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Giving what we can [Development Drums podcast]
My guest in the latest Development Drums podcast is the moral philosopher Toby Ord.Toby has made a commitment to give away the majority of his lifetime income to charities working in the poorest countries. He is also the founder of Giving What We Can, a society of people who commit themselves to give away at least 10% of their income to wherever it will do the most to relieve suffering in the developing world.
In the podcast, Toby talks why he thinks it is important to identify and support the most cost effective programmes. The podcast also discusses the moral philosophy which guides Toby's approach.
Toby Ord
One of Toby's insights which I found interesting was his observation that the cost per year of life saved varied enormously between different development programmes. You can buy an additional year of life for $3-$10 by investing in interventions such as zinc fortification, childhood vaccination and managing tropical diseases, compared to about $500 for antiretroviral therapy. Toby challenges the common assumption that we should spread money around to do a little of everything, or that we are entitled to choose the issue which most interests us. He suggests we have a clear duty to identify the most cost effective approaches and then focus our money on those.
In the final part of the podcast we discuss Toby's decision to establish Giving What We Can, and the choice that Toby has made to give away most of his lifetime earnings.
You can listen to Development Drums directly on the website, download it to your MP3 player, or subscribe free of charge in iTunes.
[This blog post was updated on 27 April 2012 to reflect corrections to the original DCP2 estimates of the cost effectiveness of treatment of Soil Transmitted Helminths, which were found to be incorrect]
20 thoughts on "Giving what we can [Development Drums podcast]"
Julian Hows April 20, 2012 at 11:32 am
…and/or of course you can give your money (and your time) to bring the cost of ARVs down to the same as that for bed nets or parasitic infections; but as someone living with HIV I would say that wouldn't I ?
Sam Gardner April 20, 2012 at 3:19 pm
This links to the results agenda. Choosing an ineffective programme is choosing not to save lives. In various sectors, often in health, where there is a tradition of measuring results, we can even calculate how many lives we choose to "terminate" by making bad choices.
In health provision in the rich countries, defending a non-results agenda would lead to prosecution.
ken April 21, 2012 at 2:14 am
I don't think Julian Hows's comment should be easily dismissed. Focusing so much on cost effectiveness implies that costs are constant and exogenous, and that is wrong. Costs change depending on what sorts of activities we engage in (there are scale economies, so more focus on bednets, for instance, might bring the cost of bednets) and costs can be altered through other interventions that lower prices (e.g. the introduction of generic competition lowers the costs of HIV/AIDS treatment). I'm not convinced by the argument that we should do less of things that are not cost effective and, to the contrary, find the inverse argument, that if there are good reasons for making certain interventions then we should try to make them more cost effective, quite compelling (or at least not easily discarded).
Owen Barder April 21, 2012 at 7:27 am
@julian @ken
I completely agree that in thinking about cost effectiveness we should take account of the future benefits of our actions today – and that those future benefits may include bringing down future costs. (There are other possible future benefits which need to be taken into account, such as new knowledge, public awareness, etc). There may also be future costs which should be included. A cost effectivess measure should include realistic estimates of these future effects of today's decisions
Indeed, I have myself worked on programmes such as Advance Market Commitments whose cost effectiveness is significantly dependent on the expected impact on future prices.
None of that means we should not examine the cost effective of proposed interventions: it means we should be comprehensive and forward looking in our estimates of cost effectiveness to include our best estimates of all these future benefits and future costs.
Perhaps advocates for spending money now on ARVs believe that, properly measured to include the future benefits and costs, the cost per QALY of ARV programmes is substantially lower than the $500 estimated by DCPP. In that case, let's see the analysis. I would be surprised if it changes the figures enough to change the conclusion, but I am certainly open to the possibility that it could do so.
In short: it is right to argue that cost effectiveness analysis should be done properly. What is not right is to say that because of these future benefits, cost effectiveness is not a good basis for taking these decisions.
ken April 21, 2012 at 10:58 am
Owen — Thanks for the reply, one of the things I appreciate and like about your blog is the willingness to engage with comments. Two brief remarks, if I may.
Your final paragraph: I don't disagree with this and can't imagine there are too many people that would. I hope my comment didn't imply that "cost effectiveness is not a good basis" but rather that it needs to be done properly. But there is a lot of room for disagreement over what constitutes "done properly."
ARVs: Consider the cost effectiveness of ARV treatment in 2000 vs 2010. It still may be low, but it's gone down greatly. You have to ask why. There are lots of factors, of course, some having nothing to do with giving and philanthropy, but at least some role was played by decisions made by donors (individual and organizational) to promote the treatment ARV campaign notwithstanding low QALY-based cost effectiveness. Busby and Kapstein have forthcoming book about this process by which donors/activists built the generic ARV market, which in turn has increased the QALY of each dollar spent.
Owen Barder April 21, 2012 at 12:54 pm
@ken Thanks. One of the main reasons I blog is because I learn a great deal from the conversation in the comments.
Gregg Gonsalves April 21, 2012 at 9:27 pm
Hi, Owen, so this reply is actually a response to the larger dialogue that you, Matthew Greenall and I have had over the past few days, but which was spurred on by your podcast with Toby Ord.
First, I think Toby's decision to give away the majority of his lifetime income to others less fortunate than him, through charities working in poor countries, is a noble gesture. Whether this will make a difference in the lives of the people he hopes to reach or their communities is an open question.
What concerned me in the podcast was the over-emphasis on a narrow conception of cost-effectiveness, not as a rubric for guiding Toby's personal choices (which are his to make), but by extension as a framework for how others, including donor nations should be allocating aid.
I've pointed you to the critiques of simply tabulating the cost of interventions for a single disease like AIDS or between those for different conditions, for instance between HIV and helminth infections, and categorizing them as all crudely comparable in other ways (see Walensky and Kuritzkes from 2010 or Moatti from 2008). However, in the podcast, Toby runs down the cost of treatment for Kaposi's sarcoma, for antiretroviral therapy, for condoms, for AIDS prevention education, in a stepwise fashion commenting on their relative and descending price tags, just in this way.
In our subsequent exchange, I think we both agreed that more sophisticated cost-effectiveness analyses are critical components of decision-making around health funding, lest we end up simply prioritizing the cheapest interventions for the poor.
As far as I know, at least where it concerns HIV and interventions for other diseases, none of the cost effectiveness analyses have hit this level of complexity, ignoring many of the spillover benefits of ARVs (e.g. on prevention of new infections; maternal survival and survival of uninfected children), let alone addressing the relative impact of these indirect effects in comparison to interventions for other diseases as you have suggested we require.
Meanwhile, these more rudimentary cost-effectiveness analysis are routinely trotted out and used in the public realm to suggest ART is not cost-effective, and Toby's short analysis seems to fall into this trap. You seem to suggest the burden of proof is on AIDS advocates to do these analyses, but say nothing about the use of simplistic formula by others in the public sphere to make the case against AIDS funding.
It is also worth noting that even if we can say confidently that X is more cost-effective than Y, the political economy of global health doesn't simply flow out of these kind of technical analyses. For instance, a certain political alignment happened in many countries and globally around AIDS that was very effective in driving institutions and the elites that control them to respond to the epidemic after years of neglect. Just because ARVs are more expensive than deworming medicines doesn't affect that fact. It's not as if you can push a button and redirect the complex history of AIDS activism towards another more cost-effective goal. In fact, sometimes I wonder if people prefer a generalized insufficiency where everyone suffers with little than to let progress happen by fits and starts, in ways that aren't exactly how rational actors would have set the path forward.
You also seem to discount the role the AIDS movement has had in vastly expanding the pot of money for global health, saying at least in Europe, this activism has affected allocations for programs rather than the aggregate sum up front. What I would like to see though to support this is some data on global health spending pre- and post-2000 in the states of the EU, when there was a huge groundswell of AIDS activism which led to the establishment of the Global Fund to Fight AIDS, TB and Malaria, the US President's Emergency Plan for AIDS Relief, and a series of other related initiatives. Is it indeed true that in Europe, governments were immune to the global advocacy around HIV, TB and malaria over the past decade or more?
