I like Bill Gates.  I really do.  They guy created a universal platform for microcomputing that pretty much birthed the computer business era.  Yeah, Zune sucks.  Vista sucks.  Lots of his ideas suck.  And his business model is passe and needs to give way to the innovation of open source and open access.  But I really like him for his charitable works.  The Gates Foundation has done more good for the world than anything you or I will ever do.

So I gve Bill Gates a lot of slack.  He’s also one of the top backers of research into “geo-engineering”, which is the science of technologically transforming the physical world.  One of the immediate applications of geo-engineering is to reduce the effects of global Climate Change. Check this out.

But this plan horrifies long time eco-warriors like George Monbiot, who makes strong arguments against geo-engineering here.

Here’s my take:  First, I believe Climate Change to be real and deadly deadly serious.  How serious?  Apocalytpically serious.  Given that seriousness, I think all options should be explored and developed… including extreme options like geo-engineering.

Second, it’s best to have that option well-researched and tested and ready to go, if indeed the Climate Change precipice is as sheer as the experts are suggesting.

But third, history has shown that such simplistic technological solutions never end well.  Why would this be any different?  We should be properly concerned and indeed horrified by the probable negative consequences of such extreme measures.  Let’s not pretend for a second that this is without substantial risk.

And fourth, who gets to make decisions about whether to engineer the Earth?  Bill Gates is but one man, as is George Monbiot.  The majority of humanity lives hand-to-mouth in powerless silence over these global events.  What arrogance it is to suggest that a wealthy few can decide to put the Earth at such pervasive risk.

So what is the solution?  Fund the research, prepare the options, and wait.  For what?  For things to become so dire that the world will want a solution –any solution, no matter the risk.

Okay, back to my drink.

Today, a friend sent me a news article by a colleague, Dr Prabhat Jha, who explains the link between behaviour in Canada and his research on the use and abuse of selective abortion in India. This presented the ideal opportunity to reproduce here a paper I wrote recently about the implications of Dr Jha’s landmark finding that there are millions of “missing” girls in India, due to selective abortion.  Please note that a more scholarly version of the text below has been submitted to a peer-reviewed journal.  Therefore please do not excerpt or cut-and-paste any part of this blog post.  However, linking to the post is fine.  Thanks.

Implications of India’s Skewed Sex Ratio

by Dr Raywat Deonandan

Dec, 2011

In their widely cited 2011 paper, Dr Prabhat Jha and colleagues used publicly available demographic data (the national census and household health survey data) to show that there were likely 4.2-12.1 million selectively aborted girls in India from 1980 to 2010.  The authors convincingly suggested that selective abortion was the primary explanation for a steadily declining female-to-male sex ratio in India, which in turn is driven by cultural factors associated with a preference for boy children.

Their paper was not the first to point to a crisis in India’s sex ratio.  In 2001, the UN estimated that there were 44 million “missing women” in India.  And in 2008, researchers examined hospital delivery data over 110 years to show that India’s national sex ratio fell dramatically after 1980, when ultrasound technology for antenatal sex determination became available.  Many regional studies confirm that this trend is truly national.

Similar trends have been famously seen in other countries, especially in China, where the “one child policy” is thought to have resulted firstly in an epidemic of female infanticide, and secondly, after the arrival of antenatal sex determination technologies, in an increase in selective abortions of female foetuses.

Beyond the moral objections to female foeticide is the demographic crisis represented by a severely unequal sex ratio.  However, the likely impacts of such imbalance are not well known, nor have they been well considered in the wider health literature.   They include:

• Speculatively, a rise in levels of violence amongst unmarried men of reproductive age, as competition for brides increases, although violence always has multifactorial causes.  This is because, in affected societies, marriage and paternity are linked to social prestige among men.

• A shortage of marriageable women may lead to a disavowing of lower class or less socially desirable men, causing social strife stratified to the less economically robust classes.

• An expansion of the sex industry, probably involving coercion and trafficking and possibly contributing to higher rates of sexually transmitted infections.

• An increase in inter-generational relationships, most egregiously manifesting as child marriage.  In India, child marriage (usually involving young girls and much older men) is already such a serious problem that it has attracted the attention of the Clinton Global Initiative and other global NGOs.  Child brides are at greater risk for a host of additional unwelcome experiences, such as reduced educational opportunities, increased economic dependency and greater rates of maternal complication and mortality.

• Parts of India already have a classical history of polyandrous marriage.  While polygyny has been popular in many societies historically, polyandry seems to arise more sporadically and in times of resource crisis or bride shortage.  Recent trends in Indian fraternal polyandry have arisen from a desire to keep ancestral lands from being divided by marriage.  But it is conceivable that such an arrangement might become more commonplace if the sex ratio continues to skew.

• Two possible positive outcomes include a greater tolerance of homosexual relationships and a greater acceptance of cross-class and cross-caste marriages.  However, the latter would likely involve unions between powerful men and vulnerable women, which may only serve to exacerbate existing gender tensions and exploitative relationships.

In India, the social drivers for sex selection are both deeply cultural and shallowly economic.  Amongst orthodox Hindus, the care for elderly parents is traditionally the domain of the eldest son and his wife.  Thus, the economic disincentive for having a girl is reflected in the local saying that raising a daughter is akin to “watering someone else’s garden”.  A preference for sons manifests in many agrarian societies in which a male work force is valued for their wage-earning capacity.  And the tradition of dowry, originally intended as a vehicle for assuring that a new bride had personal wealth, often in the form of jewellery, in the event that she was widowed or abandoned, has mutated into a form a “bride price”, in which families often go into debt to marry off their daughters.   These are all economic disincentives for having girl children.

Interestingly, Dr Jha found evidence that sex selection is most prominent amongst affluent households for whom the economic disincentives are less relevant.  For them, it seems likely that a simple and sexist preference for sons is at play, which has at its heart a cultural bias for the social cache and prestige that sons provide.  The prime distinction between the affluent and the poor in this sense, then, is that the former can more readily afford expensive sex selection technologies.  Importantly, the clustering of the trend in wealthier households also means that India’s vaunted economic expansion, especially in the middle class, is unlikely to assuage the sex ratio situation; indeed, as more families enter the realm of the affluent, it may exacerbate it.

With drivers and incentives for sex selection being social, cultural and economic, policies for addressing the crisis cannot be limited to the medical realm.  In Jha’s paper, it is noted that India’s Pre-Natal Diagnostic Techniques Act of 1996, which seeks to penalize the misuse of prenatal sex determination technologies, is largely unenforced.  The authors suggest that India’s traditional inability or unwillingness to police private medical practice is the greatest hindrance.  The paper’s accompanying commentary recommended better enforcement of existing policies as the appropriate solution.  But it is possible that the desire to penalize sex selection, while evident at the policy-making level, has yet to penetrate to the street level, due to the depth and pervasiveness of cultural and economic drivers.

