externalized environmental risks are not limited to those associated with mining raw materials. The developed world is also increasingly exporting its trash into the third world.

The US, for example, are the world’s largest exporter of paper trash, exporting scrap paper worth US$ 3.1 billion each year. The US is also the largest producer of electronic waste (E-Waste), estimated at more than 7 million tons of E-Waste per year (PDF). Every new smartphone or tablet release generates mountains of E-Waste as consumers discard their older devices. Re-cycling the older devices sounds like a reasonable solution bu true recycling and re-using of electronic components is quite costly and time-consuming. It is also often not clear which electronic components of devices actually get recycled. To track the fate of discarded electronic devices, Jim Puckett from the Basel Action Network and his colleagues placed GPS-trackers in old electronics dropped off at US-based recycling centers. They found that a third of the “recycled” electronics were shipped overseas to countries such as Mexico, Taiwan, China, Pakistan, Thailand and Kenya. Puckett used the GPS signal to identify the sites where the E-Waste ended up and visited such a location in Hong Kong, where he found that the “recycled” electronics were being dismantled in junkyards by migrant workers from mainland China who were not wearing any protective clothing that would have protected them from hazardous materials released during the extraction of salvageable E-Waste materials. There are many regulations that restrict the trading of E-Waste but the United Nations Environment Program (UNEP) estimates that up to 90% of the world’s E-Waste is traded or dumped illegally. This means that even though dropping off old devices at a recycling center may alleviate the conscience of consumers, a significant number of these will not be re-used but instead shipped off to junkyards in other countries – without appropriate monitoring of how these electronic waste products will affect the local environment and health of the population.

Exporting environmental risks to developing countries by either outsourcing high-risk extraction of raw materials or simply dumping waste is just one example of externalization according the Lessenich. Externalizing occupational health risks and poverty by severely under-paying workers are other examples. Bangladesh has now emerged as one of the world’s largest manufacturers of clothing because of its cheap labor. In 2011, the typical monthly wage of a garment industry worker in Bangladesh was estimated at $91 per month – roughly one and a half dollars per day! In addition to this dismally low pay, garment factory workers in Bangladesh also face terrible occupational risks. The collapse of the Rana Plaza garment factory building in 2013 which called over 1,100 people and injured more than 2,500 people is just one example of the occupational risks faced by the workers.

Lessenich’s concept of the externalization society isn’t just another critique of the global inequality that we so often hear about. The fundamental principle of the externalization society put forth by Lessenich is the interdependence between the “imperial lifestyle” of wealth and comfort in the developed world and the “wretched lifestyle” of poverty and hardship in the developing world. If those of us who live in the developed world want the convenience of upgrading our smartphones every few years or buying cheap cotton t-shirts, then we need those who manufacture these products in the developing world to be paid lousy wages. If those workers were paid humane wages and their employers instituted appropriate occupational safety measures, as well as health and disability insurance plans that are routine in most parts of the developed world, then the cost of the products would be incompatible with our current economy and lifestyle which are fueled by consumerism and the capitalist imperative of incessant growth.

The pillars of the externalization society are indifference and ignorance. We are indifferent because we see the differential in lifestyle as a Selbstverständlichkeit – a German word for obviousness or taken-for-grantedness. They were born in developing countries, so of course they have to struggle – tough luck, they ended up with the wrong lottery tickets. This Selbstverständlichkeit also extends to the limited mobility of the people born in the developing world. They lack the birthright of the developing world citizens whose passports allow them to either travel visa-free or obtain a visa to nearly any country in the world with minimal effort. This veneer of Selbstverständlichkeit is easiest to maintain if “they” and “their” problems are invisible and thus allow us to ignore the interdependence between our good fortune and their misery. We might see images of the toxic flood in Brazil but few, if any, members of the externalization society will link the mining of cheap iron in Brazil to the utensils they use in their everyday life.