As far the crowding out phenomenon from HIV funding, Shiffman's paper from 2008 does indicate shifts in funding for AIDS vs. other areas of health, but also says the influx of funds overall may have mitigated possible displacement affects. Importantly, he notes that the counterfactual—what would have happened in a world without AIDS and an increase in funding—is missing from our analyses. The Lordan paper from last year sees a within-country crowding out of malaria funding and to a lesser extent of health funding overall. Furthermore, this crowding out disappears in countries with low HIV prevalence, which suggests that even if HIV is sucking money from other areas of health (i.e. malaria), it is happening in countries dealing with significant AIDS epidemics.
We need to maximize efficiency in spending, by donors, by national governments. Health spending needs to reflect local needs, with assessments made in a way that doesn't reduce the complexity of what is happening on the ground to DALYs or QALYs alone. In the current economic and political climate, where funding for all global health is in jeopardy, we have to avoid fighting for the the crumbs from the table too, focusing on AIDS as the policy villain rather than larger issues around funding for health and other social programs that are being discussed in capitols across the globe (e.g. austerity-mania in Europe).
No one I know thinks AIDS should suck all the money out of global health and foreign assistance, in fact, most of us working on AIDS have branched out since the beginning to address larger health issues, even moving on to other development issues like education and sanitation, corruption and good governance.
We all need our assumptions questioned, constantly and vigorously. One of the wonderful things about the recent head-on collision between AIDS activists and economists around the Jim Kim nomination, is that people are being called out to defend their views, whether they are hot-shot economists or street activists. We have to keep this dialogue going—it is vital. Groupthink around how we deal with global health and development is our biggest enemy, something that does no good for anyone, particularly the world's poor.
Sigrun Møgedal April 21, 2012 at 10:54 pm
Owen, I agree with the reasoning in Greggs comment here.
In addition it would be useful to have a discussion of the cost, including the social and economic impact of not treating AIDS and not stopping HIV transmission. This would obviously be different depending on the prevalence of infection and burden of disease in each country, and underlines the complexity when comparing cost effectiveness of interventions. The argument for treatment as prevention would bring in yet another sett of factors to consider.
It is interesting to note that this global debate on cost effectiveness tends to focus on HIV/AIDS versus any other investment priority.
What then about investment in polio eradication? Nobody would say it is not worth it if transmission can be stopped and the wild polio virus eradicated. But the size of the investment necessary to complete the job continues to be huge. Does it make sense to compare this with the cost of additional year of life saved by treating parasitic infections?
Clearly there is a strong case for informing priority choice by cost effectiveness of each intervention. What is risky is however is if this is left to donors, making aid flows determine country priorities. These must be national decisions on how to spend overall resources available for health – where cost effectiveness analysis can contribute, but not be a stand alone basis for priority choice. We talk about political processes, and we talk about the need for broad inclusive processes with democratic accountability.
In terms of HIV/AIDS there is now a growing focus on national leadership for an agreed investment framework, country by country. This is a good basis for dialogue about better, smarter and quicker scale up to turn around the HIV epidemic both by direct investment in HIV specific interventions and in critical enablers to stop the transmission. HIV investments can no longer be done in isolation.
Garth Luke April 22, 2012 at 2:11 am
Given that health aid is still only 16 or 17% of sector allocable aid (DAC Development Cooperation Report 2011 Stats Table 19) shouldn't we be focussing more on increasing the share of aid to health. Perhaps the focus should be on the cost effectiveness of health vs other types of aid.
@Garth Thanks. What do you think the share of aid to health should be? How do you know that 16-17% is too little? I'm interested that many of the comments here count as success increasing the share of aid going to global health.
Gregg Gonsalves April 22, 2012 at 11:27 am
Hi, all. The podcast was far broader than a discussion about HIV/AIDS, but as an example of the folly of some of the thinking around resource allocation, it's a good example of what is happening now.
I agree with much of Sigrun's analysis, particularly her observation about HIV/AIDS routinely hoisted up by many to be pilloried around the cost-effectiveness claims, while other massively expensive health campaigns (e.g. polio) are never brought up. There is something going on here that needs further explanation–what makes economists see red when they think of HIV/AIDS? Just as a side note–when Sigrun and I first met we clashed around some of these issues, though once we talked, we saw we had a lot of common ground and now consider her a dear colleague. So we don't always have to end up on opposite sides of the table.
I do agree that we need to ensure decision making happens in-country, and even in country pushed down to the district level. However, we need to address the real crisis in governance in many countries, even those that are democratic, where health isn't a priority for elites or in the case of AIDS in some countries marginalized populations are most affected and have little political power, where corruption and patronage capture sizeable chunks of public spending, where accountability mechanisms are weak and oversight lacking, etc.
Finally, Garth's point is key. This is what I mean by fighting for crumbs from the table. We need a real analysis of aid overall to assess how it has affected people's lives, which uses cost effectiveness analyses, but a wider range of tools as well. If we had more of the pie for health–if this turns out to be among the more effective choices for foreign assistance and domestic spending–some of our conversations would be a lot less fractious.
@Gregg
Thanks for your contributions to this discussion.
I admire your efforts to stand up for people with, or at risk of, HIV/AIDS. I also think it is unhelpful that antiretroviral therapies have become the most commonly cited example of interventions which are less cost effective: there are many other examples in development of spending which is poor value for money.
We agree, I think, that cost-effectiveness (properly defined and estimated) should be an important determinant of how aid is allocated, either by each of us and individual givers, or by us collectively acting as donor agencies.
We also agree that a proper measurement of cost-effectiveness should include estimates of future costs and benefits of the decisions we take today. To use Sigrun's example, the benefits of vaccinating against polio should include not only the benefits to the person vaccinated today: it should also include the herd immunity effects for their immediate community, and the expected contribution these vaccinations may make to the possible eradication of polio, with big benefits for everyone.
We agree that cost effectiveness calculations should be done right. Where we part company is in how we respond to your claim that the existing cost-effectiveness calculations are 'rudimentary'. You say that this means that there is a problem with 'simply tabulating the cost of interventions'. I don't agree: with the best available estimates, such a tabulation is a very good starting point for a discussion about the use of resources. (I do not claim that such decisions should be taken mechanistically.)
Since you focus in your comment on the cost effectiveness of antiretrovirals, let's persist with that example. The cost per QALY of some childhood vaccinations is estimated to be less than $25 per QALY. According to DCPP, the cost of antiretroviral therapies in sub-Saharan Africa ranges from $350 to $1,494 per QALY. You are certainly entitled to say that the HIV studies overstate the cost per QALY because do not take account of some important benefits which should have been included, such as prevention of new infections, or effects on the future costs of medicines. But if you want me, or governments acting on my behalf, to spend a lot of my money on antiretroviral therapy instead of on childhood vaccinations, then you need to do more than cast doubt on the existing estimates. If we spend $1m on these vaccines, our best estimate is that this would buy 40,000 life years. If we spend the same money on antiretrovirals, the current estimates (with which you do not agree) imply that we would buy about 2,000 life years. We cannot, in good conscience, simply sacrifice the 38,000 additional life years which appear to be available by spending money on vaccines. So for those of us who are not advocates for any particular disease, it seems entirely reasonable to ask you to produce evidence (or at least a plausible calculation) which shows that, when all these other factors are included, spending $1m on anti-retrovirals would save a number of life years which is broadly comparable to spending that money on childhood vaccination. If you think spending $500 on antiretrovirals saves more than 1 QALY, how many do you think it saves, and why?
