Talk Like TED by Carmine Gallo

Listened to a few chapters, and learned some interesting patterns about the most popular online TED talks, should probably finish the book to see what the other ones are, but most are common sense, like telling stories, identifying emotion, finding common ground with the audience, etc

My Antonita by Willa Cather

Really enjoyed the descriptions of place, and got a good sense of time, but found the story a bit restrained, almost censored. 

Adirondack Distance Festival

Slowest out of the three times I've done it

Mile splits as follows for first half

6:26

6:21

6:17

6:43

7:17

7:05

6:37

6:40

7:11

6:48

7:00

8:11

6:57

+40 sec = 1:30:18

"First Do No Harm: A qualitative research documentary" by Alyson and Timothy Holland

Medical tourism = medical voyeurism

- assumption that you can go to developing world and have an impact

- have a service mentality

- it's like outsiders coming to a trauma bay just to see amazing things

- exotic

Motivations

- travel

- experience

- resume

- work with and for communities

- going abroad to learn things that you're actually going to use?

So...

- good intentions are insufficient to warrant a trip

- humility that other ways sometimes work better

- consider each trip as entirely an educational experience, and attempt to have an experience with as little impact as possible

Assessing the impact and known harms of visiting healthcare professionals

- Often ineffectual

- steals resources from domestic learners and volunteers

- because you need community support, that community support requires person power

- can drain the systems they visit

- does your presence create a drain on the healthcare system (interpreters etc)

- lots of energy to get visiting people up to speed

- undermine local professionals by creating the appearance of higher quality care

Preparation

- often a majority is fundraising instead of culture and language training

- standards should remain the same, if you don't have the training, don't do it, you can always make things worse

- must be prepared to resist opportunities that exist without structured learning experiences (cowboy medicine)

So why do it?

- a good doctor can adapt to any condition

- a doctor is not just a doctor of their country, but a doctor of people who live in different countries 

Aiming for sustainability

- Only those who learn the language, spend years, and partnership

- Cooperative partnered collaborative where both sides gain

- donor recipient relationship abolished

- long term vision

- not a gap to fill, financial/knowledge transfer useful

- what can we learn from you?

- what can we do for you? (not help)

Minimizing the harms

- pre-departure training

- cultural sensitivity

- humility

- organized structure with goals and limitations

No such thing as global health, it's just health

- how can you serve health to people in different places

- what are we doing and why are we doing it?

- challenge our place in global health

How to Change the World: Social Entrepreneurs and the Power of New Ideas by David Bornstein

So interesting how I picked up this book at the end of winter break and it continued the trail of ideas from where my social determinants of health class had left off. So many theories of behavior change recognize the role of the larger community but in the effort to avoid victim blaming, these theories fail to recognize some amazing individuals. So are these success stories inevitable and any number of people could connect the social resources or do they truly require a social entrepreneur?

Bornstein chronicles the organizational history of Ashoka Innovators for the Public and outlines this more individualistic theory of change.

The stories were really amazing, and for that you should read the book. But the real insight for me was the compilation of principles that defined successful change. The examination of commonalities between these change-agents. That's what was really cool to see.

Considering the gaps in social infastructure as potential markets is enlightening. "Firms arise where markets and one-on-one transactions don't conrdinate well enough" (175). Bornstein uses College Summit as an example, where the benefits of a college education are broadly distributed and the only way to bring them together is through a firm. The beneficiaries of that kid making it include the high school where she came from, the city that won't have to pay to assist her, the college that increases diversity, the company that hires her, the government that taxes her, and then all those indirect effects on peers, not to mention individual wealth and well-being. All those smaller amounts "add up to a return to society well in excess of the $1000 that changed her life but any single one of them wouldn't be enough to economically justify paying to changer her path" (175).

Mosaic meeting of multiple programs allowed some other principles to emerge.

1. Get youth in leadership role.

2. Enlist "barefoot" professionals. The real professionals are too expensive and too rare, so you must train ordinary citizens to reach underserved markets at scale.

3. Work to change legal frameworks to give as much advantage as possible. Lobby and be active in the media.

4. Help small producers capture greater profits. Just increasing profits pushes toward larger enterprises which tend to rely less on human labor and more on technology. This actually increases poverty and the shift of village to city. Instead of maximizing production, must seek to maximize producers and the best way to do that is to ensure that they get a decent profit, enough to motivate them to stay in their villages and towns and not move to a slum near a megalopolis.