A decade ago, disposable single-use coffee pods such as the Keurig K-cups or the Nespresso pods were extremely rare but by 2014, K-cup manufactures sold a mind-boggling 9 billion K-cups! A new need for disposable products that had previously been met by standard coffee machines arose without considering the environmental and global impact of this need. In theory, the K-cups are recyclable but this would require careful separating of the paper, plastic and the aluminum top. It is not clear how many K-cups are properly recycled, and the E-Waste example shows that even if items are transported to recycling centers, that does not necessarily mean that they will be successfully recycled. Prior to the advent coffee pods, our coffee demands had been easily met without generating additional mountains of disposable plastic and aluminum coffee pod trash. Out of nowhere, there arose a new need for aluminum which again is extracted from the aluminum ore bauxite – another process that generates toxic waste. Instead of feeling a sense of absolution when we drop a disposable item into a recycling bin, we should simply curtail unnecessary consumption of products in disposable containers.

How do we overcome the externalization society? We can make concerted efforts through advocacy, education and regulations that restrict exporting environmental waste, improve health and safety conditions for workers in the developing world and try to restrict our consumerist excesses by clarifying the interdependence between wealth in the externalization society and the poverty in the developing world as well as the moral imperative to abrogate the inequality and asymmetry. Numerous advocates have already attempted this approach for the past decades with limited success. Maybe instead of appealing to the ethics of interdependence, a more effective approach may be to educate each other about the consequences of the interdependence. When millions of refugees show up at the doorstep of the externalization society, “they” are no longer invisible. One can blame wars, religious extremism and political ideologies for the misery of the refugees but it becomes harder to ignore the extent and central role of the underlying inequality. Creating humane working and living conditions for people in the developing world is perhaps the most effective way to stop the so-called “refugee crisis“.

Global climate change is another threat to the externalization society, a threat of its own making. Transferring carbon footprints and pollution to other countries does not change the fact that the whole planet is suffering from the consequences of climate change. Political leaders of the externalization society often demand the closing of borders, erecting walls and expanding their armed forces so they are less likely to have to confront the victims of their externalization but no army or wall is strong enough to lower the rising water levels or stabilize the climate. The externalization society will end not because of a crisis of conscience but because its excesses are undermining its own existence.

Reference:

Lessenich, S. (2016). Neben uns die Sintflut: Die Externalisierungsgesellschaft und ihr Preis. Hanser Berlin.

 

Note: An earlier version of this article was first published on the 3Quarksdaily blog.

Plastic Words are Hollow Shells for Rigid Ideas: The Ever-Expanding Language of Tyranny

Words are routinely abused by those in power to manipulate us but we should be most vigilant when we encounter a new class of “plastic words“. What are these plastic words? In 1988, the German linguist Uwe Pörksen published his landmark book “Plastikwörter:Die Sprache einer internationalen Diktatur” (literal translation into English: “Plastic words: The language of an international dictatorship“) in which he describes the emergence and steady expansion during the latter half of the 20th century of selected words that are incredibly malleable yet empty when it comes to their actual meaning. Plastic words have surreptitiously seeped into our everyday language and dictate how we think. They have been imported from the languages of science, technology and mathematics, and thus appear to be imbued with their authority. When used in a scientific or technological context, these words are characterized by precise and narrow definitions, however this precision and definability is lost once they become widely used. Pörksen’s use of “plastic” refers to the pliability of how these words can be used and abused but he also points out their similarity to plastic lego bricks which act as modular elements to construct larger composites. The German language makes it very easy to create new composite words by combining two words but analogous composites can be created in English by stringing together multiple words. This is especially important for one of Pörksen’s key characteristics of plastic words: they have become part of an international vocabulary with cognate words in numerous languages.

lego-crowd

 

Here are some examples of “plastic words”(German originals are listed in parentheses next to the English translations) – see if you recognize them and if you can give a precise definition of what they mean:

exchange (Austausch)

information (Information)

communication (Kommunikation)

process (Prozess)

resource (Ressource)

strategy (Strategie)

structure (Struktur)

relationship (Beziehung)

substance (Substanz)

progress (Fortschritt)

model (Modell)

development (Entwicklung)

value (Wert)

system (System)

function (Funktion)

growth (Wachstum)

supply (Versorgung)

quality (Qualität)

welfare (Wohlfahrt)

planning (Planung)

Even though these words are very difficult to pin down in terms of their actual meaning, they are used with a sense of authority that mandates their acceptance and necessity. They are abstract expressions that imply the need for expertise to understand and implement their connotation. Their implicit authority dissuades us from questioning the appropriateness of their usage and displaces more precise or meaningful synonyms. They have a modular lego-like nature so that they can be strung together with each other or with additional words to expand their authority; for example, “resource development“, “information society“, “strategic relationship” or “communication process“.