We agree that governments have not been immune to 'the global advocacy around HIV, TB and malaria over the past decade or more'. AIDS advocates have been very successful in using their political power to shift resources to these issues. The question is whether this has been a good thing. I live in a country which has an explicit target for aid of 0.7% of GNI, and the aid budget is set to follow a trajectory to that level by 2013. In this case, it is highly implausible that AIDS advocacy adds to the total resources available for development: the effect is to shift resources from within a fixed development budget. This is the case in most of the donor countries, and that means there is a direct trade-off in these countries between AIDS spending and other development spending. I do accept that the situation is different in the US, where the foreign assistance budget is built up from a number of specific items. It may be that PEPFAR added, at least in the short run, to the amount of money which Congress was willing to spend on foreign assistance. But I suspect that there is nonetheless an implicit budget constraint on foreign assistance even in the US, and that there is therefore a long-run trade-off (though perhaps not 1:1) between these programmes and other forms of development spending. There really is a very significant trade-off between AIDS spending and other development priorities.
I strongly agree with Sigrun in her comment that it is for developing countries themselves to determine their priorities. It is reasonable to challenge the global AIDS movement that they have made this very difficult, by advocating the establishment of vertical funds such as GFATM and PEPFAR which – by design – make it difficult for developing countries to use funding in their own countries according to their own priorities. I wrote about the effects of this in a blog post in 2009.
I was interested by your remark that 'most of us working on AIDS have branched out since the beginning to address larger health issues, even moving on to other development issues like education and sanitation, corruption and good governance'. I'm glad to know that AIDS activists are now recognizing that there is more to development than providing funding for specific diseases – that is what many of us have said all along.
In reply to your question Owen: The share required depends on the total volume of aid but at current aid volume levels I think it should be around 30% to reach a total of around $40 billion a year. This is the level suggested by the main recent estimates of health aid requirements (eg High Level Task Force on Innovative International Financing for Health Systems) and the sum of separate estimates for HIV, maternal and child health, family planning etc.
Given 1) the importance of health to human happiness 2) the large unmet needs (eg 8 million people needing ARVs, at least 5 million preventable child deaths per year etc) and 3) that health aid appears to be having a significant impact (not so easily said about some other aid sectors) then I think there is a very strong case to increase the share of aid to health.
@Garth – thanks. That sounds like a perfectly good case for spending more money on health. But it can only become a case for spending a greater share of (unfortunately limited) aid resources on health if you make an explicit comparison between the benefits of spending on health and the benefits of spending on other possible priorities.
Agreed Owen – however in reality I find that other issues often appear to be more important in the making of these allocative decisions: personal priorities of elites in donor and receiving countries, economic and strategic benefits to donors, the eternal hope of kick starting economic development.
If we are to get rational about this stuff then it appears to me that health aid has more runs on the effectiveness board than many other aid sectors (eg cuts in measles, malaria and AIDS deaths). However I must admit I found Sven Wilson's analysis which could not find a link between health assistance and mortality challenging and confusing.
As we discuss all of this, I can see we agree on lots of things.
Now for the question of why not spend your money on vaccines rather than ARVs?
First, I don't want to pit AIDS against childhood vaccinations or other diseases. It's clear we have to grow the pot of money to allow us to do more for health as Garth suggests.
Second, I think it is problematic to posit that AIDS activists have been dictating what happens on the national level from some global perch. It doesn't match up with the history. The push for ARVs started in developing countries, first Brazil, then Thailand with other countries such as Uganda and South Africa having strong local efforts to put people on ARVs or challenging their leaders when their governments refused to do so. We can't erase the real local push for ARVs and then say we're for local autonomy and decision making.
Third, I would maintain that the birth of things like the GAVI Alliance came about as an indirect effect of the AIDS push in the late 1990s, which gave birth to the Global Fund, PEPFAR, etc. with similar donors, actors involved in this work. So even if the UK hasn't changed its aggregate amount of health aid over the past 15 years in response to pressures from AIDS activists, there has been a knock-on effect from AIDS in what has happened in global health more broadly. Another example–the human resources for health work, the current work on a framework for an international convention on health, have been largely led by people from the HIV/AIDS arena and many AIDS people are involved.
Finally, you miss one of my biggest points.
I want national health care in the USA, selfishly for myself, but also because we have 45-55 uninsured Americans. I want comprehensive primary health care around the world, a vision that has been with us for more than 30 years since Alma-Ata.
What I am trying to get across to you is the fact that wishing doesn't make it so.
While governments can allocate funding for developing countries, or from their national treasuries based on cost-effectiveness, DALYs or QALYs, alone, this is insufficient for developing the needed political and institutional framework for success.
We have great ideas on paper around primary health care scale-up, but momentum has been lacking to secure real and sustained commitments from elites in many countries (even in the UK where it looks like your government is trying to weaken state commitment to the NHS).
What I am trying to say is you don't push a button and say: "now build a movement to push for the most cost-effective intervention for X or Y"–though economists want people to act as rational actors, they do not.
As the great South African AIDS activist Zackie Achmat said recently: people have been advocating for primary care for years, about taking on the state and corporations on health,etc. but in AIDS we found a way to actually do it. For him and for the rest of us, this is a foot in the door.
This foot in the door has allowed the transformation of citizens' expectations around health in South Africa and many other places, instituted real mechanisms of accountability and incentives for change (from legal challenges to monitoring initiatives), broken corporate resistance to generic forms of on-patent medicines.
What I hear you saying is I am glad AIDS activists have now acknowledged that we need more than vertical initiatives. What I am saying is: WE KNEW THIS ALL ALONG. Health systems need breadth and focus. AIDS IS a disease of primary care, it requires strong fundamental commitments to basic health services. As I mentioned earlier, most people I know were working on national health insurance issues for a long time, long before there was even a seed of the idea of the Global Fund.
What I hear you saying is: my (Owen's) political strategy is to start with the most cost-effective interventions and push for them one by one, or even as a set, and then move on much later to things as expensive as ARVs.
I say: we have a foot in the door, now let's push it open further, not shut it and try again, because we went with the wrong thing.
We can try this, but what I fear is that the perfect becomes the enemy of the good, that we can't replicate the kind of phenomena we need to achieve health goals in this way and we head back to the old days where health wasn't nearly as important on national and international stages, where galvanizing the resources to challenge elites on these issues simply can't be reconstituted in the short to medium term.
This is about the political economy of global health and it matters as much as does the cost of what we are trying to provide.
Owen Barder April 23, 2012 at 2:32 pm
I think we are narrowing our point of disagreement to this. You don't think that your AIDS advocacy pits AIDS against childhood vaccinations, or other global health interventions, or education or clean water or agriculture. In contrast, I think that there is a very real trade-off between spending money AIDS and spending money on these other things. If I am right that AIDS advocacy shifts money from more cost effective alternatives, then the consequence is that on current estimates it may cost hundreds of thousands of life years. Like Toby Ord, I think it reasonable to ask whether this is justified.
You make the point that the perfect should not be the enemy of the good. Agreed. In a world in which we do not have unlimited budgets for health and for development, should we behave as if budgets were elastic, and maximise the amount of money spent on AIDS? Or should we accept that in a constrained world, 'good' is spending finite resources in the most cost effective way? I fear your perfect world – which involves much larger spending on AIDS – is the enemy of my good world in which we do the best we can with the money we have got.
So, the point I'd like you to address is about the ability to drive an agenda on cost-effectiveness alone–not whether it's right or proper–but whether we should make another kind of trade-off, that is, assume we can build the political and institutional support for the least expensive intervention(s) and all that entails when with AIDS we've made strong gains around the political economy of global health even though the intervention(s) are more expensive.
As Acemoglu and Robinson note in their new book, Why Nations Fail, the ignorance hypothesis, that if countries knew the right thing to do they'd just do it, doesn't pan out, yet as they say the idea "still rules supreme among most economists and in Western policy-making circles." I think you have to address this conundrum. It's not OK, just to say it's the right thing to do and people should just do it because sadly, as Acemoglu and Robinson note, this isn't the way the world works.