In the words of one researcher, “It is evident that mere legislation… cannot solve this social evil. Moves to address all forms of gender inequality… are needed to strike at the causes for distortion of the sex ratio.”  Social change for improving women’s rights, both in India and elsewhere, is required.  As noted by another writer, “Nothing can realistically be done in the short term to reduce the current excess of young males, but much can be done to reduce sex selection now”.  While official policies have their place, in India no progress will be made unless the social and economic drivers are addressed.  For the former, this means public awareness and educational campaigns focusing on the value of girls.  And for the latter, it means finding creative solutions to expand employment opportunities for both sexes, and to remake the social welfare infrastructure to limit the expectation of gender-based elder care, inasmuch as such is determined by an expectation of the roles of the eldest son and his wife.

Given the status of India and China as both the world’s fastest growing economies and our most populous lands, the demographic situation faced by both countries is relevant to all of us.  To refer to those nations’ skewed sex ratio as a mere crisis is an understatement.  Such profound demographic change may prove to be the basis for a host of pervasive social, economic and medical woes manifesting as the present generation of newborns reaches reproductive age.

Comments are welcome.

This will likely surprise you, but did you know that infertility is considered to be at epidemic levels worldwide?  This is clearly at odds with our conception of the world as being overpopulated.  But, primarily in wealthier, developed nations, the provision of medical reproductive services to people deemed infertile is now a billion dollar global industry, spurred on both by advances in technology and the emergence of a globalized economy. Unsurprisingly, India is one of the world’s most popular providers of reproductive services, leveraging her medical depth, advantageous currency exchange, and her pervasive poverty.  But when human reproduction meets commerce, gender inequality and wealth disparity, the potential for ethical transgression becomes great indeed.

Someone is considered infertile if he or she has been having unprotected (heterosexual) sex for one year, with an intent to reproduce, without achieving pregnancy.  Conservative estimates hold that at least one billion women worldwide (and an unknown number of men) are presently experiencing a degree of infertility.  This estimate is stunted by the obvious fact that you don’t know if you’re infertile unless you’re actually trying to get pregnant.  The actual number is therefore likely to be substantially higher. The experiences of assisted reproduction clinics suggest that a fair proportion –if not a majority– of infertility issues are actually so-called “male factor” issues, meaning that the problem is often related to sperm quality.  Indeed, semen samples collected over the past seven decades suggest a global, dramatic reduction in semen quality, such that what is considered normal today might not even make the scale 70 years ago. This may be a universal, global human trend, or it may be relegated to the developed world.  We just don’t know yet.

Many theories have arisen for the increase in infertility in both sexes.  Undeniably, women in high income countries are waiting into their 30s and 40s to start their families, and this is dramatically reducing their ability to become pregnant.  The rise of obesity, and with it diabetes, has certainly contributed.  It is possible that soy products, mimicking human hormones, are affecting our reproductive cycles.  Some have theorized that overuse of the female contraceptive pill has made our drinking water more hormonal, or that some artificial compounds, such as plastics, may decay into substances that also mimic hormones.  At this point, all of this is mere speculation.  What is known is that the seeking of assisted reproductive techologies (ARTs) is at an all time high, and shows all the signs of accelerating.

The services sought include in vitro fertilization (IVF) –the classic “test tube baby”– a technology, that has been with us for over 30 years now; fertility drugs; sperm and egg donation; and maternal surrogacy.  The latter is characterized by a woman hiring out her womb to gestate an embryo on behalf of a client.

With the increase in demand, and with the maturation of reproductive technologies and services has come a global industry of cross-border reproductive service provision, rife with philosophical quandaries, legal pitfalls and ethical concerns.  Presently, in terms of financial transactions, the United States is the world’s greatest provider of reproductive services.  But hot on its tail is India, which is fast becoming the undisputed world champion of all manner of ARTs.  This phenomenon is most commonly called reproductive tourism, and is being monitored by ethicists and epidemiologists, myself among them, for its challenges to our ideas about the valuation of human biology.  This is particularly true for maternal surrogacy, since it necessarily involves the biological cooperation of another human being unconnected to the infertile couple.

The power of the industry in India is based upon several factors.  They include: (1) the overabundance of English-speaking, highly trained doctors, as every Indian family strives to have at least one doctor in their midst.  (2) The existing, well developed and recognized medical tourism infrastructure, which includes integrated travel, hotel and insurance services.  (3) An advantageous currency exchange rate leading to a reduction in prices, often by a factor of 10 or more.  (4) A complicit Indian government; and (5) perceptions of Indian women.

The last two are particularly interesting.  The Indian government has actively been promoting its medical tourism services for some time now, for example by sponsoring junkets around the world.  The extent to which the state is complicit in encouraging the growth of reproductive services specifically is a bit more difficult to measure, but may include the nature of India’s adoption laws with respect to surrogates.  A surrogate mother in India loses all rights to a child that is not genetically hers at the point of delivery.  Whereas, in other countries, a surrogate tends to have some time after delivery to decide whether she wishes to state a claim on the child.  It is unclear to what extent the law in India is shaped by the needs of industry, and to what extent it truly reflects the values of Indians.

The perception of Indian women is a subtle and largely immeasurable point.  Poor, village-based Indian women are often perceived in some circles as being ideal surrogates due to their global image as demure and submissive.  Indian women are peceived to be less likely to drink alcohol, to smoke, and to engage in other practices seen to be detrimental to a successful pregnancy.  In other words, it is their powerlessness relative to men and to the structures of their society that make them attractive to this trade.  Hence, maternal surrogacy is where India’s dominance in the world ART market truly manifests, given her abundance of young, poor women.

And therein begins the discussion of the ethics of the international reproductive tourism industry.  When clients from a wealthy country, like the USA, Canada or the UK, seek biological services from vulnerable –and likely uneducated– individuals in a poor country, like India, the opportunity for exploitation, even unintentional, is great.  A maternal surrogate in India is handsomely paid, receiving anything from $2000 to $6000 per pregnancy, which is considerably more than she is typically likely to see in a year.  A strictly libertarian argument holds that “fair” monetary compensation, combined with freedom of choice, obviates any ethical concern.  A more nuanced perspective asks, if the alternative is poverty and death, is there really a choice at all?  This is the classic tension between autonomy and exploitation, in that a desperately poor person can be co-opted to express her autonomy in such a way that it leads to her exploitation.  There are identical scenarios involving international organ tourism, in which th extreme poor are convinced to sell their organs, and in many forms of prostitution.  The fundamental question becomes, is it ethical to seek a profoundly intimate (and sometimes self-damaging) service from a vulnerable stranger, knowing that she likely offers it from a position of desperation?

My work as an epidemiologist and ethicist has been to explore and describe the phenomenon of maternal surrogacy in India, without passing judgement on the service providers, clients or surrogates. I have managed to identify 21 distinct ethical pitfalls inherent in the extant industry.  But I wish to bring readers’ attention to just two of them: insufficient medical advocacy and limited informed consent.

The present commercial model for maternal surrogacy in almost every clinic in the developing world holds that a contractual relationship is forged between the client (usually a woman or couple from a wealthy country), the clinic and the surrogate.  But from a medical perspective, the clinician is directly responsible for the care of both the client and the surrogate, though is being paid by just the client.  This is clearly a conflict of interest.  Consider if a medical situation were to arise in which the clinician must act either to save the life of the fetus or the surrogate.  He has a strong financial incentive to choose on behalf of the the paying client, and thus the fetus. The absence of an independent medical advocate acting on behalf of the surrogate immediately nudges this relationship into the realm of exploitation.