How about the word “love”? Love is also very difficult to define but when we use it, we are quite aware of the fact that it carries many different nuances. We tend to ask questions such as “What kind of love? Erotic, parental, romantic, spiritual? Who is in love and is it truly love?” On the other hand, when we hear “resource development’, we may just nod our heads in agreement. Of course resources need to be developed!

lego-blocks

Pörksen published his book during the pre-internet, Cold War era and there have been new families of plastic words that could perhaps be added to the list in the 21st century. For one, there is the jargon of Silicon Valley that used by proponents of internet-centrism. Words such as digital, cyber, internet, online, data or web have entered everyday language but we rarely think about their actual meaning. The word internet, for example, technically refers to a bunch of servers and input devices and screen connected by cables and routers but it has taken on a much broader cultural and societal significance. An expression such as internet economy should elicit the important question of who is part of the “internet economy” and who is left out? The elderly and the poor have limited access to the internet in many countries of the world but we may gloss over this fact when we speak of the internet. The words innovation, integration, global and security/safety have also become key plastic words in the 21st century.

How do these plastic words become vehicles for the imposition of rigid views and tyranny? Two recent examples exemplify this danger.

The British Prime Minister Theresa May justified Britain’s decision to leave the European Union after a campaign characterized by anti-immigrant prejudice and nationalism in a speech by invoking Britain’s new global role:

I want us to be a truly Global Britain – the best friend and neighbour to our European partners, but a country that reaches beyond the borders of Europe too. A country that goes out into the world to build relationships with old friends and new allies alike.

It is difficult to argue with the positive connotation of a Global Britain. Global evokes images of the whole planet Earth, and why shouldn’t Britain forge new relationships with all the people and countries on our planet? However, the nationalist and racist sentiments that prompted the vote to leave the European Union surely did not mean that Britain would welcome people from all over the globe. In fact, the plastic words global and relationships allow the British government to arbitrarily define the precise nature of these relationships, likely focused on maximizing trade and profits for British corporations while ignoring the poorer nations of our globe.

Similarly, an executive order issued by the new American president Donald Trump within a week of his inauguration banned the entry of all foreigners heralding from a selected list of Muslim-majority countries into the USA citing concerns about security, safety and welfare of the American people. As with many plastic words, achieving security, safety and welfare sound like important and laudable goals but they also allow the US government to arbitrarily define what exactly constitutes security, safety and welfare of the American people. One of the leading enforcement agencies of the totalitarian East German state was the Stasi (Ministerium für Staatssicherheit – Ministry for State Security). It allowed the East German government to arrest and imprison any citizen deemed to threaten the state’s security – as defined by the Stasi.

How do we respond to the expanding use of plastic words? We should be aware of the danger inherent in using these words because they allow people in power – corporations, authorities or government agencies – to define their meanings. When we hear plastic words, we need to ask about the context of how and why they are used, and replace them with more precise synonyms. Resist the tyranny of plastic words by asking critical questions.

Reference:

Pörksen, U. (1988). Plastikwörter: die Sprache einer internationalen Diktatur. Klett-Cotta.

English translation:

Poerksen, U. (1995). Plastic words: The tyranny of a modular language. Penn State Press.

Note: An earlier version of this post was first published on the 3Quarksdaily blog.

 

We Have Become Exhausted Slaves in a Culture of Positivity

We live in an era of exhaustion and fatigue, caused by an incessant compulsion to perform. This is one of the central tenets of the book “Müdigkeitsgesellschaft” (translatable as “The Fatigue Society” or “The Tiredness Society“) by the German philosopher Byung-Chul Han. Han is a professor at the Berlin Universität der Künste (University of the Arts) and one of the most widely read contemporary philosophers in Germany. He was born in Seoul where he studied metallurgy before he moved to Germany in the 1980s to pursue a career in philosophy. His doctoral thesis and some of his initial work in the 1990s focused on Heidegger but during the past decade, Han has written about broad range of topics regarding contemporary culture and society. “Müdigkeitsgesellschaft” was first published in 2010 and helped him attain a bit of a rock-star status in Germany despite his desire to avoid too much public attention – unlike some of his celebrity philosopher colleagues.