Thanks. In think there are two points to make in answer to your very fair question.
First: I accept the possibility of the situation you describe in which an intervention contributes to political change, institutional development, public awareness, change in attitudes or some other long term social gains, and that those gains may not be available to the same extent from an alternative programme which is otherwise more cost effective. In this case, I agree that these possible broader benefits should be taken into account when making the choice. But I think you will agree that these social benefits should not be preferred at any price. We need to know to what extent this choice would result in a lower direct health impact, and compare the direct health benefits forgone with the institutional benefits we expect to gain. Would (say) greater political commitment to primary health care be worth an immediate sacrifice of 100 life years? 10,000 life years? A million? Different people may reach different conclusions about this. But it seems reasonable to say that this trade off should be described explicitly, and quantified to the extent possible. In an ideal world, we might try to express these benefits in terms of their expected impact on the long term health of the population, and then include them directly in the cost benefit calculation.
My second point is to challenge your assertion that we have made strong gains around the political economy and global governance of health. I think that is far from certain. Let us remember some of the negative effects. We have undermined country health systems by channeling money through vertical funds. We have undermined country processes for deciding their health priorities, and strengthened the role of rich country elites in determining health priorities. We have used monopsony power to drive down the economic returns to investment in pharmaceuticals whose main use is in developing countries, threatening the flow of future innovation and investment. We have focused too much on treatment and too little on prevention. I am sure there are offsetting benefits which may balance some of this, but it is far from obvious that the balance of effects comes out positive.
So I do accept that the trade off you describe is potentially important, but given that many life years are at stake, I also believe that the judgement must be made explicitly and with the best possible quantified estimates of the costs and benefits.
Sam Gardner April 30, 2012 at 5:40 am
Dear Owen,
As you know, I think the results agenda is very important.
However, as I can read from the discussion above, you seem to think the ultimate choices will be made on basis of the results. What Gregg hints to is only the start of it.
In a society, you normally do your distributions on basis of political choices. These choices are seldom technocratic. Within these choices, allocation is ideally made through transparent processes to the best deal (bang for buck). This is where the results agenda stands. (he will inform the other step but not decide there)
This means that even in times of crisis, culture will be subsidized. Even knowing the cost is prohibitive, some child illnesses will receive treatment. This means the pump and circumstances of the royal anniversary will be maintained and the Olympic Games will be organized.
And it is good that way. Where results come in, is when we decide to allocate money to lift somebody from poverty, then we should have as our baseline the practice we know will have some guaranteed result (say handing out the money through a government scheme) and judge every alternative. Calculate the diminishing returns of handouts, and from micro-credit schemes. etc. The same goes for health. If your goal is realizing the health MDGs as a rights based approach, probably your aids-allocation will be importantly lower than it is now.
As I said before, we should define our goals first, secondly allocate money to these individual goals and take it from there. Step one and 2 are very political. Step 3 is where the development expert and the results agenda comes in.
As you will notice, the critique on the results agenda comes mainly from two sides: development is a vague holistic concept, so just leave me doing what I am good at, and detailed discussions within a sector.
A vertical approach with clearly defined common goals per sector is what is really needed to get the results for the poor.


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washington over what from monday is the cuban embassy to the united states. cuba sang their naicial national anthem. mistrust still links. lingers. cuban minister bruno be rodriguez warned. >> we move forward in a constructive spirit but with no prejudice whatsoever to the independence or interference in each other's affairs. >> that is part of a strategy for seeking to engage the cuban people more effectively and bring about the kind of change that we would like to see inside of cuba. >> later meeting with secretary of state john kerry at the state
department, rodriguez had a list of demands. >> lifting the return of illegally occupied territory of guantanamo as well as full respect of the cuban sovereignty, and recompense for economic damages. >> stand embargo only congress can lift it. anticastro congressmen blasted normalization. >> if anyone thinks that the sanctions are going to go away, if the so-called embargo is going to go away they have not been paying attention to the attitude of congress. congress unlike president obama understands that castros are the oppressors. >> the president's spokesman is tight-lipped who would be named or when.
not until havana improves their record on human rights. >> freedom of simply freedom of the press, it is clear cuba has progress to make in all of those areas. >> reporter: and antonio both the laws of fiction and compromise dictates, what goes up must come down. the cuban flag was just lowered. john kerry plans to visit havana august 14th. the embassy is opened but for the first time in equally long time some 54 years a top american official there on the ground in havana. >> it might be -- administration has made it clear that they want the next step to be the lifting of the embargo but we heard the
congressman say that he and others on capitol hill don't want that. is it likely to happen soon on capitol hill? >> it's not likely. politics are complicated and no one needs to be reminded of the political stance of florida although those issues are changing. december 17th of last year announcing the normalization that is culminating over the course of today and into next month, don't look for congress to move to lift that trade embargo any time soon. you mentioned a lot of democrats in the white house certainly want it to happen, a lot of cubans want it to hatch as well. but the foreign minister calls it a blockade. >> thanks mike. melissa chan joins us from havana. melissa.
>> well, antonio all the pomp and circumstance happened in washington d.c today. certainly a lot of interest here. here in havana though there is a u.s. embassy. the first u.s. embassy in more than 50 years and so there was excitement. although people understand that that ceremony that secretary of state john kerry is going to isn't going to happen for another few weeks. now in terms of normalization i think it's important to point out that 97% of cubans according to one poll that came out earlier this spring, 97% of them support normalization. on this day with the embassies opening, a lot of cubans understand this is mostly symbolic in terms of substantive impact. they are not going to feel any different today than yesterday antonio. >> right so are there any new opportunities available to cubans on the island now that the ties have been normalized? >> well, i think it depends on what cuban you're talking to. those involved in the tourism
industry have told us they have seen an uptick in the business. that president raul castro made in december of last year, you have got an impact on the economy. as you mentioned earlier it always goes back to the embargo and until the blockade as they have called it is lifted that is a decision that washington d.c. is going to have to make that they are not going to feel feel of transformative change. six months down the line that optimism has been tempered. they understand it is going to take some time, probably years not increments of months, before people will really get a sense of change and what normalization really will mean between the two sides. >> melissa chan thanks. frank calsone the
organization to free cuba, the organization opposes the castro regime. frank joins us from washington d.c. frank good to have you with us. as a cuban american -- >> thank you for having me. >> -- what was it like to be a few blocks from the white house the cuban anthem being sung and the flag raised? >> as one hears about cuba, once you go behind the headlines you find a different reality. everybody keeps talking as that building became the cuban embassy. that building is the place that cuban be government was representsince jimmy carter. the american embassy has been the place for american diplomats. there have been more where american diplomats in cuba than be canadians or russians for
more than 20 years. the change today is mostly symbolic. a sign has been changed. and the flags came up. >> right. >> now this is very important -- >> symbolism is important and you know speaker of the house john boehner encapsulated the main argument of those who oppose the thawing of relations by issuing a statement. he says it's appalling to see america's president welcoming and rewarding a regime that has no comparison to american values. if that is the standard then we should have no embassies in left and right wing owner governments around the world. >> that's true but many left and right wing governments throughout world were not caught trying to ship cuban migs on a
north korean ship to north korea. many other governments that you talk about do not have troops in venezuela, oppressing the venezuelan people. many of those governments around the world have like castro has said, that a new spy base is going to be open in havana, a russian spy base. so this whole idea of many other governments around the world is just a way of arguing. one has to look at the cuban situation and decide. >> all good points. now ranking member of the senate foreign relations committee ben cardon argues that normalization will strengthen the position of the you u.s. to normalize its interests, won't effectively pressure for change on the island something your organization is dedicated to? >> well, first of all there have been relations or the all of these years. this is again a little fairy
tale that is being brought out. even ronald reagan sent people to cuba to talk to the cuban government. you should talk to another democrat, a former chairman of the be committee of foreign relations, robert menendez, who opposes iran and cuba. >> what is your biggest objection at this point? one of the strongest points of criticism is that the mairch government has ignored human rights and beleaguered cuban dissidents during the negotiations. have the dissidents been brought into the conversation and do you some there is improvement in human rights in cuba? >> there isn't a question of improvement. in the past year and a half, when the president has been discussing with the cuban government, discussion between the president of the united states and a cuban dictator trying to decide the future of cuba. what about the cuban people?