5. Link economic development to environmental protection

6. unleash resources in the community you are serving

7. Link citizen, government, and business sectors for comprehensive solutions.

8. Institutionalize listening

9. pay attention to the exceptional

10. design real solutions for real people

11. focus on the human qualities of workers

Six qualities of successful social entrepreneurs. Willingness to;

1. self-correct
2. share credit
3. break free of established structures
4. cross disciplinary boundaries
5. work quietly (John Woolman)
6. strong ethical impetus (think mission driven)

Chapter 19 discusses the work of James Grant, a champion of the GOBI movement to within primary care, the core of selective primary care which epitomizes the conflict within medicine about how many of the social determinants of health should society allow healthcare to manage or shape. Ignoring this larger debate, Grant was able to focus his energy on child mortality and championed oral rehydration and child immunization to reduce mortality significantly. He even got a war to go on hold in order to vaccinate children in El Salvador, but even this action could be seen in the larger light of his unwillingness to focus on the larger causes of that war (his own country's militarism).

Bornstein concludes with the idea of blueprint copying as the most efficient way to transmit and implement knowledge. He criticizes social movements for using only idea diffusion that come detached from their implementation details, forcing adopters to go through the slow and painful process of working out the kinks before they can take advantage of good ideas.

And finally how do we make social entrepreneurialism as cool as profit-oriented entrepreneurialism? Both the citizen and business sectors market products and services to fill gaps. Both are operational that are inventive and productive when political and cultural environments are supportive. Both sectors exist to create value for society. If they are so similar, then competition should drive huge improvements, the same way that competition increased productivity so much when markets gained mobility through technology. But how do you assess various organizations and allocate capital correctly when success is not measured in dollars? Bornstein warns against using numerical metrics and asks instead for judgement, the way that the law applies judgement. I wonder why he distrusts such measures as DALYs or other measures meant to compare diverse services. His idea is to fund citizen sector research analysts to publish expert opinions.

Support social entrepreneurship as a career through private funding, education, recruitment, and media.

Flight Behavior by Barbara Kingsolver

I masterful example of how difficult it can be to explain climate change to non-scientists. Ultimately before you tell anyone anything, you have to ask and listen, that's what this book reminded me of. The story was almost secondary. It was more an exploration of the very real disconnect between two very different realities, that of the scientists and that of rural and conservative America.

Small is Beautiful: A Study of Economics as if People Mattered by E. F. Schumacher (1974)

I. The Problem of Production
We are "inclined to treat as valueless everything that we have not made ourselves" (11). Schumacher blames even Marx for falling into this trap in the labor theory of value.  Fossil fuels, "the tolerance margins of nature", and "the human substance" are the three categories of capital that Schumacher claims we "cheerfully treat as income" (16).

II. Peace and Permanence
Economic growth has "no discernible limit, and must necessarily run into decisive bottlenecks when viewed from the point of view of the environmental sciences" (23). Rather than growth, the central concept of wisdom within economics should be permanence. "The cultivation and expansion of needs is the antithesis of wisdom. It is also the antithesis of freedom and peace" (26). "Every machine that helps every individual has a place but there should be no place for machines that concentrate power in a few hands and turn the masses into mere machine minders, if indeed they do no make them unemployed" (28).

Small scale operations are less likely to be harmful to the natural environment. People will take better care of their land than anonymous companies that imagine the whole universe "is their legitimate quarry" (29).

III. The Role of Economics
The verdict of "uneconomic" kills many activities that should proceed. Fascinating history about the birth of the discipline of economics, and how many predicted that its separation from social philosophy. Sure enough, economics alone has moved into the center of public concern. Economic growth, expansion, performance have become an obsession of all modern societies. Activities branded as "uneconomic" are questioned about their right to even exist. The judgement of economics is "extremely fragmentary; out of the large number of aspects which in real life have been seen and judged together before a decision can be taken, economics supplies only one--whether a thing yields a money profit to those who undertake it or not" (35). The fragmentary nature gives undue weight to the short term over the long term, and is based on a definition of cost which excludes all 'free goods' or environmental capital (36). "If economic thinking pervades the whole of society, even simple non-economic values like beauty, health, or cleanliness can survive only if they prove to be 'economic'" (37).

IV. Buddhist Economics
   Modern Western economics views labor as a necessary evil, simply a cost, to be reduced to a minimum if not eliminated. This view of economics also claims that work is a disutility for the worker, a sacrifice of leisure and comfort, and wages are a compensation for the sacrifice.
   The Buddhist point of view gives work at least 3 functions; a way to utilize faculties, a way to enable teamwork through common task, and a way to bring goods and services needed for a becoming existence (45). Work and leisure are complementary and cannot be separated without "destroying the joy of work and the bliss of nature".