Fatigue

The book starts out with two biomedical metaphors to describe the 20th century and the emerging 21st century. For Han, the 20th century was an “immunological” era. He uses this expression because infections with viruses and bacteria which provoked immune responses were among the leading causes of disease and death and because the emergence of vaccinations and antibiotics helped conquer these threats. He then extends the “immunological” metaphor to political and societal events. Just like the immune system recognizes bacteria and viruses as “foreign” that needs to be eliminated to protect the “self”, the World Wars and the Cold War were also characterized by a clear delineation of “Us” versus “Them”. The 21stcentury, on the other hand, is a “neuronal” era characterized by neuropsychiatric diseases such as depression, attention deficit hyperactivity disorder (ADHD), burnout syndrome and borderline personality disorder. Unlike the diseases in the immunological era, where there was a clear distinction between the foreign enemy microbes that needed to be eliminated and the self, these “neuronal” diseases make it difficult to assign an enemy status. Who are the “enemies” in burnout syndrome or depression? Our environment? Our employers? Our own life decisions and choices? Are we at war with ourselves in these “neuronal” conditions? According to Han, this biomedical shift in diseases is mirrored by a political shift in a globalized world where it becomes increasingly difficult to define the “self” and the “foreign”. We may try to assign a “good guy” and “bad guy” status to navigate our 21st century but we also realize that we are so interconnected that these 20th century approaches are no longer applicable.

The cell biologist in me cringed when I read Han’s immunologic and neuronal metaphors. Yes, it is true that successfully combatting infectious diseases constituted major biomedical victories in the 20th century but these battles are far from over. The recent Ebola virus scare, the persistence of malaria resistance, the under-treatment of HIV and the emergence of multi-drug resistant bacteria all indicate that immunology and infectious disease will play central roles in the biomedical enterprise of the 21st century. The view that the immune system clearly distinguishes between “self” and “foreign” is also overly simplistic because it ignores that autoimmune diseases, many of which are on the rise and for which we still have very limited treatment options, are immunological examples of where the “self” destroys itself. Even though I agree that neuroscience will likely be the focus of biomedical research, it seems like an odd choice to select a handful of psychiatric illnesses as representing the 21st century while ignoring major neuronal disorders such as Alzheimer’s dementia, stroke or Parkinson’s disease. He also conflates specific psychiatric illnesses with the generalized increase in perceived fatigue and exhaustion.

Once we move past these ill- chosen biomedical examples, Han’s ideas become quite fascinating. He suggests that the reason why we so often feel exhausted and fatigued is because we are surrounded by a culture of positivity. At work, watching TV at home or surfing the web, we are inundated by not-so-subtle messages of what we can do. Han quotes the example of the “Yes We Can” slogan from the Obama campaign. “Yes We Can” exudes positivity by suggesting that all we need to do is try harder and that there may be no limits to what we could achieve. The same applies to the Nike “Just Do It” slogan and the thousands of self-help books published each year which reinforce the imperative of positive thinking and positive actions.

Here is the crux of Han’s thesis. “Yes We Can” sounds like an empowering slogan, indicating our freedom and limitless potential. But according to Han, this is an illusory freedom because the message enclosed within “Yes We Can” is “Yes We Should”. Instead of living in a Disziplinargesellschaft(disciplinary society) of the past where our behavior was clearly regulated by societal prohibitions and commandments, we now live in a Leistungsgesellschaft (achievement society) in which we voluntarily succumb to the pressure of achieving. The Leistungsgesellschaft is no less restrictive than the Disziplinargesellschaft. We are no longer subject to exogenous prohibitions but we have internalized the mandates of achievement, always striving to do more. We have become slaves to the culture of positivity, subjugated by the imperative “Yes, We Should”. Instead of carefully contemplating whether or not to pursue a goal, the mere knowledge that we could achieve it forces us to strive towards that goal. Buying into the “Yes We Can” culture chains us to a life of self-exploitation and we are blinded by passion and determination until we collapse. Han uses the sad German alliteration “Erschöpfung, Ermüdung und Erstickung” (“exhaustion, fatigue and suffocation”) to describe the impact that an excess of positivity has once we forgo our ability to say “No!” to the demands of the achievement society. We keep on going until our minds and bodies shut down and this is why we live in a continuous state of exhaustion and fatigue. Han does not view multitasking as a sign of civilizational progress. Multitasking is an indicator of regression because it results in a broad but rather superficial state of attention and thus prevents true contemplation

It is quite easy for us to relate to Han’s ideas at our workplace. Employees with a “can-do” attitude are praised but you will rarely see a plaque awarded to commemorate an employee’s “can-contemplate” attitude. In an achievement society, employers no longer have to exploit us because we willingly take on more and more tasks to prove our own self-worth.

