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With my post on "Everything is Connected" I thought I'd investigate a bridge between happiness and the level of development in a country...
The Happy Planet Index (HPI)

"The HPI is an innovative measure that shows the ecological efficiency with which human well-being is delivered around the world. It is the first ever index to combine environmental impact with well-being to measure the environmental efficiency with which country by country, people live long and happy lives."
The Human Development Index (HDI)

"The first Human Development Report (1990) introduced a new way of measuring development by combining indicators of life expectancy, educational attainment and income into a composite human development index, the HDI. The breakthrough for the HDI was the creation of a single statistic which was to serve as a frame of reference for both social and economic development. The HDI sets a minimum and a maximum for each dimension, called goalposts, and then shows where each country stands in relation to these goalposts, expressed as a value between 0 and 1."
Thoughts and Hypotheses
There are two relationships we will want to consider:

Correlation: Is there any direct relationship (positive or negative) between the values of the HDI and HPI?

Clustering: By region (or other characteristic field) can we find any clusters in the data?

Since these are composite indices of several weighted variable inputs, hopefully this top-level approach can identify some possible matches and mismatches between underlying data fields too. Related to the HDI, I bet the UN's HPI (Human Poverty Index) has a bridge to happiness... or most likely, unhappiness.
Data/Discussion

There seems to be a connection between deviations in the data. When there exists a large deviation, for a specific region, for the HDI, there seems to also be a large deviation of values for the HPI. Notice that Africa, Australasia, and the Middle East all have similar double-digit deviations. What does this tell us about the range of development and happiness within a specific region? Perhaps this could be tested across many country-level metrics to see if the similar deviations occur more frequently.

As with the above note, since we have these metrics on a same scale/range, let's combine them to see who has the highest composite score. In alphabetical order we have: 84, 125, 138, 137, 133, 134, 126, 134, 119, 117, 119. There seem to be three groups here: High (>130), Medium (100-130), Low (<100). Depending on a user need, algorithms can be created to join metrics to provide a big picture representation of economic, political, sociological, etc metrics, and flexibility can be built to dig into the weeds on the underlying data. This would be a nice comprehensive framework for understanding how countries (and regions as a whole) change over time.

Looking at the scatter plot, it is clear that some clusters may exist, for example with Africa (blue). Caribbean (orange), Europe (green), and Russia and Central Asia (purple) also show some quick visual clustering, while the Middle East (red) shows the opposite. What could this mean? That regional trade, policy, weather, etc are good supplementary foundations for providing happiness and development?

We could add trend lines and quickly check for any linear (or logarithmic) relationships. If any relationship does exist as a whole or with a region, it is certainly not a directly proportional or inversely proportional one. This was expected as these metrics are quite different (despite the overlap in life expectancy as an input dimension).

Moving forward, the methodologies and underlying dimensions (with their sources) should be compared. Data is always good, but with good data one still must be careful. That being said, this is a good start for a much larger investigation into the connections between different country-level metrics, especially if they are to be used in international and national policy.

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Happy Planet Index vs Human Development Index

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With my post on "Everything is Connected" I thought I'd investigate a bridge between happiness and the level of development in a country... The Happy Planet Index (HPI) Link: http://www.happyplanetindex.org/ Dimensions: Life expectancy, life satisfaction, ecological footprint Total Countries: 143 Range: [0,100] "The HPI is an innovative measure that shows the ecological efficiency with which...

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80:20 Debating Development

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Lesson 1: Measuring development

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Cuba's child mortality rate is on par with some of the world's richest countries. With six deaths for every 1,000 births, according to World Bank data from 2015, Cuba is level with New Zealand. In 2015, the global average was 42.5 deaths for every 1,000 births. Despite more than half a century of a US economic embargo, Cuba's average life expectancy matches that in the US: 79.1 years, just a few months shorter than Americans who, on average, live to 79.3 years, according to 2015 data from the World Health Organization (WHO).

Much of Cuba's success in these areas is due to its primary healthcare system, which is one of the most proactive in the world. Cuba's population of 11.27 million has 452 out-patient clinics and the government gives priority to disease prevention, universal coverage and access to treatment.

Cuba has also produced innovations in medical research. In 1985 the country pioneered the first and only vaccine against meningitis B. The country's scientists developed new treatments for hepatitis B, diabetic foot, vitiligo and psoriasis. They also developed a lung cancer vaccine that is currently being tested in the United States. Cuba was also the first country on earth to eliminate the transmission of HIV and syphilis from mother to child, a feat recognized by the WHO in 2015.

In 2015, Cuba spent 10.57% of its GDP on health, slightly higher than the global average. According to the World Bank in 2014, the European average spending GDP spending was 10%, compared to 17.1% in the United States.

Two-tier system

A lesser-known characteristic of Cuba's healthcare system is the existence of special clinics, reserved for tourists, politicians and VIPs. The state reserves the best hospitals and doctors for the national elite and foreigners, while ordinary Cubans sometimes must turn to the black market or ask expatriate friends or family to send medicine.