when you think about the dissidents, it's not something that happened 20 years ago yesterday, again a group of cuban women who go to our church, perhaps 100 of them were dragged down the street because they're relatives of political prisoners. the president remains silent for the most part about many of these things. the president wants to have relations with mr. castro because the president cares about his legacy. but he will have a horrible legacy if he is simply supporting a cuban dictatorship. furthermore the men through latin america is now you can have a military dictator and it's okay with washington. until this president for more than 20 years that was not case. >> i'm sure this is a conversation we will continue to have frank calson, executive director for free cuba, thanks very much.
some members of congress slammed president obama today for calling to follow the lead of the comiefnt. al jazeera am paul beban reports. >> the draft resolution has been adopted unanimously. >> reporter: within hours of the security council's signoff on a deal to scale back on iran's nuclear program in exchange for stopping of sanctions. president obama stated. >> this is by far our strongest approach that iran doesn't get a nuclear weapon. there is broad international consensus around this issue. not just among the international community but also among experts in nuclear proliferation. and my working assumption is that congress will pay attention to that broad based consensus.
>> reporter: but on capitol hill there is anything but broad consensus. members of both parties say they're frustrated the u.n. voted on the deal before they had a chance to weigh in. we are disappointed that the u.n. security council passed a resolution on iran this morning before congress was able to fully review and act on this agreement. house republican ed royce and democrat elliot engle said in a joint statement regardless of this outcome congress will continue to play its role. if iran doesn't live up to its part of the bargain the deal allows all u.n. sanctions to snap back into place. iran's intor toiran's ambassador was defiant accusing israel spreading what he called iran-phobia. >> it considers peace as an
exenlsexistential threat to itself. >> even as secretary of defense ash carter visited israel to try to sell it, saying israel remains the bedrock of american strategy in the region. >> make no mistake. this deal limits iran but places no limits on the united states, the department of defense or the u.s.-israeli defense relationship. we're moving full speed ahead. >> reporter: the u.n. resolution takes effect in 90 days. that time frame was negotiated specifically to give congress enough time to review it. president obama however says he'll veto any changes congress might make. those changes would require a new u.n. resolution effectively starting a process that has taken years all over again. tony. >> paul beban, thanks. the new president of nigeria goes to the white house. coming up why the fight against
boko haram gets muhammadu buhari face time with president obama only weeks after getting elected. former president of chad, a warning to all dictators.
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>> nigeria's new be president muhammadu buhari, met with president obama at the white house less than two months after he was inaugurated. in context tonight pathy culhanepattyculhane looked at the issues. >> at the end of the day it does not appear that the obama administration is ready to make any drastic changes on that. they'll point out they have
already bifn $34 million to the multinational task force that's fighting boko haram in the region. we do know some light arms are given othat group but they don't go to nigerian soldiers. the obamas, obama administration has grave concerns, that some are going to the are boko haram. military. he thanked for getting into office. >> the maintenance of pressure 50 united states and mainly europe to make sure that the elections were free, fair and credible led us where we are now. it could have been almost impossible if the united states did not maintain the pressure on the former energize government, that in order to accept anything
less constitutional as far as the processes of the election are concerned. >> reporter: president buhari is also asking for help getting what he says was $150 billion out of foreign banks. he said that was looted and he asks president obama's help to find it and bring it back to the nigerian economy. >> patty culhane thanks. yvonne ndege reports from abuja how many people there want the u.s. to join the fight against boko haram. >> her husband and brother were killed by boko haram a couple of years ago. so she fled with her six children and two grandchildren here to this camp for displaced in abuja. she says she's happy the president, muhammadu buhari, is traveling to united states to
speak with president obama how to fight boko haram fighters. >> we want them to give us peace. i tell you as i lose my husband now my children is just like, they are just upside down. not school not work no anything, nothing nothing. >> reporter: obama and buhari will discuss how to help over a million people displaced by boko haram. still many areas be destroyed by the armed group will have to be rebuilt before thinking of going home. muhammadu buhari promised to defeat boko haram if he became presidential. buhari is expected to ask obama for help. >> he is actually going with a wish list, a shopping list he will present to the american president to help nigeria battle
insurgency, it won't be in the area of deploying troops things like that but intelligence, equipment that kind of help. >> reporter: some believe the u.s. is in a difficult position when it comes to military aid to nigeria. it is barred from its own law to provide services to forces that it believes violates human rights. but the military here rejects such allegation. u.s. government already provides what it calls meaningful assistance. some are critical of the trip because president buhari has not formed a government yet or chosen his ministers. >> domestically we still have huge gaps in terms of getting a government started. you would expect that a visit of this nature would indeed encompass a whole lot of issues, relevant government officials ministers are accompanying him on a athe visit.
>> it is felt that many other issues may not be properly addressed at the meeting but for many displaced by boko haram this woman and her family, improving security should be the number one issue on the meeting without it, nigeria can't move forward without it. yvonne ndege. abuja. >> ronrobin sanders good to have you with us. i want to talk about this important -- >> thank you. >> -- this important visit today of nigeria president buhari, meeting with president obama. what do you expect will come out of this meeting? >> well first and foremost, it is a resetting reformulating and reorganizing the situation in many ways. what's going to come out of this
session is for the two men to establish a relationship between them. one of the things that is very important on the agenda is the security issues in nigeria including is around the region. >> you and i have spoken in the past and you have been fairly optimistic about nigeria's willingness to help out the u.s. but there has been some tension there, even though u.s. has sent military advisors especially after the kidnapping of the girls last year. where does that stand on military cooperation especially against groups as violent as boko haram. >> as i said in the beginning this is a resetting of the relationship and i think that's important to underscore that. president buhari hasn't even been in office for 60 days, he was invited for a visit with president obama. that almost doesn't ever happen. this is a new way to work with
nigeria not only in the military realm but in trade and investment opportunities. >> the u.s. attitude towards nigeria is similar to the have nigerian attitude torts buhari. they feel he will be have a stronger hand in fighting boko haram? >> when i sat to to witness the inauguration, he had first and foremost strengthening the health system, also has a very big focus on the human quality of life. he understands that nigerians are suffering at all levels and he plans to address this. >> but as you know, they can talk as much as they want about trade, and trying toably nigeria back toto bringnigeria where it should be, but without security they're going
to have a hard time to do that. and nigeria has recently increased its attacks even though there's -- around boko haram has increased its strikes even though the international community has strengthened against boko haram. >> nigeria is a huge country like saying what's going to happen in the north is like will also happen in the central and southern part of the country. right now it's concentrated in the north and they definitely need to do better job in managing that. over the last two weeks you're absolutely right, boko haram has stepped up and done heinous activities, particularly using young girls as bombers as suicide bombers and definitely that is. but the other part of the country, there are other challenges in health systems and education that they also have to address. >> it is a huge country.
it is the most populace country in africa. boko haram has bane tacking in chad and cameroon and niger and some of the neighboring countries there so are you optimistic that buhari also with his partners in those country and the international force will be successful from a security standpoint in attacking and defeating boko haram? >> we have an opportunity to put a lot of pressure on boko haram a lot of pressure on where boko haram gets is money and recapturing some of the towns that boko haram has taken not only in nigeria but certainly across borders. so i think we have to look at how we measure success. it may not be 100% defeat but let's try to contain them. >> ambassador robin sanders always great to have thank you.
>> deadly mistake in afghanistan, and teaching children to commit atrocities. how i.s.i.l. is training captives to fight for it.