While reading Han’s book, I was reminded of a passage in Bertrand Russell’s essay “In Praise of Idleness” in which he extols the virtues of reducing our workload to just four hours a day:

In a world where no one is compelled to work more than four hours a day, every person possessed of scientific curiosity will be able to indulge it, and every painter will be able to paint without starving, however excellent his pictures may be. Young writers will not be obliged to draw attention to themselves by sensational pot-boilers, with a view to acquiring the economic independence needed for monumental works, for which, when the time at last comes, they will have lost the taste and capacity. Men who, in their professional work, have become interested in some phase of economics or government, will be able to develop their ideas without the academic detachment that makes the work of university economists often seem lacking in reality. Medical men will have the time to learn about the progress of medicine, teachers will not be exasperatedly struggling to teach by routine methods things which they learnt in their youth, which may, in the interval, have been proved to be untrue.

Above all, there will be happiness and joy of life, instead of frayed nerves, weariness, and dyspepsia. The work exacted will be enough to make leisure delightful, but not enough to produce exhaustion. Since men will not be tired in their spare time, they will not demand only such amusements as are passive and vapid. At least one per cent will probably devote the time not spent in professional work to pursuits of some public importance, and, since they will not depend upon these pursuits for their livelihood, their originality will be unhampered, and there will be no need to conform to the standards set by elderly pundits. But it is not only in these exceptional cases that the advantages of leisure will appear. Ordinary men and women, having the opportunity of a happy life, will become more kindly and less persecuting and less inclined to view others with suspicion.

While Russell’s essay proposes reduction of work hours as a solution, Han’s critique of the achievement society and its impact on generalized fatigue and malaise is not limited to our workplace. By accepting the mandate of continuous achievement and hyperactivity, we apply this approach even to our leisure time. Whether it is counting the steps we walk with our fitness activity trackers or competitively racking up museum visits as a tourist, our obsession with achievement permeates all aspects of our lives. Is there a way out of this vicious cycle of excess positivity and persistent exhaustion? We need to be mindful of our right to refuse. Instead of piling on tasks for ourselves during work and leisure we need to recognize the value and strength of saying “No”. Han introduces the concept of “heilende Müdigkeit” (healing tiredness), suggesting that there is a form of tiredness that we should welcome because it is an opportunity for rest and regeneration. Weekend days are often viewed as days reserved for chores and leisure tasks that we are unable to pursue during regular workdays. By resurrecting the weekend as the time for actual rest, idleness and contemplation we can escape from the cycle of exhaustion. We have to learn not-doing in a world obsessed with doing.

Notes: An earlier version of this article was first published on the 3Quarksdaily Blog. Müdigkeitsgesellschaft was translated into English in 2015 and is available as “The Burnout Society” by Stanford University Press.

ResearchBlogging.org

Byung-Chul Han (2015). The Burnout Society Stanford University Press

African-Americans Receive Heart Transplants at Hospitals With Poor Performance Track Records

About five million people in the US suffer from heart failure, and approximately half of them die within five years of being diagnosed. Only about 2,500 people a year receive a heart transplant – the treatment of last resort. A new heart can be life-saving, but it is also life-changing. Even under the best conditions, the surgery is complex, and recovery carries a heavy physical and emotional burden.

And not all heart transplant recipients fare equally well after the surgery. Researchers have found that black heart transplant patients are more likely to die after surgery than white or Hispanic patients.

While many different factors contribute to the disparity, the research indicates that where patients received their heart transplants played a big role. Black patients were more likely to have their transplants performed at the worst-performing centers.

Patient with his family and physician (via Shutterstock)
Patient with his family and physician (via Shutterstock)

 

This is merely one of many examples of health disparities faced by black Americans. But as a cardiologist, I find this finding especially troubling because many of the heart failure patients I treat are black.

So how do patients decide where to have their heart transplants performed? And wouldn’t a person who needs a heart transplant choose to go to a top center?