Given that the surrogate is often quite poor, uneducated and semi-literate, it seems unlikely that she is even aware of the dangerous nature of her unequal status in this commercial relationship. This vulnerability further complicates the proper receipt of true informed consent.  In legal terms, informed consent is a process to avoid fraud and the imposition of one party’s will upon another.  In medical ethics, it is the process of a clinician receiving genuine permission from an autonomous person to perform a medical procedure on that person.

Contrary to its portrayal in popular media, informed consent is not simply the receipt of permission.  In TV shows like “House”, informed consent is co-opted from patients who are tricked into giving permission for a dangerous procedure. It is often rationalized away because “the doctor knows best”. True informed consent involves an ascertainment that the patient understands the nature of the procedure and the likelihood of all its known risks.  Illiteracy is but one barrier preventing the communication of such risk.  But when risk is presented in the same package as a significant financial incentive for accepting that risk, the negative consequences are necessarily muted in comparison.

But what are these risks?  Childbirth is, after all, a natural process that pretty much all of these women have already gone through, since proven gestational ability is usually a prerequisite for serving as a surrogate.  However, there is a reason that maternal mortality rates are monitored in every country: pregnancy is an innately dangerous state for a woman, especially in a developing world context.  Surrogates risk metabolic and cirulatory complications, such as diabetes or extreme hypertension.  Death is a small but real risk, as is, through gestational injury, impairment of her ability to have future children.

Those are the known, medical risks that any obstetric specialist knows to communicate to a woman considering pregnancy.  In the case of maternal surrogacy in India, there are social risks that are just as dangerous as the biological ones.  Domestic violence and household strife have been known to arise when a surrogate’s husband dislikes the fact that she is carrying “the child of another man”.  There is one story of a surrogate being forced from her village after her neighbours learned she was carrying the baby of two gay Israeli men.  There is also uncertainty surrounding whether the surrogate will be able to control her diet, or enjoy continuing carnal relations with her husband, or whether her current childcare responsibilities will be interrupted.  These are all downstream negative consequences of the surrogacy procedure that need to be considered when formalizing the contractual relationship, though there is no evidence that these considerations are formally included in existing surrogacy negotiations.

Further complicating the quest for informed consent is the unavoidable power imbalance between doctor, client and surrogate. As the least powerful member of this triad, the surrogate is at risk for being cowed into compliance.  The fear is that unless conscious and overt steps are taken to ensure her full expression of choice and autonomy, a poor, semi-literate village woman will typically accept at face value the estimation of risk presented by a wealthy, educated and typically male doctor.  It takes unusual strrength to find the voice to question points in a formal contract if presented as a fait accompli by an officious clinician. It is in some ways the legacy of India’s colonial heritage, wherein informed consent can literally be coerced by identity; an English-speaking clinician in Western garb weilds extraordinary cultural authority.

A brochure of one Indian ART clinic featured the following quotation from a surrogate who had recently produced a child for an American client: “It’s a miracle.  I myself was wondering how I managed to deliver such a beautiful American, totally white baby.  I couldn’t believe it –I am very happy.”  The statement is presented as a marketing tool for potential foreign clients.  But what should be evident is that this woman failed to understand the genetic realities of the procedure in which she was a central part.  In other words, truly informed consent was not in play.

There is no doubt that maternal surrogacy presents a ripe opportunity for very poor women to make a dramatic improvements in their families’ lives.  So long as infertility remains prevalent globally, and so long as India experiences the tandem of advantageous global prices and widespread poverty, it is assured that India’s reproductive tourism industry will continue to grow.  Our goal, as responsible global consumers seeking to minimize suffering and exploitation, should be to make the process as fair and as safe as possible.  Ultimately, the creation of life is meaningless unless we also strive to respect the living.

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Dr Raywat Deonandan is an Assistant Professor in the Interdisciplinary School of Health Sciences at the University of Ottawa, the former Chief Science Advisor to Assisted Human Reproduction Canada, and an expert on the global industry of reproductive medical tourism. Links to this post are welcome, but please do not excerpt elements or text without informing the author.  Thank you.

Greetings from onboard a Westjet flight from Ottawa to Vancouver.  Award for funniest line of the morning goes to the Westjet flight attendant who announced, while in mid-air: “Smoking is strictly prohibited on this flight. Anyone caught smoking will be asked to leave the aircraft immediately.”  Okay, so things seem funnier in the air.

The big news in global health and development today is that the UN is due on Monday to annouce that the human population has reached 7 billion people.  The United Nations Population Fund (UNFPA) will publish its insights on this matter in “State of the World Population, 2011.”

Seven billion is nothing to sneeze at.  That’s a lot of people.  In fact, it seems likely that the world will see 15 billion people by the year 2100.  Most likely, the 7 billionth child will be born in India or China.  It’s worth pointing out that, despite those nations’ remarkable economic growth over the past two decades, they still suffer from crippling poverty, due in part to a uneven distribution of wealth and opportunity.  In fact, half of all undernourished children in the world live in South Asia.

When we consider population pressures, two thoughts immediately come to mind: starvation and ecological degradation.  The two items are inextricably linked, of course.  With more people comes increased use of environmental assets, increased pollution and increased weight put upon regional ecosystems.  This also means a decreased ability to potentiate food production, given the increased tendency for people to live upon and build upon arable land.  The irony is that with more people, there are more mouths to feed, and thus a greater need for food production.

In a global health context, when we talk about food security, we usually define it as a construct with two dimensions: availability and accessibility.  The former relates to our ability to produce food, while the latter to social, political and geographical barriers that limit proper food distribution.  Most experts will tell you that accessibility is the true limitation to feeding the world.  In most countries, there is sufficient food for everyone, but due to a variety of factors large numbers of hungry people do not have access to sufficient calories.  Perhaps the most famous person putting forward this view is Nobel prize-winning economist Amartya Sen.

While I agree that accessibility is indeed the dimension of food security we must address first, I think it’s becoming preponderantly more important to consider aspects of food production.  This is because it is inextricably linked to the environment; and given the accelerating negative impact of Climate Change on the most populated parts of the world, I fear that food production will be at a crisis level in a couple of decades, if not sooner.

The reason for this is multifold, but I will list but three points:

1. -One of the great crises in the world is the declining availability of fresh water.  This has a most immediate effect on the growth of agriculture.  Climate Change, pollution and population growth have combined to drastically reduce the world’s groundwater reserves, to render many existing freshwater sources untenable, and to change rain patterns such that previously reliable agricultural zones are becoming less so.
2. -In the past century, human beings have begun doing something really foolish: building on arable land.  In previous centuries, we have lived on rock and barren land, and have reserved arable land for farming.  But due to some strange economics, it has become more lucrative to sell farmland to a strip mall developer than to continue to grow crops on it.
3. -Point #2 seems in conflict with the inexorable truth that the world is increasingly urban.  People the world over are fleeing the countryside to live in squalor in cities, again due to the strangeness of our economic systems.  But an important aspect of this observation is that, while some rural land is being abandoned, other rural land is being absorbed by growing cities to become suburbs and exurbs.