>> welcome back to al jazeera america, i'm antonio mora. coming up in this half hour of international news the british launch a campaign to keep people from traveling to syria and iraq to i.s.i.l. first, the stories happening in our american minute. cheeg gunman's home the official would b -- chattanooga gunman's home, could shed lied on mohammed yousef abdulazeez's motive.
the memo an inmate was found dead inside her cell. san sandra bland committed suicide according to officials bust now it's being treated as a murder. be wisconsin governor scott walker has introduced a bill that outlaws abortions after 20 weeks of pregnancy. doctors could be sued for damages and face fines. wisconsin is now a 15th state with a 20 week abortion ban. walker is running for president. united states is offering apologies to the afghan military. investigates of how and why the bombing happened. jennifer glasse reports from kabul. >> this was a mission to remove
the wounded and zed after.a military fight hit afghan fighters rather than taliban. >> i can't see any other reason why this would happen. >> some of the wounded soldiers had already been evacuated to a local school in logar province when the taliban attacked the medical teams. the fight went on for hours. afghan soldiers continued to retrieve their comrades despite the enemy fire. they don't have much choice. afghan forces have limited air capabilities and rely on coordinating with u.s. and nato forces for air support. >> translator: we do have a coordination center. in this case they weren't informed at all. >> reporter: only asmall force remains mainly to train afghan forces. authorized to carry out what they describe as counterterrorism operations.
the afghan defense ministry said the incident occurred after the taliban fired on u.s. helicopters. u.s. officials say they're investigating. a high level afghan delegation will look into what went wrong in the worst friendly fire incident.since the beginning of the year. jennifer glasse, respect kabul. >> meeting of activists today. group was discussing the reconstruction of kobani across the syrian border which kurdish fighters captured from i.s.i.l. this year. no one is claiming responsibility for attack but turkish officials believe it could have been carried out by a female fighter from i.s.i.l. government not doing enough to fight i.s.i.l. a peaceful demonstration but
protesters clashed with turkish police at another gathering. police tried to break up the the.demonstration with water canons. hasaka has been a three way battle between i.s.i.l. the government and kurdish fighters. today a group of syrian kurds claimed victory. the ypg said those who remain are surrounded. some of the youngest victims in the fight against i.s.i.l. are children. many of them have been killed, forced from their homes or captured and taught to fight for i.s.i.l. al jazeera's victoria gatenby has the story. >> this is an i.s.i.l. training camp where children are shown how to use weapons and given religious education. a boy was taken to a camp like this after i.s.i.l. took over his town in northern iraq.
>> they told us how to decapitate people. they told us about the koran they also played with our minds by saying we wouldn't go back to our families in iraq. >> reporter: in june last year tens of thousands of yazidi people were forced to leave their homes in northern iraq after their towns were seized by i.s.i.l. fighters. some survived what the u.n. calls attempted genocide, by escaping to sinjar mountain. thousands of others were captured, men were killed, women were trafficked as sex slaves, murdered or imprisoned. >> once they head us the beheading video of the pilots and videos of attacks and executions we saw how they were shooting they brought it to us every week and they showed us. >> this boy was taken to the syrian city of raqqa.
he says he and other prisoners were told to practice beheadings on dolls. >> they brought dolls and brought swords and told us how to behead because they were not good. >> victims of this seemingly never ending conflict. victoria gatenby. al jazeera. four italian construction workers have been kidnapped in libya. italy's foreign minister says they do not know who took the men but they are working with intelligence services to try and arrange their self-release. libya has been steadily descending into chaos since the overthrow of moammar gadhafi in 2011.
tunisia against the fight of.extremism. diplomats agreed on several cooperative measures. eu policy chief frederica mogherini said it was in best interest to stop the threat. in london today, david cameron put forward a five year plan to combat the group's ideology. paul brennan reports on cameron's prevention strategy. when the girls left to join i.s.i.l. in february it left deep three teen aged london girls to choose an uncertain life in a war torn country versus life in britain.
prevention strategies have surveilled to stop young brittons from joining i.s.i.l. >> you won't be some valued member of a movement, you are cannon fodder for them. they will use you. >> mr. cameron admitted, he had an omg news sounding warning this so-called british values would increasingly be enforced. >> let us also recognize we'll have to enter some pretty uncomfortable debates especially cultural ones. too often we have lacked the confidence to enforce our values for fear of committing offense. human rights are mentioned as much in the koran as they are in the magna carta but the prime minister's use of the word force
suggests compulsion in all of this and handled badly there is a potential for clash of cultures here. ignoring the impact of british foreign policy on radicalization, and there is a concern creating thought crime. >> to be liberal you had the right to criticize a lifestyle. to be liberal you have the right to criticize government's foreign policy. you have the right to criticize israel if you want to. to be liberal is all of that and more. so for the prime minister to straight jacket everybody into one prison of liberalism is in itself very shallow very unenlightened and unintellectual in my view. >> not just a muslim issue. >> i think it's a job for everybody and you'll recall also that in the speech this morning the prime minister sets you out responsibilities for media companies, for social media companies for schools for prisons and i see muslim
communities as one element of that broader civil society strategy. >> the british prime minister has set out its government's strategy and sparked debate. the implementation of that strategy will come when the other issues are introduced in autumn. paul brennan, al jazeera london. more than two decades after he was ousted from power the former president of chad is brought under trial. nicholas hack was inside the coursecourt as the extraordinary case got under way. >> reporter: chad's former president hissene habre is in the dock. people say they were tortured under his rule. this is an unprecedented trial.
never before has an african been judged by africans for crimes against humanity in africa. a decade long campaign to bring habre to justice the lawyer walks into court. >> it is a big day, there are all sorts of emotions going through me pride joy and relief that the is president is in the dock. >> for successfully fighting moammar gadhafi's libyan troops in the 1980s. western leaders were accused of turning a blind eye to the atrocities habre committed at home. 40,000 died and 200,000 were tortured until habre moved to
senegal, where he has lived in peace for 20 years. >> those that commit the horrible crimes that are alleged crimes against humidity and torture should face their accusers. >> the big question was will hissene habre appear? [ owner screaming ] >> it is his supporters, they are threatening the lawyers and witnesses. habre joins in. the shouting in french, it's a masquerade. [ screaming ] >> reporter: as he's removed from court he shouts, "god is great." and then he adds, "the court is a knees owe colonial tribunal."
the trial will continue without him. >> translator: for victims and human rights organizations. this is history in the make. the moment jacqueline modena has been waiting for. nicholas honk, al jazeera dacca. >> how the european union is struggling to locate tens of thousands of immigrants across europe. the banks in greece have reopened you but serious challenges remain.
>> the greek government met two debt payments today to the international monetary fund and the european central bank. it used an emergency $7.7 billion loan from creditors to meet the dealt line. also banks reopened for the first time in three weeks but strict limits remain on
withdrawals. the country is not close to being back to business as usual. mohammed jamjun reports. >> lazarus has been sewing sweaters since 1978. this isn't the first time he last had to shield his knitting company estos from a maelstrom. his employees are working as efficiently and these machines are moving as swiftly as ever. still in his offices lazarus says it's been a situation. >> i wasn't able to write checks or pay suppliers, goods coming from abroad. >> lazarus is relieved that the drama has come to an end.
after three long weeks the banks have finally reopened here. lazarus went to his this morning. but it wasn't to withdraw money. like many other greek citizens we spoke with today it was to check on his safety deposit boxes to make sure he could still access it, that its contents were secure. while an affair anxiety still hangs over athens, monday morning was a calm one. the lines weren't long. the crowds weren't angry. lazarus isn't surprised. >> this is something temporary and it will be overcome. as long as we are member of the european union the european union has and particularly the eurozone has the tools. and these tools will be implemented. >> reporter: he like his employees thinks the austerity measures will be punishing but they are necessary for greece. >> if we had the same thing without the measures we would be
more happy. but since they are necessary i will certainly support them. >> reporter: he now hopes for a better future one in which he can sell more sweaters. one whose harsh chill will come only from a winter that's cold and not an economy that's frozen. mohammed jamjum, be al jazeera athens. >> because of the shortage of food and other basic goods in venezuela, the government has ordered be supplies delivered to state run supermarkets. 30% of their goods ostate stores. strict currency controls have led to a scarcity of imported goods in the country for years. europe's quest to resettle 40,000 refugees has fallen short. a meeting in brussels today resulted in commitments of relocating 32,000 refugees
greece and italy committed to take 10,000 the largest share. 137,000 people have made their way to italy greece, spain and maltsa this year. the relocation are expected to start in october. migrants are also arriving in greece after a long and dangerous journey north through macedonia, hoda abdel hamid spoke to some of the migrants on the greek-macedonian border. is. >> reporter: they're marching by the hundreds under the bake sun. an the roads and in the fields. step by 10 until they reach the macedonian border and as they go along they form groups that become bigger and bigger. >> translator: i didn't expect it to be so difficult but now i have to go on. i left everything behind. i'm doing this for my daughter.