V. A Question of Size
Rural to cities move explained. Those who have nothing to sell but labor remain in weakest bargaining position. Schumacher argues for "production by the masses rather than for the masses" (61).

VI. The Greatest Resouce -- Education
Humanities provides 6 main ideas that fail to overcome economic values because they lead to "an abyss of nothingness" (74).

1. evolution
2. competition
3. class struggles are based on economics
4. Freud
5. relativism
6. positivism which denies the possibility of objective knowledge about meaning and purpose of any kind.

Education is breaking down due to a lack of metaphysical training. There is no thought about the levels of being. We have abandoned the cardinal vurtues, the seven deadly sins, but "what new ideas have taken their place?" (83). How can one think about virtue, love, and temperance with the above 6 ideas?

VII. The Proper Use of Land
Agriculture should keep man in touch with living nature, humanize and ennoble man's wider habitat, and bring forth food and other materials which are needed for becoming life. Modern economics recognizes only the latter.

VIII. Resources for Industry
IX. Nuclear Energy -- Salvation or Damnation
X. Technology with a Human Face
The goal is to have enough time to make a good job out of any work, to enjoy oneself, to produce real quality, even to make things beautiful.
Schumacher calls for the use of "intermediate technology". Accessible, more advanced than primitive.

XI. Development
A dynamic approach is required because an economic approach fails to recognize the value of abandoning efficiency and maximal profits in favor of meaningful and human work.

XII. Social and Economic Problems Calling for the Development of Intermediate Technology

XIII. Two Million Villages
XIV. The Problem of Unemployment in India
What is education for? The specialization of tasks (and sacrifice in humanness of work that that implies) means that a college education requires 150 years of peasant work to supply. What what do the peasants get back for it? Therefore Schumacher's essential questions are: "is education to be a passport to privilege or is it something which people take upon themselves almost like a monastic vow, a sacred obligation to serve the people?" (173). "Can we establish an ideology that issists that the educated have taken upon themselves an obligation and have not simply acquired a passport to privilege" (173)? The presence or absence of this ideology affects the content of education. If the former view is taken, then education focuses on village life, manual labor, social justice, etc. But the latter suggests that you need electricity, cement, and steel before we can do anything at all.

XV. A Machine to Foretell the Future
A theoretical warning to not mix up events and acts, future and past, certain and uncertain. Predictions vs forecasts. Forecast vs feasibility study.

XVI. Towards a Theory of Large-Scale Organization
Achieve smallness within large organizations.

XVII. Socialism
Pure market economics are "an institutionalization of individualism and non-responsibility" (213).
Ownership is not a decisive question. "There is no case for public ownership if the objectives to be pursued by nationalized industry are to be just as narrow, just as limited as those of capitalist production: profitability and nothing else" (217).

XVIII. Ownership
XIX. New Patterns of Ownership
Middle road between privatization and capitalism. Points out that people hate being taxed and thus fight against public expenditure. "The need for public expenditure should thus be recognized in the structure of ownership of the means of production" (229).

"All the educational, medical, and research institutions in any society bestow incalculable benefits upon private enterprise -- benefits for which private enterprise does not pay directly as a matter of course, but only indirectly by way of taxes, which are resisted, resented, campaigned against, and often skilfully avoided...It is illogical that payments for benefits obtained by private enterprise from the infrastructure cannot be exacted by the public authorities by direct participation in profits but only after private appropriation of profits has taken place. Private enterprise claims that its profits are being earned by its own efforts, and that a substantial part of them is then taxed away by public authorities. This is not a correct reflection of the truth. A large part of the costs of private enterprise has been borne by the public authorities -- because they pay for the infrastructure" (229)

Schumacher goes on to propose three spectrum on which decisions could be made
Freedom--Totalitarianism
Market Economy -- Planning
Private ownership -- Collectivized ownership
In the simplest interpretation, this gives 8 combinations.

He suggests a middle road on all three spectrums. First that the 'public hand' should receive 1/2 of distributed profits of large-scale private enterprise by means of 50% ownership of the equity of such enterprises" (239). Public shares wouldn't have voting rights normally, but woul dhave the right to information and observation.


Epilogue
The idea of economy, work, and technology that sustains "the human substance" continuously reappears in this book. Work that takes away any hint of humanity, becoming a merely mechanical activity, turns the worker himself into "a perversion of a free being" (29). The "humanization" of work would lower GDP, decrease profits, and decrease the way that the current "standard of living" is calculated. Schumacher argues that the calculation leaves out key factors that would be wise to include.

Wisdom is also thrown around quite casually, with what seems to me a lack of theoretical and philosophical underpinning. Schumacher suggests that we need a revision of the ends which economic means are meant to serve.