A final thought on this matter is to point out the conflict between our concern over a crisis of potential overpopulation and the demands of our growth-driven economics.   On the one hand, seven billion people represents a strain on our resources and on our ability to manage the planet.  On the other hand, we have created a civilization in which wealth is defined by the sum total of economic activities of its citizenry, meaning that more people often means more sustained wealth.  The Western world bemoans its current demograph trap, wherein the fabled Demographic Transition has created so much personal security and longevity that fertility rates have dropped beneath replacement rates.  There is concern in Canada, Japan and much of Europe that the smaller sizes of upcoming generations are insufficient to pay for the demands of our complex and expensive society.

The obvious solution is two-fold: allow the freer movement of people across borders and seek to recompute how we define wealth.  But both of these require a profound shift in both political will and social vision.  Then again, given that the crisis of Climate Change requires a similar shift, maybe the world is ripe for such a change.

As I hope most of you know, I supposedly have a regular column/blog over at the MicroSoft Canada website.  The problem is that their interns keep turning over, and I have no idea anymore who is responsible for uploading my content!  The last article I wrote for them, and that was published, was in April of 2010.   I wrote another one in August of that year, and sent it to every one of my contacts over at MS Canada… but they all seem to have disappeared.  Or maybe my column/blog has been quietly discontinued.  I have no idea.

But I have other things to do.  So here is the article I wrote on Aug 25, 2010, meant for the MicroSoft Canada website.  I doubt I’ll be writing any more of this kind of stuff:

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The Human Resource Gap

It’s been a while since I updated this blog.  Sorry about that.  I’ve been traveling a great deal and haven’t found a free moment to organize a thought lucid enough to be worthy of you gentle readers.

One of my recent travels took me on a lecture tour of India.  It was a bit of a game show atmosphere at times, wherein I wasn’t told the topic of lecture until the morning of the event!  But, interestingly, that’s part of what makes a public speaking career so exciting.  It’s also interesting to have actually reached a point in my development as a speaker that I feel comfortable traveling to a foreign country and culture, and delivering a two and a half hour talk to a room full of scholars… on a topic for which I had very little time to prepare.

So how was it?  In a word… fun.

Part of my journey took me to a town called Kakinada in the Indian state of Andrah Pradesh, where I met with Dr Chandra Sankurathri.  If you do a web search for his name, you will learn of his remarkable personal trajectory.  His is a story well covered in various media profiles, so I won’t go over it here.  But suffice it to say that Dr Sankurathri transformed incredible tragedy into public service of a nature that can only be called transcendent.  His foundation has educated hundreds of underprivileged and impoverished young people, and, in the past 7 years, treated almost two million opthalmological patients too poor to have otherwise received such life-changing medical treatments.

The work I’m doing with Dr Sankurathri’s foundation involves the analysis of some of his carefully kept databases.  This requires the extraction of large amounts of selected data from relative databases kept in Access format.  This sounds like a simple process, but it’s actually fairly trying if you don’t have a certain amount of database management expertise.  Luckily, a MicroSoft certified software engineer lives nearby and volunteers his pricey services to the foundation.  Frankly, I can’t imagine how much more difficult simply gaining access to the relevant data would have been, had this gentleman not been available.

More than just a paean to MicroSoft-certified technicians and engineers, this anecdote is a distilled example of a wider concern in the larger world of do-gooders.  It is true that the remarkable work of Dr Sankurathri’s foundation requires funds, and thus its founder spends almost all of his precious time courting donors.  However, his need –and that of almost all philanthropic endeavours in the low-income world– is for human resources.  Yes, both well-meaning students and seasoned Western professionals undergoing mid-life crises alike can be relied upon to donate intermittent swaths of their time to such ventures.  But the long term problem will always be finding well trained local talent to adopt middle management and administrative roles.

It’s a bit of a lesson for small businesses, as well, which, while similarly driven by a singular vision, also often operate on inconstant funding, yet rely on that most temporal of skills sets: the efficient and competent administrator.

I was just reading an article on Gawker about NASA’s new Mars rover.  The first reader comment, right on schedule, was an image of a starving African child and the statement, “shouldn’t we spend our millions worrying about life on earth, before worrying about life on Mars?”

Arrrgh!  How I hate that naive argument.  And how I hate the manipulative and simpleminded appropriation of the images of Black children to sell simplistic ideas of global health and development.

Now, I’ve tackled this before, as in this blog post about the idiot and hypocrite Ashton Kutcher.   Beyond their obvious exploratory value, I made the point then that each and every space mission is essentially a mini-industry that employs thousands and that re-injects millions of dollars into the local economy, serving as an investment in a nation’s high level human capital.  And this is done with a completely peaceful purpose and process, unlilke similar endeavours that are undertaken by the military.

Another reader of the Gawker article linked to the following clip from the TV show The West Wing, which sells the idea from a different perspective:

But what really annoys me is the unconcious hypocrisy of the people who insist that we should turf our scientific exploration budgets in favour of humanitarian aid.  Science expenditures are actually miniscule, but end up having enormous impacts down the road on everything from local and international economies to the development of new technologies that allow the actual humanitarian aid that we seek.  Few people realize that almost all of the techniques and materials utilized in the provision of primary health care by humanitarian aidworkers traveling to the most benighted parts of the world were developed in large part as a result of the space programme.

As Sam says in the clip above, “No one is hungrier, colder or dumber because we went to the Moon” (or something like that).  More to the point, I think it is demonstrable that many people are warmer, healthier and smarter exactly because we went to the Moon.

But the hypocrisy that eats at me is the inability for people to see the much larger expenditures wasted on frivolous items that have much fewer positive impacts on the world than does the space programme: fast food production and consumption, the glorification of professional sports, subsidized gas and agriculture, a bloated government bureaucracy, massive corporations that exist to do nothing more than move money from one pile to another, the bloated salary of any North American who makes over 100K/year, and, of course, pretty much anything military.

A given space mission costs tens of millions of dollars, is profoundly peaceful, publicly transparent, economically stimulating and results both in increased human knowledge and spin-off industries in textiles, manufacturing, information technology, medicine, and scores of other related disciplines.  Now think about the fees of top Hollywood actors, athletes and CEOs, each of whom could fund a space mission per year on his salary alone.  Now think about the cost of a single nuclear aircraft carrier, which exceeds the price of the entire Apollo space programme that employed tens of thousands and that sent 14 men toward the Moon.  And now ask yourself how much return on investment society gets for allowing so much of our resources to be controlled and pooled by such players.

We choose each day to spend the bulk of our treasure on frivolities that do nothing more than two things: line the pockets of a privileged few and spin the wheels of a few local economies in an unsustainable fashion.   And yet some insist that a fraction of that total invested in peaceful scientific exploration, despite the profound and wide-reaching intellectual and economic implications of such exploration, is a selfish waste because we could be saving starving kids in Africa.  Until you accept that sacrificing our other luxuries –professional sports, Hollywood movies, the empty middle-man roles of the corporate  West, the military, or indeed our daily latte and 20 minute hot showers– would do the job a million times better than denying us knowledge of the universe, then you are engaging in both hypocrisy and poor math.