>> reporter: greece in the midst of its own financial crisis has no means to provide assistance. so refugees and migrants rl on eachrely onsupport and solidarity. hurns are waiting in this makeshift camp with no hygienic facilities and one tap of running water. macedonian police patrol the border and are often heavy hand he. ali is 63 and traveling alone. he was beaten when he tried osneak across the border. he'd been waiting for four days. >> translator: my son needs treatment. i'm doing this so he can join me. >> reporter: recently macedonia has allowed refugees and migrants to transit through the country for three days but they have to wait until they are
allowed in. so throughout the night more people have arrived and some have already left. they are organizing themselves in groups hoping that at some point the macedonian police will let them through. there are many afghans some eritreans pakistanis but most are syrians. >> we have been here for 14 or 15 hours. we slept on the ground. there's no water my clothes are dirty, i used to have a good life but look at me now. it's been a month and a half and i'm sleeping on the streets. sometimes people come and help us or at least smile at us that makes us feel like human beings. >> translator: i was afraid to bring my system here. i didn't want to put them at risk. nobody knows what's ahead. we hear about bandits and gangs. i could go it alone but i won't let anything happen to my children. >> reporter: one after
another, the groups are allowed into macedonia. but here starts a new struggle to get a transit permit. and then, their journeys continue through serbia and hungary before they hope reaching germany or further north. hoda abdel hamid, al jazeera on the greek-macedonian border. >> while violence is driving most of the economics around the world, the norwegian refugee council set the incidents took place in asia following typhoons in china and the fill philippines people are 60% more likely to be displaced by disaster than in the 1970s. areas of rapid growth and poorly built housing are putting more people at risk specifically in
mexico city, mumbai and port au prince.
>> government committees. >> they're spending money, they're not saving it. >> costing millions and getting nothing. >> it's a bogus sham. >> america tonight investigates. money for nothing. >> they've gotten away with it for years.
>> now our global view segment a look at how news outlets across the world are reacting to various events. in the wake of greece's financial crisis germany's der spiegel, options for buying or leasing and talks about the bureaucratic difficulties involved in adding an island to your portfolio. it says the barrier to entry is much lower than you might think and quotes the price of one island as 1.6 million euros. the japan times uses a baseball metaphor, shinzo abe faces in
his world war ii anniversary. before the ball crosses the plate. and the new england herald, the editorial cartoon shows her grand sons watching old home movies and prince william saying quote i say granny what is your take on celebrity grandchildren being photographed? an australian medical school is working with replicas. the new technology could change the way doctors are trained. >> caked in this powder is the latest innovation in 3d printing. replica body parts. designs are based on ct scans of people which are colored in a computer to create a file to
send to a 3d prifnter. it builds a block of powder, and selects solidifying colors into a tiny portion of the powder. as the block is lowered a 10th of a millimeter a detailed form is created. >> it was rising out of the powder very eerie. >> traditionally students learn from books crude molded models or occasionally from parts dissected from dead people's bodies cadavers. >> two hours a week maybe. it's great having the cadavers there to have that 3d he be sweact really, that practical aspect to what you're learning
in your textbooks. you could argue that it is a little bit less than we would ideally want. >> cadavers are rare and expensive and in some cultures they are taboo. >> frown with the dissection or interference with a zed body and i would like to think that the parts of the world where there are issues of teaching medical students with cadavers that this could fill a unique niche. >> molded models can't get close. the time the ambition is a fully dissectible printed body parts. so far there hasn't been a complete body printed. there isn't yet a machine big enough to do it. this is actually a mix of body parts based on scans of different people. a modern model frankenstein. this isn't the ability to print
something that could give life, it is a big footstep forward. andrew thomas, al jazeera melbourne. >> that is it for this edition of al jazeera world news. fault lines is up next. i'll see you again in an hour. >> several months ago, we received a package of dvds. it came from a group of lawyers in michigan, and it contained video testimonies by young inmates of the state's adult prisons. we're hiding their identities - but the stories we heard if true, were horrifying. >> tell me what he does. with his arm. >> now he's saying i want you to suck my d***. and i say no, i don't do that, man, i don't do that. he said you're going to now. >> the videos are testimony for a lawsuit.
Al Jazeera July 20, 2015 9:00pm-10:01pm EDT
International news with in-depth analysis.
Nigeria 14, Cuba 12, U.n. 6, Havana 6, Washington 5, Buhari 5, John Kerry 4, Obama 4, Boko Haram 4, Abuja 3, Macedonia 3, London 3, Israel 3, Iran 2, Lazarus 2, Jennifer Glasse 2, Yvonne Ndege 2, Paul Brennan 2, Rodriguez 2, Melissa Chan 2
Al Jazeera America
The Chin Grimes TV News Archive
Uploaded by TV Archive on July 21, 2015

redpajama_set_name: RedPajamaCommonCrawl


One of our favorite historical "notes" about Palace Cafe's building, is that it was once home to the flagship store of Werlein's for Music. The music superstore's humble beginnings can be traced back to Vicksburg, Mississippi, where German-born American music publisher Philip Peter Werlein opened up shop for the first time in 1842. Just over ten years later he moved the company to New Orleans, and in 1905 established Werlein's flagship store at 605 Canal Street, where the Palace Café is located today.
The store specialized in manufacturing pianos but offered everything from sheet music to lessons and repairs. Over the course of its history, Werlein's made great efforts to keep music available to the city and to the generations of musicians who made some of their first purchases there. Among the other musical greats who got their start there such as Sweet Emma and Al Hirt, Louis Armstrong purportedly bought his very first horn from Werlein's; Jimmy Buffett got his first guitar there, and Fats Domino was a fan of its Steinway pianos.
An infamous but lesser-known part the store's earlier history, founder Peter Werlein was actually a rather large proponent of the Confederacy during the American Civil War. Originally written by Daniel Emmett for a Northern minstrel show, the song "I Wish I Was in Dixie" quickly gained popularity, and Werlein took advantage of its growing success by publishing the same song under the name "Dixie," attributing the lyrics to someone else. New versions of "Dixie" with different lyrics were also developed, and the song eventually became the anthem of the Confederacy. As a result, Werlein's went out of commission while Union troops held the city, but reopened after they left.
By the 1980s, Werlein's had expanded to fourteen locations throughout the South. The family closed the Canal Street location in the 1990s, and the last of their stores shut down in 2003 following the online movement of business and retailing. A decades-long Canal Street landmark, the huge "Werlein's for Music" sign atop the building still remains there today but reads "Palace Café" instead. The restaurant officially opened its doors at 605 Canal in 1991.
Palace Café, a classic New Orleans restaurant located at the foot of the French Quarter, serves contemporary Creole food in an upbeat and lively grand café. As bearers of the torch keeping Creole cuisine alive and vital, Dickie Brennan and Palace Café's culinary team are constantly evolving traditional Creole dishes and creating a few new favorites.