Quality is obviously a major factor. But there is another big consideration in deciding where to get a transplant: accessibility.

Not all transplant centers have the same results

Researchers at Ohio State University reviewed the records of heart transplants performed at 102 transplant centers in the US from 2000 to 2010. The researchers focused on the rate of death during the first year after the transplant in over 18,000 heart transplant recipients.

They found that black patients had a higher rate of dying within one year of receiving a new heart (15.3%) than either Hispanics (12.5%) or whites (12.8%).

To find out why this was happening, the researchers used a mathematical model to predict the risk of dying within a year after the transplant for every patient based on the severity of their disease and complicating risk factors such as advanced age or reduced kidney function. They then compared the calculated risk with the actually observed death rates. The difference between the prediction and reality allowed them to determine the quality of a transplant center.

Care doesn’t end when surgery does.
Heart via www.shutterstock.com

It turned out that a greater proportion of blacks received their heart transplant at centers with higher-than-expected mortality as compared with whites and Hispanics (56.4% versus 47.1% versus 48.1%, respectively).

The contrast was even starker between the top- and worst-performing centers. Blacks had the lowest rate of being transplanted at centers with excellent performance (blacks: 18.5%; whites: 25.3%; Hispanics 28.3%). They also had the highest likelihood of undergoing their transplant surgery at the worst-performing centers.

It turns out that where a person has their transplant is critical. Only 8.7% of black patients died during the first year after the transplant if they were fortunate enough to undergo surgery at a top center. But this number was more than twice as high (18.3%) for blacks at the worst-performing centers.

The study didn’t provide any definitive explanations as to why the majority of blacks underwent heart transplantation at centers with lower than expected outcomes.

Choosing a transplant center isn’t much of a choice

Patients do not “choose” a transplant center by simply looking it up in a catalog or on a website. While performance statistics for each organ transplant center in the United States are publicly available in the Scientific Registry of Transplant Recipients, those statistics are only part of the decision for where a patient will get their transplant. The “choice” is often made for the patients by the doctors who refer them to a transplant center and by the accessibility of the center.

I’m a cardiologist, and in the Chicago area, where I practice, there are five active heart transplant centers. We can show the numbers for the centers to our patients when discussing the possibility of a heart transplant and also provide some additional advice based on our prior experiences with the respective transplant teams. Because our patients are nearly all based in the Chicagoland area, most of these programs are reasonable options for them. However, patients and doctors in cities or regions that don’t have as many transplant centers, or who live in more remote areas may not have the luxury of choice.

Far from home?
Hospital bed via www.shutterstock.com

Accessibility matters because care doesn’t end with the surgery

Unless you’ve had a heart transplant, or know someone who has, it’s hard to understand just how life-changing the surgery is. I’ve noticed that many people are unprepared for the emotional and physical toll from the surgery and recovery. And it’s this toll that can makes accessibility such an important factor when choosing a transplant center.

After surgery, patients spend a couple of weeks recovering in the hospital. Even when they can go home, their health is closely monitored with frequent lab tests and check ups.

After transplant, patients will start taking medications to suppress their immune systems and keep their body from rejecting the new heart. And they have to stay on these medications for their rest of their lives. This means a lifetime of close monitoring to make sure that their heart is functioning well and that there aren’t any complications from the immune suppression.

For instance, during the first couple of months after surgery, patients have heart biopsies, where a small piece of the heart is removed to check for signs of rejection, every one to two weeks. As recovery progresses, biopsies may become monthly. The heart sample is so small that it does not damage the heart, but the biopsy is still an invasive procedure requiring hospitalization. And waiting for results can be stressful.

All of this means heart recipients spend a lot of time during the first year after their transplant seeing doctors and waiting for test results. Being close to a transplant center is important – it’s just easier to get to appointments. But accessibility isn’t just about the patient. It’s also about their support network. Imagine going through all of that alone.

On a practical level, family members and friends provide rides to the hospital, keep track of medications and doctor’s appointments and help with household chores during the recovery period. But what is most important is the emotional support that they provide.

So why do black transplant patients tend to wind up in transplant centers that don’t perform as well? Right now, we don’t know. Is it because they were referred to these centers by their cardiologists despite other feasible alternatives? What role does the health insurance of patients play in determining where they receive the heart transplant? Why are centers with a high percentage of black transplant recipients performing so poorly? And most importantly, what measures need to be taken to improve the quality of care?