You want to save starving African children?  So do I.  But I also want to explore the cosmos.  Here’s the thing: there’s plenty of money out there to do both.  It’s all about priorities and will.

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Want some more?  Here’s another great West Wing clip on the same topic.

The Grand Challenges grant seeks to identify emerging leaders in global health research and reward their innovative ideas with a hefty start-up grant.  My idea is something called “Gwitter”, which is essentially a social networking platform akin to Twitter, but which links clinicians in low income countries with specialists in high income countries, for the purposes of allowing for timely access to high quality specialist consultation.  Why?  Because lack of such access is one of the great causes of preventable deaths in the developing world.

Gwitter is a little more complicated than just a new kind of Twitter.  We aim to create an efficient online linguistic translator and a rapid speech-text-speech converter so that language and technical savvy will not be barriers to its global use.  But most importantly, we will create an algorithm for ranking responses from multiple specialists so that the most appropriate answer to any query is the first that reaches the person who asked the question.  In this way we hope to leverage the vast untapped wisdom, skills and energy of professionals in the developed workd.  Instead of asking for weeks of donated time, we instead ask for mere seconds.

(And yes, I’m aware that one of the great barriers to this project is the potential liability on the part of the consulting specialists… that’s one of the things we will work on, if we get the money.)

So why am I telling you?  Because there’s a public voting process involved in the grant competition.  I’m asking you, dear reader, to vote for my project by visiting this link and following the instructions:

GWITTER

Now, be aware that my video SUCKS.  This is because it was put together on a moving train 10 minutes before the deadline.  Do not interpret this as me not caring about the project.  It’s just that I was negotiating for a more professional video production service up until the last minute, and when that fell through my only option was to film something quickly on my webcam.

So please judge it on the merits of the project.  I hope you will vote for Gwitter!

One week of schlepping bags across the Upper Mazaruni area of Guyana’s rainforest, as part of the latest Ve’ahavta medical team, and I’m finally in the Georgetown airport, awaiting my flight home… just in time for whatever Hallowe’en festivities await.

Since internet connectivity was not available in the interior, I saved up my blog posts.  Have at ‘em!

Oct 22

What a charmed life I lead.  Hours ago I was hunched in front of a computer in frigid Toronto, and now I’m… hunched in front of a computer inside a tent in the Amerindian village of Waramadong in the remote interior of Guyana.

Arriving in Georgetown early morning, I hightailed it to Ogle airport to catch a bush plane to Kamarang, which is a remote community near the Venezuela border.  The plane only had two passengers: me and a young man who was transporting a birthday cake. Yes, a birthday cake.

Here’s a pic of the view from my seat on the bush plane, of the rainforest below:

Here’s a pic of the front of the plane’s cockpit.  My mobile’s camera is able to detect the propeller:

There I met up with my contacts who filled both my hands with bottles of Guinness and loaded me onto a dug-out canoe.  So there we were, tipsy on beer, making our way down a jungle river, stopping only to piss.  Weird life.

Over for now.

Oct 23
Jawallah Village

Day 2 of the current expedition to Guyana.  My good friend and strong-like-ox team leader Bekkie departed for Canada today.  We took a long leisurely boat ride to Kamarang village to drop her off at the airstrip before continuing on another two hours to Jawallah.

Last night was sort of interesting.  After traveling for close to 24 hours straight, I bedded down in a palatial tent inside the Waramadong health centre, with my new compatriots fast asleep in adjacent tents.

I was awakened in starts, first by the lovely growl of distant howler monkeys, and then by the less than pleasant cantankerous outbursts of a drunken and profane man, whose voice indicated that he was inside the health centre.  I could hear the snores of my colleagues.  Why weren’t they awakened by this man?

I would drift back to sleep, quite confused, only to be awakened by a long string of very loud four letter words.  I had the presence of mind to reach for my knife, never far from hand.  But being semiconscious and very confused, I never found the wherewithal to get up and investigate.  Was it a dream?  Heck, I’d been in Ottawa earlier that day, and now I was in a tent in the South American jungle, possibly hearing a drunken AmerIndian man wander in our midst.  I was confused and dazed.

In the morning I learned that the drunk had been our boat captain, who was engaged in either an inebriated argument with persons real or imaginary, or having night terrors.  I lean to the former.  A weird first night.

After exhausting ourselves lugging our bags about 200 metres from the boat landing to our tenting location, we relaxed into a delicious swim in the black waters.  (For me, more like a splash than a swim… I can’t bring myself to swim in river waters that are too black to see more than an inch beneath the surface.)

Afterwards, I was overcome with a desperate desire for carbonated pop. A can of coke goes for US$3 here.  A colleague bought me an ice cold sprite, and I cherished it like my firstborn.

The evening ended with us lazily enjoying the full moon reigning over the Kamarang jungle river.  A tropical thunderstorm forced us back to our tents.  A long, hopefully sleep-filled night awaits.

Oct 24
Jawallah village

The village is nestled in a gorgeous section of the interior, with a moonlit river snaking between two banks of somewhat well developed human settlement.  The problem is that, frankly, people suck.  The young men seem perpetually drunk. Sexual assault is highly prevalent. Even the women of our team, usually deemed beyond such unwanted attentions, suffer vile comments and innuendos.  Indeed, one of our doctors witnessed what seems to be a rape attempt within the confines of our very clinic.

I’m afraid to say that my impression of Jawallah, despite its gorgeous children and friendly villagers, is one of drunken louts and sexual predators.

Nonetheless we had a productive clinic today, with about 70 patients seen.  One in particular ate up a fair amount of clinical time: an older man needing a circumcision after suffering an inflamed foreskin.  Not the most pleasant thing to watch.

I find myself strangely worried about some water purification kits I gave out to scores of villagers.  I gave strict instructions for one packet of the agent to be used for 10 litres of water…. but I’m worried that someone might create an over-concentrated batch as drinking water, and end up feeding his children insufficiently diluted bleach!

I think the fears are unfounded.  But I’m a worrier.

Off to sleep now… in a tent on concrete, as a dying generator and howling dogs scorch the background soundscape.

Oct 25
Kamarang

A half day clinic in Jawallah was instructive.  The day began with a house call to a house down the way, where an elderly woman had split her knee open after a bad fall.  Doing triage, I had my joyous fill of wrestling with adorable AmerIndian kids fighting to avoid having their temperatures taken.

I’ll never forget one particularly adorable 2 year old girl with undiagnosed Down’s Syndrome and partial paralysis resulting from a stroke.

Heartbreaking, yes, but as one of our doctors reminded me, each child is –as cliched as this may sound– a source of hope.

We took down our clinic and went off by boat to Kamarang, transporting two patients in the process, one of whom had to be carried the agonizing 60 feet or so of stairs going straight up from the boat landing to the health centre.

And here we are now, camped out in a local guest house.  The rest of the team is bedded down in tents on the guest house grounds.  I opted to pay the $20 for a private room and a bed.  Hey, I’ve got nothing to prove.

Tomorrow, off to Bartica…. and a chance to upload these blog posts!

Oct 27

Bartica

It’s 10:30 pm and I’m drunk off my ass.  We’re toasting the early departure of Dr Louis , a fascinating and hardworking man who easily won my respect and affection.