"Cuba's health service is divided in two: one for Cubans and the other for foreigners, who receive better quality care, while the national population has to be satisfied with dilapidated facilities and a lack of medicines and specialists, who are sent abroad to make money for Cuba," says Dr. Julio César Alfonzo, a Cuban exile in Miami and director of the NGO Solidaridad Sin Fronteras.

In 1959, the country had only 6,000 doctors, half of whom emigrated after the Cuban revolution. By 2014, Cuba had 67.2 doctors for every 10,000 inhabitants, with only Qatar and Monaco ahead of it.

However, despite these impressive statistics, the quality of primary healthcare, which has been fundamental to Cuba's success, has been declining in recent years. Between 2009 and 2014 there was a 62% fall in the number of family doctors, from 34,261 to 12,842, according to Cuba's National Statistics Office (ONEI).

An army of white coats

In the words of Fidel Castro, Cuba's "army of white coats" was formed in 1960, when a medical brigade was sent to Chile after an earthquake left thousands dead. Since then, Cuba has sent more than 300,000 healthcare workers to 158 countries in Latin America, Africa and Asia, according to Cuba's state news agency. Today, around 50,000 Cuban medical workers are present in 67 countries.

"Cuban doctors are rooted in solidarity and in the Hippocratic Oath. Our job would be unthinkable without foreign missions," says Salvador Silva, a doctor specializing in infectious diseases who has worked in Haiti and Liberia.

"Yes, our salary is low and maybe that pushes us to go abroad, but it also makes us proud when we see our work recognized throughout the world, on top of just helping in our own country," he adds.

Doctors are arguably Cuba's most profitable resource and the country's medical missions have proved to be a lucrative diplomatic tool. The healthcare industry is also one of the country's main sources of income. In 2014, Cuban authorities estimated overseas healthcare services would bring in $8.2 billion, putting it ahead of tourism.

Patients waiting for their results at the Julio Trigo hospital in Havana.

Cuba has a different deal with each country it works with. For example, in exchange for sending 3,500 health care workers to work in and provide training in Venezuela, a close Cuban ally, Venezuela sends oil.

With such a high demand for personnel, some suspect that the Cuban government has been reducing educational requirements to hasten students' entry into the work force.

"They are giving doctors licenses in record time to meet the need to export them, and this has been detrimental to the quality of training and medicine, which used to be the best. This has been happening since they started the program in Venezuela, between 2003 and 2004," says Dr Alfonzo.

Doctors are also eager to be sent abroad, not only to help the less fortunate, but also for money. Salaries are higher - depending on the location, with doctors abroad reportedly making up to $1,000 per month (minus taxes), whereas those in Cuba make around $50. On the island, it isn't rare to find taxi drivers, shopkeepers or construction workers with medical degrees.

Juan drives a 1950s Chevrolet he bought with his brother and he uses it as a taxi from 6pm to midnight. He's also a doctor in the clinic Hermanos Ameijeiras.

"The wage is a pittance. We find ourselves obligated to make a living doing other things. I have coworkers who sell prescriptions to pharmacies, who work in unlicensed clinics or help their families in shops. It's frustrating," he says. "It's like they're pushing us to enlist in international missions, the business of Cuba."

Cuba's health service is free, but as a poster behind this nurse points out, it is expensive.

The country's medical missions abroad have been an important escape route for Cubans looking to defect. Before migratory reforms were passed in January 2013 allowing Cubans with passports and visas to travel abroad, the preferred way to abandon Cuba was via Venezuela. In 2013 and 2014, more than 3,000 doctors deserted the island to go to the United States through a special visa program called Cuban Medical Professional Parole, a program started by George W. Bush to help healthcare workers who had escaped while working abroad.

Lucia Newman, a former CNN correspondent in Habana, said Cuban doctors complain that travel restrictions prevent them from attending conferences or keeping abreast of the latest medical advances. The US trade embargo on Cuba includes some textbooks, but the major problem is that Cuban doctors cannot buy medical equipment from the United States or from any US subsidiaries.

For Odalys, a young patient waiting at the Hospital Salvador Allende, "the situation is becoming unsustainable in this country and it's not because of a lack of specialists, it's because we have to bring everything ourselves. I just bought a light bulb for the hospital room. I've called home so that they can bring me bedding, towels and even toilet paper. There aren't even stretchers, I saw a family carrying their sick son into a room. Free and universal health care, yes, but it's a bit of a mess and very informal," she says.

English version: Alyssa McMurtry.

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How does Cuba manage to achieve first-world health statistics?

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Cuba's child mortality rate is on par with some of the world's richest countries. With six deaths for every 1,000 births, according to World Bank data from 2015, Cuba is level with New Zealand. In 2015, the global average was 42.5 deaths for every 1,000 births.

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Lesson 4: Governments and social progress

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Lesson 4: Governments and social progress

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https://www.theguardian.com/world/2014/apr/23/north-korean-health-system-crumbling-sanctions

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Touring a new hospital in Pyongyang recently, North Korea's leader, Kim Jong-un, boasted that it would "let the people live in luxury and comfort under socialism in good health".