These are important questions that physicians, public health officials and politicians need to ask themselves in order to address these disparities.

The Conversation

This article was originally published on The Conversation.
Read the original article.
ResearchBlogging.org
Kilic, A., Higgins, R., Whitson, B., & Kilic, A. (2015). Racial Disparities in Outcomes of Adult Heart Transplantation Circulation, 131 (10), 882-889 DOI: 10.1161/CIRCULATIONAHA.114.011676

How Often Do Books Mention Scientists and Researchers?

Here is a graphic showing the usage of the words “scientists”, “researchers”, “soldiers” in English-language books published in 1900-2008. The graphic was generated using the Google N-gram Viewer which scours all digitized books in the Google database for selected words and assesses the relative word usage frequencies.

Ngram

 

(You can click on the chart to see a screen shot or on this link for the N-gram Viewer)

It is depressing that soldiers are mentioned more frequently than scientists or researchers (even when the word frequencies of “scientists” and “researchers” are combined) in English-language books even though the numbers of researchers in the countries which produce most English-language books are comparable or higher than the number of soldiers.

Here are the numbers of researchers (data from the 2010 UNESCO Science report, numbers are reported for the year 2007, PDF) in selected English-language countries and the corresponding numbers of armed forces personnel (data from the World Bank, numbers reported for 2012):

United States: 1.4 million researchers vs. 1.5 million armed forces personnel
United Kingdom: 255,000 researchers vs. 169,000 armed forces personnel
Canada: 139,000 researchers vs. 66,000 armed forces personnel

I find it disturbing that our books – arguably one of our main cultural legacies – give a disproportionately greater space to discussing or describing the military than to our scientific and scholarly endeavors. But I am even more worried about the recent trends. The N-gram Viewer evaluates word usage up until 2008, and “soldiers” has been steadily increasing since the 1990s. The usage of “scientists” and “researchers” has reached a plateau and is now decreasing. I do not want to over-interpret the importance of relative word frequencies as indicators of society’s priorities, but the last two surges of “soldiers” usage occurred during the two World Wars and in 2008, “soldiers” was used as frequently as during the first years of World War II.

It is mind-boggling for us scientists that we have to struggle to get funding for research which has the potential to transform society by providing important new insights into the nature of our universe, life on this planet, our environment and health, whereas the military receives substantially higher amounts of government funding (at least in the USA) for its destructive goals. Perhaps one reason for this discrepancy is that voters hear, see and read much more about wars and soldiers than about science and research. Depictions of heroic soldiers fighting evil make it much easier for voters to go along with allocation of resources to the military. Most of my non-scientist friends can easily name books or movies about soldiers, but they would have a hard time coming up with books and movies about science and scientists. My take-home message from the N-gram Viewer results is that scientists have an obligation to reach out to the public and communicate the importance of science in an understandable manner if they want to avoid the marginalization of science.

Dual Identity and Radicalism Among Immigrants

The majority of my scientific colleagues with whom I work in the United States are either immigrants or children of immigrants. Most of them are American citizens, but they also retain strong cultural bonds with their ancestral homelands. This does not seem to constitute much of a problem for them. America is the land of immigrants where one is surrounded by people who are quite comfortable with their hyphenated dual identities. Irish-Americans or Chinese-Americans can be proud of their respective Irish and Chinese heritages without feeling that this makes them “less” American.

The situation was rather different when I lived in Germany. I was the only German with Pakistani roots among all the medical students at my university in Munich, and I did not know of any other hyphenated Germans at the research institute where I worked in the early 1990s. We had visiting scientists or PhD students, such as a grad student from Taiwan in our laboratory, but it was generally understood that they would go back to whatever country they came from. Their colleagues did not expect them to ever “feel German” and the visiting scientists or students also did not intend to “become German”. My Taiwanese lab-mate learned enough German to complete his PhD dissertation, but had no long-term plans of living in Germany. He clearly identified with being Taiwanese and his goal was to return to Taiwan.

Twenty years later, the situation in Germany has changed quite a bit. Hyphenated Germans are becoming far more common at universities. This is in part due to the fact that it has become much easier to become a permanent resident or acquire German citizenship, both for adult immigrants as well as their children. Children from immigrant families have grown up in Germany and they now have to grapple with their dual identities. Unlike the United States, where dual identities have been around for centuries and there is a broad acceptance of having two or even more identities, German society and the emerging hyphenated Germans are still trying to figure out what it means to be a Turkish-German, Nigerian-German or Russian-German.