Today was a profoundly interesting day.  We provided a full day of clinical services to the inmates of the Mazaruni Prison (for long term offenders) and of Sibley Hall (for first time offenders).

The prisoners were uniformly respectful and pleasant.  A brief altercation arose after someone called someone else an “Auntie Man”, but otherwise things went swimmingly.  We saw 110 patients, much more that we would have seen in a community clinic, due to the regimented nature of the prisoner consults.

Some observations…

I don’t ever intend on being in a Third World prison.  Please Zod, never.

Almost everyone had a low back pain complaint.  Our physiotherapist had to see them four at a time.  Increasingly, I am convinced that the fastest growing global health needs are for psychiatric counseling and physiotherapy.

There were many cases of men who thought they had TB, but who just had migraines.

There were many cases of men with headaches and coughs who likely had TB.

There were a great many cases of swollen testicles (a result of undiagnosed STI perhaps) and at least one likely case of testicular cancer.

Language continues to be a barrier in providing services.  Yes, everyone speaks English, but not all English is alike.

I’d like to give more anecdotes, but I don’t think it would be ethical.  Suffice it to say that this visit has been downright fascinating, and certainly justifies my participation in this mission, as I hope to write a paper about it all.

Okay, off to bed.  Tomorrow we provide a clinic to the community of Itaballi then do a call-in TV show.

Oct 30

Toronto

So glad to be back in Canada.  The Customs dude caught me bringing back more rum than  what I am allowed, but let it pass since my mission had been a humanitarian one.  See, kids?  Volunteering pays off!

I didn’t mention than on our last day in the frontier, as we took a boat ride toward the city, we passed a bloated body that had been washed up on the beach.  This is officially the 4th random dead body I’ve seen in my various trips to Guyana.  What is it about this place?

Awaiting my flight to Ottawa now, and a frantic search for a Hallowe’en costume.  I have soooo much work to catch up on, and now I can add getting a TB skin test.  I’m concerned about my exposure, particularly in the Mazaruni prison.

In addition, I have a special treat for my students on Monday.  First they get to see my various bites.  Here’s a pic of my ankle:

Then they get to watch me take my medication for possible intestinal worm infection.  I don’t know that I have worms, but so many of the kids that we saw did have them.  And so many cute little toddlers –whom I was holding while their mothers received treatment– stuck their dirty little hands in my mouth.  There are no toys in my mouth!

Okay, off to get a stiff drink.

Feb 16 – Bethany, Guyana

It is Feb 16 and I’ve been back in Guyana for almost 4 days. As I write this, I am huddled under a mosquito net, recognizing the keyboard keys by the illumination afforded by my headlamp, and sweltering in heat that feels like 35 degrees or so. It is 9pm in Bethany in region 2, and I am presently visiting a clean, organized medical mission run by 7th Day Adventist missionaries. I expected to be sleeping on an open deck, knife clutched for fear of nocturnal aggressive dogs and other such creatures. Instead, the mission has given me a luxurious private bungalow in which to spend the night.

Luxurious is a relative term, of course. This is still mostly rainforest. My bed is shielded by a mosquito net. But all types of creepy crawlies are being drawn to the glow of the computer screen, and the net is now crawling with life. Oh, and there’s a family of frogs living in my toilet bowl. The missionaries call them “surpprise frogs” for the obvious reason. They may regret their choice of abode tomorrow morning when my bean-heavy meal is fully digested. Then they’ll be the ones who are surprised.

Yes, my line of work really is stressful. To greet us in Bethany, the college arranged for their top massage students to give us each a one our relaxation massage. Beneath starlight, nestled in the jungle’s humid embrace and soothed by the otherworldly tweets and chirps of creatures unseen, we had the knots of our muscles expertly pressed away.

The college, by the way, is a training centre for vegetarian Seventh Day Adventist Bible workers who wish to attach medical skills to their missionary work. I have my hesitancies about mixing religion and medicine, but it’s nothing new in the history of humankind, and there is no doubt that these are intelligent, caring people who –religion or no religion– can provide some much needed health relief for the tens of thousands in Guyana who suffer without regular medical care. And there’s also no denying that the college has created a wondrous, peaceful and comfortable home here in the Essequibo region, literally carved out of pure jungle. With all the holiness about, it’s a wonder my unclean self doesn’t burst into flames.

Their vegetarianism is also a boon. Despite my regular bacon fixations, I am mostly a vegetarian myself (mostly!), and prefer to remain strictly so while traveling. Guyana has proven particularly difficult to maintain such a diet, so it’s a fantastic thing to be housed in a compound that produces very creative and healthy vegetarian fare.

This is my umpteenth trek to Guyana, each time with a different mission and purpose, and each time with a different destination. In the morning we travel to the AmerIndian village of Mashabo, where we will explore potential new development projects. Then it’s back to Georgetown to await our Friday morning flight home. A medical team attached to the NGO I’m representing on this trip is presently in the deep interior, near the Venezuelan border; they are returning to Georgetown Friday evening and I’m sad that I won’t be able to meet up with them before leaving.

Our first stop was the frontier town of Bartica, outpost of boatmen and gold miners straggling in from Brazil, Venezuela and all points within Guyana. Here’s an object lesson for those North Americans among you who have never ventured abroad: one night, at dinner with four senior men of Bartica, they turned the conversation, in all seriousness, to the topic of whether one’s first love can truly end. It’s something I’ve seen throughout my journeys, but never in the “West”: men from all walks of life –builders, miners, politicians, labourers– gathering together to discuss the nature of love.

The bugs are spooking me now. Got to turn off the computer!

Feb 17 – Bethany, Guyana

Just returned from a visit to the AmerIndian village of Mashabo, which is home to 400-500 Awarak and Carib Indians, cared for by one overworked health care worker, the very charming and experienced Esther. Our job here is to scope out the community’s appropriateness for a medical intervention. My personal agenda is to determine whether any smaller, low investment but high income, projects can be initiated here. The answer to both questions is yes.

Mashabo is a gorgeous set of wooden homes nestled above a seemingly pristine lake. Like all waters in Guyana, the lake is brown and muddy, but somehow seems cleaner and almost blue from a distance. Esther informed us that ongoing issues include malaria, maternal health problems, chronic pain management, blood counts and contraception needs, all within the NGO’s mandate. Additionally, our visit to the underresourced primary school leads us to conclude that teaching aids, particularly with respect to language and science teaching, are most needed. This, I think, is a potentially cheap and impactive development initiative.

At one point, I went for a walk down one of the trails cut by a tractor (logging is the major industry here). Exotic plants and insects abounded, as well as the ubiquitous rustle in the foliage that was usually a splendid ground-dwelling bird or one of many species of large lizard. This is the jungle, after all.

