Academics and Research / Magazine Feature

Professor receives grant to study effects of good health in Bangladesh

DU's Randall Kuhn and the Matlab data room staff celebrate the 40th birthday of the Demographic Surveillance System.

In the United States, television shows like “The Bachelor” and “Keeping Up with the Kardashians” suggest that to attract a man, women need only be sexy, fashionable and fun. So it might surprise some to learn that in developing nations, the first step toward better marriage prospects is—wait for it—eliminating diarrheal and respiratory diseases.

That’s the theory, anyway. Randall Kuhn, director of the Global Health Affairs Program at DU’s Josef Korbel School of International Studies, is about to test it with his colleagues—and 24,000 study participants—in Bangladesh. Kuhn believes that better health can have far-reaching social and economic effects, like enhanced education, job and marriage opportunities.

“If you had measles as an infant and it had gone encephalitic and affected your brain, arguably your marriage prospects would suffer,” Kuhn says.  “But an even more nuanced story would be that repeated episodes of disease, which tend to intersect with each other and with malnutrition, tend to compromise your human capabilities and affect how others see your capabilities.”

Kuhn and his team at DU just netted $240,000 to prove it. It’s part of a larger $3.2 million grant from the National Institute on Aging, which will be shared by researchers from CU-Boulder, Brown University and the International Centre for Diarrheal Disease Research. “To receive U.S. government funding for a project of this magnitude, in a place as far away as Bangladesh, during a recession is a major achievement for DU,” Kuhn notes.

But the real beneficiaries are likely to be people in developing nations throughout the world, as Kuhn tries to answer the overarching question: Under what circumstances does better health lead to better development and human security — and when does it not?

Kuhn’s project builds on work done earlier, in what is now the world’s longest-running health research project. In 1963, researchers set up a field office in Matlab, Bangladesh (then called East Pakistan), distributing cholera vaccines to villagers, who had the second-highest rate of cholera in the world. By 1966, the fatality rate had plummeted to 1 percent. In the 1970s and 1980s, health workers began “doorstep delivery” of contraceptives there, as well as vaccinations for mothers and children against devastating illnesses like polio, measles, mumps, rubella, tuberculosis and tetanus. In a 15-year period, fertility rates declined dramatically, from 6.5 to three children, on average. “The latest UNICEF health study [showed that] the leading cause of death for Bangladeshi children ages 1 to 5 is now drowning. The real message is not what kids are dying of, it’s what kids are not dying of,” Kuhn added. “That’s a huge victory.”

Some have called it the “Bangladesh Miracle,” Kuhn says. But the real measure of the program’s success will be whether Bangladeshi people have better lives, not just longer ones, he adds. And, indeed, in 1996, researchers discovered that teenagers in Matlab who had the health interventions as children scored an average of two points higher on cognitive exams, regardless of how far they went in school, compared with those who didn’t have treatment.

“Fifteen more years in the future … the differences are going to start to disappear unless there’s something you can do with those two points of cognition. This would be where the benefits of health run out, unless people have ways of converting it into a better life,” Kuhn says.

So perhaps it was serendipity: Right around the same time the cognitive effects were observed, another type of intervention was gaining widespread attention: microcredit — or making very small loans to help impoverished people finance a small business. (The idea was pioneered by Muhammad Yunus — a Nobel laureate who has also been feted with a cameo appearance on a recent episode of the Simpsons.) So in 1996, Matlab researchers set up a multifactorial study, investigating the effects of microcredit, singly and jointly, with the effects of health interventions. It seemed logical, Kuhn says, that “the two points of cognitive function would be a lot more useful if someone were offering you a loan.”

Kuhn and his team propose to find out. They spent two years developing a survey, which was will be administered to every woman and child involved in the 1996 research, as well as their descendants. With questions about marriage, earnings, social networks and more, it attempts to assess the impacts the health and credit interventions have had on Bangladeshi lives. In March 2012, Kuhn, his team and about 200 fieldworkers will begin collecting the surveys from all 24,000 people — whether they’re still living in Matlab or have migrated somewhere else in Bangladesh in search of a better life.

Kuhn’s work marrying health and economics will also play an important role in the upcoming volume he’s co-authoring on global health forecasting, along with Barry Hughes, director of the Frederick S. Pardee Center for International Futures at Korbel. “His work has contributed to the creation of the most extensive health forecasting system in the world,” Hughes says. “The forecasting system allows exploration of the … socio-economic implications of a wide range of interventions, such as smoking rates, obesity levels and air pollution levels.” The book will be published in December 2010.

“Leaders value health not just as a right,” Kuhn says. “Sick people throughout the world have untapped potential; their suffering will lead to a loss of productivity, to conflict — the story goes on and on. We’re trying to show the impacts of health as well as the limits of the impacts.”

Tags: ,

Leave a Reply

Your email address will not be published. Required fields are marked *