In my own experience, having a dual identity has been an asset, allowing me to interact with and learn from a broad spectrum of fellow humans. However, I also realize that having a dual identity can also be somewhat problematic. The recent study “When Dual Identity Becomes a Liability : Identity and Political Radicalism Among Migrants” by Bernd Simon and colleagues in the journal Psychological Science (advanced online publication on January 14, 2013) attempted to study the impact of having a dual identity on political radicalism. The researchers recruited university students in Germany with either Turkish or Russian immigrant backgrounds and asked them to answer a set of questions about their personal experiences with having a dual identity using a Web-based questionnaire. Roughly half of the students were German citizens and the average percentage of lifetime spent in Germany was 66%.
Four questions assessed the extent of having a dual identity:

 

1) “I feel I belong to both the Turks/Russians and the Germans”

2) “Sometimes I feel more like a German and sometimes more like a Turk/Russian—it depends on the situation”

3) “I have many similarities with Germans as well as Turks/Russians”

4) “I feel good in the Turkish/Russian as well as the German culture.”
The students were also asked to address whether they felt there was an incompatibility of their ethnic and their German identity:

“I have the feeling that I would have to give up my Turkish/ Russian identity if I wanted to become German”
The participants also answered a number of additional questions about their cultural, national and religious identity.
In addition to these questions, the researchers assessed whether the students expressed support or understanding for “radical” (illegal, violent) actions, such as participating in an illegal demonstration, participating in a violent demonstration, blocking a road, occupying houses or offices, writing a political slogan on a public wall, and damaging other people’s property. The students also indicated whether they agreed with the following statements:

“I would participate even in a protest action that may involve a confrontation with the police”

“If the police and the courts can’t provide justice, you sometimes have to bring about justice yourself.”

Rating scales for these eight items (the six “radical” actions and the two “radical” statements) ranged from 0 (no understanding/not true at all ) to 4 (total understanding/absolutely true) and these eight items were used to determine their sympathy for radical action.

The results of the study are quite interesting. Having a dual identity by itself was only correlated with sympathy for radical action, if the respondents felt that the two identities were incompatible, i.e. becoming German would mean having to give up their Turkish or Russian identity. Students who felt that the German identity was quite compatible with their ethnic identity did not express any significant sympathy for radical action. Furthermore, among students with a Turkish immigrant background, sympathy for radical action decreased when religious identification became stronger and among Russian immigrant background students, it decreased when ethnocultural identification became stronger. This may come as a surprise to people who assume that stronger religious identification encourages sympathy for radical actions.

There are some limitations of this study. It only assessed sympathy for radical action by self-report without necessarily measuring actual participation in radical action, and one can debate whether showing support for writing political graffiti or participating in an illegal demonstration is as “radical” as endorsing actual violence. The study was purely correlational, without being able to determine cause-effect relationships and it also did not assess why some participants felt that their dual identities were incompatible. Nevertheless, this research suggests that possible sympathy for radical actions is not associated with having a dual identity, but with the perception of incompatibility between the two identities. One can surmise that reducing the perception of incompatibility could potentially reduce the sympathy for radical (illegal and violent) actions, but this would have to be addressed in future studies that investigate the effect of such an intervention.

How does one overcome the perception of incompatibility? My own experience is that multiple identities are not only compatible, but they are also complementary. I do not think that I have to sacrifice one cultural identity for another one. I notice that there are numerous parallels and similarities between German, Pakistani and American cultures in terms of the core values and goals of people. However, people often tend to focus on the differences and rare incompatibilities, because they make for sensationalist stories or political rallying cries that are far more marketable than the “boring” realization of how similar we all are. Societies in other countries such as the United States have also had periods in time during which dual identities were eyed with suspicion and their citizens felt that their identities were incompatible, but they were able to overcome these conflicts. This makes me optimistic that in Germany we will also reach a point when dual identities will be widely accepted and perhaps even seen as an important part of the fabric of the future German society.

Image credit: Germany flag map via Wikimedia Commons / Public Domain – shows all the states of Germany with their individual flags