But North Koreans interviewed in China paint a grimmer picture of medical conditions across their country: citing broken equipment, declining treatment standards and widespread self-medication.

"A lot of people who are sick use 'ice' [methamphetamine] as a medicine. There are plenty of drugs, but all come from China and are more expensive," said one woman.

Universal healthcare was one of the country's founding commitments; citizens see hospitals and schools as the last remaining benefits of the former command economy.

But those too have deteriorated badly and some believe that sanctions are contributing to the problem.

"The perfect storm of a financial collapse, loss of the Soviets as trading partner, a sequence of meteorologic disasters, and sanctions has left the health care system in shambles," said Ricky Choi, a US doctor who co-authored a recent paper on healthcare in North Korea.

"The downstream effects are food shortages, a shortage of domestically produced pharmaceuticals, breakdown of the sanitation system, shortage of medical supplies, a resurgence of infectious disease, and ultimately a rise in mortality and morbidity."

Compare the system to those of countries with similarly sized economies and it might not look so bad: as of 2009, Ethiopia, which had a similar level of GDP, had just 0.2 doctors and 2.4 nurses per 10,000 citizens to North Korea's 33 and 41 respectively.

But just 6% of the North's government spending went on healthcare in 2008, according to WHO figures, while the proportion in Ethiopia was almost double that. And because citizens are used to better healthcare, they are even more aware of the shortcomings.

Conditions vary widely, say experts, with better service in the provincial centres and especially in the capital. But the worst can include syringes reused without sterilisation and major operations carried out without anaesthetic, according to a 2010 report by Amnesty International.

One man described being held down as his leg was amputated with nothing to numb the pain.

The World Health Organisation criticised that report, saying some of the information was outdated and did not reflect improvements made with external aid.

But North Koreans who left within the last year, interviewed in the northern Chinese city of Yanji where they were living illicitly, cited multiple problems, including poorer skills among younger medics.

While medical treatment is free, giving gifts of food, cigarettes or cash wins better service. Staff rely on such donations because state wages and food distributions have long been desperately inadequate. Han Myong-hee, a former nurse, said she resigned because she received her food distribution only once or twice a year instead of every two weeks.

The hospital she worked in had generators and enjoyed a regular electricity supply, unlike much of her border region. But staff stopped using the x-ray and cardiograph machines because they could not be mended when they broke: no one had the skills and it was too hard to get parts.

Choi said that neonatal equipment in a Pyongyang maternity ward he visited some years ago appeared to be from the mid-70s.

"I suspect that sanctions and the struggling economy have really limited their ability to upkeep and update technologies," he said.

Patients have to buy their own medicine; even some of the limited official supply is diverted to the markets, said Han. Most patients rely on smuggled Chinese products, sold with a substantial mark-up.

"If you have a minor illness maybe it will be cheap, but the majority of people with a serious disease are not able to pay for the medicine," she said.

Hazel Smith, an expert on the country at the University of Central Lancashire, said that at least it was now possible to buy drugs privately. In the 90s, people went without entirely.

She also noted that the country's preventative healthcare was remarkably effective, with mass vaccination programmes run with the help of the Gates Foundation and others. Diseases of poverty, which shot up in the 90s when the famine was at its height, have dropped dramatically again. The incidence of diseases such as measles is now similar to that in developed countries, she added.

But, said Choi's co-author Sanghyuk Shin, "the widespread food shortages, lack of access to clean water, and poor living conditions have placed a great strain on the health system to provide quality preventive and curative services".

Shin, a post-doctoral scholar at the University of California Los Angeles, said there were clear signs that sanctions -supposed to target the country's weapons programme and luxuries for its elite - had hit the broader economy. The ban on trade in "dual-use" items, which have both military and civilian applications, can also have unintended consequences; he pointed to a major health project, backed by a US institution, which struggled to import the laboratory equipment it needed.

A recent article in the Lancet by public health experts at the University of Oslo pressed the case for increased academic engagement with the North to help reduce "grave, morally unacceptable, health inequities".

"The effect of sanctions is likely to be even stronger in a country like North Korea, where the state is the primary health provider for the population. Sanctions directly affect the state's ability to maintain a strong health infrastructure," Shin said.
Topics

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North Korean health system crumbling as shortages and sanctions bite

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Touring a new hospital in Pyongyang recently, North Korea's leader, Kim Jong-un, boasted that it would "let the people live in luxury and comfort under socialism in good health". But North Koreans interviewed in China paint a grimmer picture of medical conditions across their country: citing broken equipment, declining treatment standards and widespread self-medication.

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Structural Adjustment-a Major Cause of Poverty - Global Issues

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This part of the globalissues.org web site looks into the effectiveness of the IMF-imposed Structural Adjustment Policies and how this has exacerbated poverty.

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IGOs and MDGS

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Government & social progress case studies

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Government & social progress case studies