I spotted another trail, mostly overgrown, that looked to have been cut by machete days earlier. Did I dare? How brave was I? This is, after all, the land of five very prevalent poisonous snake species, killer jaguars, poisonous spiders and a plethora of unnamed biting things that can cause disease, pain and even death. I’ve been to jungles in Guyana, Guatemala, India, Malaysia, Thailand and Uganda before. I’ve tracked wild mountain gorillas through the Congo jungle, bivouaced in a hammock on the Brazilian border to hear the jaguars patrolling, piloted a bamboo raft across a jungle river from Thailand into Burma, and have stared down forest foxes on the steps of remote Mayan ruins being overtaken by the forest. I contemplated the snake-proof gaiters in my pack, the mosquito mask in my back pocket and the hunting knife in my front pocket.

Yes, I dared.

And as I bravely set foot onto this path of new dangers, furtively congratulating myself on my masculine courage, I suddenly jumped back! I was surprised by six barefoot AmerIndian schoolboys, the eldest no more than 7, running happily from out of the “dangerous” path. Each turned to me and politely said in turn, “Good afternoon, sir!”

Yeah, I’m an idiot.

It’s 7pm now and I’m back at the mission. The blazing stars glare down through crystal clear skies, and the oppressive heat sets in for the night. I must awaken at 5:AM to make the boat back to Georgetown. But I go to sleep now with a strange contentment. We heard tonight the members of the mission singing, broken youth who have come here to mend and to find a new way. Christian songs echoing through the jungle, like something out of a Jeremy Irons movie (you know the one). I am not a Christian, but I understand what they do here, and I appreciate it.

Feb 18, Georgetown, Guyana

I awoke at 4:AM to catch a speedboat to the town of Supenaam, where anotherboat would take us to Parika, followed by a drive to Georgetown. In the wee hours, the jungle is dark and silent, save for the constant buzzing of weird insects and the occasional crash of something unknown against a hard surface. I took the time to examine the stars, so brilliant and skewed than what I’m used to in Canada.

I heard another of those mysterious crashes coming from the thickest part of the snaking treeline, and flipped on my headlamp to have a gander. We are below sea level, in a genuine South American jungle. The air is as thick as soup, coarse with raw oxygen spewed forth by the greenery. In front of my lamp, a line of plankton-like objects swam in the air, reminding me that life is everywhere here, even in the breathable air, fully explaining my endless allergic reactions.

Hours of peaceful boat journey back to the “city” were instructive. Passing children –7 or 8 years old– clean and lovely in their pressed school outfits, actually rowed their own boats to school. Children in Canada at that age whine about their electronic toys. Children here perform daily manual labour to earn the right to go to school.

We stop to pick up a mother and her three schoolage kids. One of them has been up all night with diarrhea, so they are heading to the hospital. There is a diarrhea epidemic across the country right now, as a mini-drought has gripped the nation, leading to improper use of stagnant waters. One child spends the boat time brushing his teeth with clean water in a cup, spitting into the myserious brownness of the river. It is a weirdly peaceful sight.

In Georgetown we checked into the Hotel Tower, my 5th time staying here in the last 10 years. Ironically, my father had been a waiter and busboy here 60 years ago. He wouldn’t recognize the place today, with its contemporary discotheque, free wifi and in-house spa. Don’t get me wrong –it’s still a Third World inn, so it’s no Ramada or Continental. But it certainly has changed since my father’s day.

We met briefly with the people who run Food For The Poor, an international NGO that delivers –you guessed it– food for the poor. Then topped off the day with a bit of tourism: a trip to the zoo.

Now, I’d been to the Georgetown zoo several times before, most recently only four days ago! But there’s not much else to do around here. For the equivalent of US$4,two people enjoyed entrance and an alcoholic beverage each. Trust me, booze helps you accept some of the horrors you see in this place. My least favourite is the adult African lion, kept in a concrete cage no bigger than a king-sized bed. The poor beast looked bored and miserable.

Most fiercesome were the harpy eagles and various species of South American owls, each big enough and with talons broad enough to easily pick a human baby from its mother’s arms. The harpy eyed me with malicious intent, until I distracted it by indicating a nearby child: much easier pickings.

Interestingly, there’s a huge fenced in exhibit featuring…. a cow. Yes, a cow. With the cow was a toucan in a cage. A cow and a toucan. I think there’s a Saturday morning cartoon there somewhere.

Further on is the tapir enclosure. A sign above it indicates that this tapir is on loan from the Philadelphia zoo. Why is this interesting? Because I’ve seen tapirs in Guyana before… wandering about, minding their own business. Tapirs are indigenous to Guyana. Why do they need to get one from Philadelphia, of all places?

Weirdest of all were the monkey enclosures. These are large metal cages holding many spider monkeys, howler monkeys, and other breeds I did not identify. The spider monkeys are huge, elegant and sad, with active prehensile tails and faces of red otherworldly delight. They are so bored that they shake the hand of any passing human, possibly writing on their palms in secret monkey script, “Send help!”

But several of the smaller monkey species have figured out how to get out. They treat the cage like a sort of townhouse, coming and going as they please, occasionally visiting other monkey species in their cages. I was concerned about one of them wandering into the anaconda or jaguar enclosure, so I alerted an employee.

“Oh those aren’t our monkeys,” she said. “They come from the outside.”

Really? If there are so many monkeys just kicking about visiting their monkey friends in prison, why do we bother even having a monkey prison?!!!

Clearly, this is not the most progressive zoo in the world. I think the alcohol might have given it away.

Off to dinner now, then a long night of catching up on overdo work. Then back to the cold winter of Canada.

During the first session of every class that I teach at the University of Ottawa, I relate to my students some of my observations from giving a lecture at Jawarlahal Nehru University in New Delhi, India, back in 2007. Essentially, I tell them about how the students at JNU take their education much more seriously than do students in Canadian universities, about how they don’t complain about extra work or the difficulty of classes, but rather appreciate the increasing competitiveness of a globalised economy and therefore the importance of every small iota of knowledge or skills that an educator can provide. This experience is contrasted with some of the complaints I get from some Canadian students, who moan about “too much math” or having to do –gasp!– written assignments or, Zod forbid, write two exams on the same day.

I tell them this in order to bring home the truth, as I see it, that the West is losing the education war, and that we North Americans need to work very hard indeed to match the work ethic of our Asian competitors. After all, I want my students to be as competitive as their Asian brethren, and to be able to work, produce and excel at a global pace.

This sentiment is touched on briefly in Hans Rosling’s famous TEDIndia lecture, in which he states that in his experience students in India study much harder than do students in the West.

I observed a similar trend during my tour of India’s major cities in 2007, where I noticed that every young person with whom I interacted seemed willing and able to sacrifice and to endure great hardship to do his part to push himself, his family and his country to the world’s economic forefront. I’ve seem similar work ethics in other parts of the world –China, Indonesia and Thailand come to mind– but never with the same weird mixture of optimism and desperation.

It’s almost a truism now that a handful of formerly impoverished nations are poised to be the superpowers of the next century. The so-called BRIC nations –Brazil, Russia, India and China– have the world’s fastest growing economies, and are posting expansive economic stats, even during a global recession. Two in particular –India and China– are seen as the great emerging powers of the world. Indeed, it should be noted that in the history of human civilization, the two strongest economies on Earth have always been India’s and China’s, with the exception of the colonial period of the past 200-300 years.

Currently, most US and Canadian foreign policy, with respect to these nations, has focused on China being the likely rival to the USA’s throne of hegemonic dominance. This is reasonable given the overlap between American and Chinese military interests (security of the Formosa Strait and arms deals in Sudan among them), and also because of the current dominance of Chinese products in US markets. Chinese GDP is 7-8 times that of India’s, her per capita GDP six times greater, and her inflation substantially lower. China’s infrastructure, her road quality, civic amenities and electrical grid, for example, are comparable to those of Europe or North America, making for relatively efficient goods production and transportation. And Chinese military power is well proven and disciplined, making China the great regional superpower of Asia.

In the comparison of Chinese and Indian economies, a practice increasingly popular in the parlour rooms of academics, China seems to win according to every traditional metric. But there are qualities that hint at a dramatic shift in coming decades. I would like to respectfully suggest that it will be India, not China, that will take the world’s economy and culture by the collars and shake it till the human race takes note. Assuming that a global economy still exists, and assuming that Climate Change or some other apocalyptic event hasn’t ravaged humanity back to the Stone Age, I predict that the close of the 21st century will see India as the world’s leading nation.

Here are my reasons:

The demographic dividend. China has an age profile comparable to that of Western nations, specifically Canada. In other words, the Chinese are old. As a result, they are heading for the same economic precipice as is the West: in 10-30 years, the number of workers will be fewer than the number of retirees. This is a considerable economic strain. India, on the other hand, is a very young nation. The bulk of its population is just entering the work force.

English. There’s a reason one of the more dynamic industries in China is English language training. They recognize that English is the current global lingua franca and the language of commerce. This will not be changing anytime soon, due to centuries of British then American global dominance. As a result of their colonial past, the elite and mercantile classes of India are already either functional or fluent in English, affording them immediate linguistic entry into the global market. It is not unusual or difficult to find fluent speakers of French, German, Portugese, Russian or any number of important world languages on the streets of India; the same cannot be said of China.

British law. Another dividend of post-colonialism is the inheritance of a relatively functional, reliable and more-or-less fair judicial system, at least to the extent that it needs to be for business purposes. China’s legal system is functional, as well, but individual rulings at the local level are theoretically subject to the whims of the central ruling party. This is relevant to business because trans-border contracts need to have legal heft. An agreement with an Indian firm is guaranteed by the Indian legal system; there is recourse, at least in theory and more-or-less in practice, should a contract go awry.

Politically engaged diaspora. Both nations enjoy large global diasporas which have sought and received commercial success. But the Indian diaspora has gone further by achieving political success. Canada, the USA, the UK, the Caribbean, Africa and beyond… all are seeing elected officials of Indian extraction who, while serving the needs of their electorate, nonetheless maintain a connection to the Motherland. This is serving to accelerate commercial, philosophical, cultural and political connections between India and the world.

Energy profile. Both growing economies are emerging energy hogs. However, China’s model is a factory-based industrial one, depending on coal-fired plants to churn out cheap consumer goods that flood Western markets. India does some of the same, but is known more for its virtual products and human resources –information technology, call centres, medical tourism, etc– all of which have fewer industrial energy demands than does strict manufacturing. The result is that as energy production becomes increasingly prohibitively expensive, the Indian model for wealth generation will become more labile and efficient than the Chinese model. This may be the difference in sustaining Indian growth when the energy crunch really hits hard.

Democracy. It’s somewhat propagandistic to suggest, as the West did during the entirety of the Cold War, that democracy is a prerequisite for national wealth; Singapore proved that assertion to be false. However, history suggests that democracy remains the best political system under which to build a thriving, stable economy. India’s functional democracy, unlike China’s one-party ruling system, is arguably more robust against major perturbations. A revolution, the argument goes, leading to a vitiation of trade deals and dramatic shifts in economic philosophies, is less likely under India’s system than under China’s.

Soft power. Whereas hard power is military brute force and money spent by one nation to affect the behaviour of another, soft power is that exercised to encourage others to become acclimatized and sympathetic –almost desirous– of one’s lifestyle and perspective. There is official, government-funded soft power and unofficial, cultural soft power that flows naturally from a nation’s character and enterprises. Both India and China have pursued the former, by sponsoring cultural exchanges and by investing in development projects and other goodwill gestures abroad. China, perhaps, has been more acutely involved in this activity, especially in regions of specific geopolitical interest, like energy-rich portions of Africa. However, the unofficial kind of soft power is arguably what is more pertinent to assuring a nation’s supremacy atop an increasingly monolithic world economic culture. After all, what has done more to promote US interests abroad, America’s vaunted military supremacy or Coca Cola, Hollywood and Britney Spears?

Chinese cultural soft power has flowed slowly but consistently over the years, bringing kung fu, acupuncture and Chinese cuisine to all parts of the globe. But in recent years we’ve seen the explosion of Indian soft power. The ancient art of yoga is now, ironically, a fast growing multimillion dollar global industry. With it has come Indian styles of meditation and Ayurvedic medicine, all the rage in trendier parts of the West. India is now the centre of the English-language book publishing world, surpassing both the USA and UK in this category, and regularly producing Booker and Pullitzer Prize-winners from her sprawling diaspora.

An increasing global acceptance of vegetarianism as a lifestyle, championed by celebrities and medical authorities alike, is being fueled both by rising food prices and by realizations that meat production is not an environmentally sustainable practice at current global levels. With the increased popularity of vegetarianism has come a gravitation toward the world’s most recognizable vegetarian culture in India. This, too, is a kind of soft power.

Bollywood is, of course, the dreadnought of Indian cultural soft power. Bollywood images of beauty, athleticism, wealth, talent and vivacity are replacing extant world views of Indians as mystics, fakirs and impoverished indigents. The Oscar win of Slumdog Millionaire has permanently cemented the Bollywood ethic into the global mainstream, and with it a growing comfort with doing business with Indians, in all the ways that that phrase suggests. To paraphrase Shashi Tharoor, in today’s world it’s not the country with the biggest guns that wins, but the country who tells the better story; and India is quite adept at telling stories.

The import of cultural soft power is being seen in the rise of Indian educational centres; a few of whom, such as the Indian Institute of Technology, are rivaling the top schools of the USA in quality and name recognition, and are attracting foreign students in increasing numbers. China has some excellent schools, as well, but the global branding of Indian schools is allowing their graduates to leverage those brands in trans-national commerce, by force of name recognition alone, a feat that was once the sole domain of top US and UK colleges.

Both India and China suffer from that great worrisome blight of the Global South: the gaping chasm between rich and poor, both within city centres and between rural and urban poles. In the Chinese case, this has been managed centrally, by establishing specific zones of economic activity. But within those zones, tragedy abounds in the form of child workers and conditions rumoured to be occasionally medieval in their brutality.

In India, the oceans of working poor underwrite the middle class’s rapid accumulation of wealth. In the streets of Mumbai, street-side sellers, sweepers and construction workers sleep in the streets or in temporary slums so that the important work of erecting skyscrapers and servicing the business class will not be slowed by the inconvenience of worker health or happiness. Neither the Chinese or Indian case is a sustainable model for labour rights or popular stability.

Both nations must solve their worker rights issues before economic stability is achieved. Frankly, the nation who can do so first may, quite literally, inherit the world.