Housed in the historic Werlein's music building, the restaurant has won a number of local and national awards since it opened in 1991. In honor of this heritage, we pay tribute to New Orleans' musical sons and daughters in three huge murals in our second-floor dining area. Additionally, one of our most popular starters- the Werlein Salad- also marks a nod to the family business that was here before us.
The Werlein's line was also the very popular "Time and Temperature" number that New Orleanians would call to find out the exact time and temperature at the moment. Today, that tradition looks a little bit different. For 23 years we have continued our summer Temperature Lunch dining tradition. On weekdays from Memorial Day to Labor Day, a two-course meal is priced at the previous day's high temperature (85° on Monday=Tuesday's $8.50 lunch). For the first course, guests have their choice of soup du jour or salad for an appetizer. Using local, seasonal ingredients, our culinary team create daily entrée specials.


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text:
©Damen, 2021
Classical Drama and Theatre
Return to Chapters
It is worth considering that the lack of conventional drama based on spoken dialogue may be as much the result of the multiculturalism of late Rome as the dominance of low-brow tastes. That is, in an empire where no single language dominated, spoken text may have represented an enterprise too limited in scope to succeed. Conversely, gladiatorial games, chariot races, mock sea-battles, pantomimes and bilingual spoofs (see below, Charition) translate more broadly across the wide spectrum of cultures which later Rome embraced. In other words, the empire may simply have been too big for drama like Greek tragedy because, where Euripides and his fellow dramatists could rely on having an audience with at least some knowledge of the Greek language, the same was not true of later Roman playwrights.
Return to Chapter 16


text:
McPhee: This will be the hardest 14 days of his life
Kermit Romer
HEILD TEST POSITIVE FOR COVID-19 – Grand Bahamian and shooting guard for the Sacramento Kings, Chavano "Buddy" Hield (center) is one of the few National Basketball Association's (NBA) players to have tested positive for COVID-19 ahead of the league's re-start set for July 30. The news was reported by The Athletic's Shams Charania, June 24. Two of his teammates, center Alex Len and forward Jabari Parker also tested positive for the virus. There was no report on where each player contracted the virus. (AP PHOTO)Sports, Top Gallery June 25, 2020 FN Sports Reporter Shayne Stubbs
In light of the recent discovery of hometown superstar Chavano "Buddy" Hield testing positive for COVID-19, the Sacramento Kings' shooting guard has received a number of well wishes from residents on social media platforms and otherwise.
The Freeport News reached out to longtime coach Gladstone "Moon" McPhee, who, has a well-documented history with the 6'5'' guard. Much like everyone the news came as a surprise.
While there was no report on where Hield could have contracted the virus, the sharpshooter's performance in the Skinz League went viral. He scored 45 points while sinking 13 three-pointers. The game was played in Oklahoma City earlier this month.
"I am surprised. But, I found out he was working out. He just loves the game so much. We all believe at times it won't happen to us, but it just happened and it's unfortunate.
"I know this will be the hardest 14 days in his life whereby he can't play or workout, and he loves the game so much. All we can do is keep him in our prayers," said McPhee.
Hield is one of several National Basketball Association's (NBA) players to have tested positive for COVID-19, just ahead of the league's re-start set for July 30.
The news was reported by The Athletic's Shams Charania on June 24. Two of his teammates, center Alex Len and forward Jabari Parker, reportedly also tested positive for the virus. There was no report on where each player contracted the virus.
Hield and the other players who tested positive must now quarantine for two weeks as teams get set to begin training camp for the league's return-to-play. June 22 marks the return of players to their respective training facilities.
According to CBSSports.com, the NBA began phase two of six, of their plan to resume the season, which meant teams could begin testing their players.
Since then, a number of NBA players have been tagged as COVID-19 positive, including the Denver Nuggets' center Nikola Jokic, Indiana Pacers' point guard Malcom Brogdo, and, two unnamed players from the Phoenix Suns.
The NBA is said to be prepared for a wave of positive tests in the coming days.
The Sacramento Kings are a part of the 22 teams set to resume the season at Disney World in Orlando, Florida. Training camp begins June 30 and teams will begin travel to the bubble location on July 7.
The Kings will resume the season in the 11th seed with a 28-36 record, 3.5 games behind the Memphis Grizzlies who are holding the eighth and final playoff spot in the western conference.
Hield is one of the main contributors to the Kings' success. Hield is the team's second leading scorer at 19.8 points per game while shooting 42.9 percent from the field and 39.5 percent from the three-point arch. He also averaged 4.8 rebounds and a career-high in assists at 3.1 per game.
The 22 teams set to resume the season, will play eight regular season games, then there will be a play-in tournament which will feature the number eight and number nine teams in both eastern and western conferences. If the ninth seed finishes the regular season within four games of the eighth seed, the number eight seed enters a double-elimination tournament, and the number nine seed a single-elimination tournament.
Teams already locked into playoff spots include Western Conference leaders in the Los Angeles Lakers (49-14) and Eastern conference leaders, the Milwaukee Bucks (53-12).
Second in the East are the Toronto Raptors (46-18), with the Boston Celtics (43-21) following in third.
In fourth are the Miami Heat (41-24), fifth place the Indiana Pacers (39-26), and sixth place the Philadelphia 76'ers (39-26) – who are all expected to clinch playoff berths.
The Brooklyn Nets (30-34), Orlando Magic (30-35) hold the seventh and eighth spots respectively in that conference while the Wizards will play from ninth place at 24-40).
With the eight-game format in the West, the second place Clippers (44-20), third place Denver Nuggets (43-22), fourth place Utah Jazz (41-23), fifth place Oklahoma City Thunder (40-24), sixth place Houston Rockets (40-24) are expected to clinch berths out West.
The seventh place Dallas Mavericks, at 40-27, are on the verge of clinching their play-off berth out West. The Trailblazers hold the ninth seed at 29-37, the Pelicans are 10th at 28-36, the Spurs are in 12th place at 27-36, Bahamian DeAndre Ayton and the Suns are 13th in the west at 26-39.
The league suspended play back in March due to COVID-19 pandemic.
Related TopicsChavano Bubby HieldGladson Moon McPhee
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The look and feel of your outdoor living space is an important foundation to how you present and interact with your home. Whether you want to throw outdoor parties or cultivate tranquil gardens for personal relaxation, your front and back yards should reflect your personality.
Whether you're up for extensive transformations or a few modest pick-me-up additions and alterations, local professionals are here to help. Here, they offer ideas on how to revive your property and create the yard of your dreams.
For any landscaping project, Benson Stone Co. offers products and expert advice to make sure you get it done correctly.
This 86-year-old, fifth-generation family business carries many full product lines of landscaping materials in its main showroom, 1100 Eleventh Street, in Rockford. From decorative gravel and mulch to patio materials and composite decking, a visit to this showroom is sure to spark ideas.
Bricks, pavers, flagstone and steppers for walkways, patios and driveways are displayed. There's also a huge selection of natural stone for retaining walls, garden and seat walls, outcroppings and decorative boulders.
Benson Stone Co. also stocks a range of outdoor kitchen pieces, fireplaces, fire pits, standard barbeque grills and outdoor lighting. Outdoor kitchens and LED lighting are especially popular, says Benson.
The business houses one of area's largest selections of advanced gas, charcoal and electric grills; smokers; pizza ovens; and a range of grilling accessories. The outdoor kitchen of your dreams can be accessorized with additional storage, outdoor refrigerators and granite countertops.
Once you have the right products, you'll need the right tools to see it through. Lincoln Rent-All and Sales, 6635 E. Riverside Blvd. and 3110 Auburn St., is one of the most complete rental businesses in the Rockford area. Its emphasis on customer service, quality equipment and trained staff members who answer questions and educate people on proper equipment use are a real asset for amateurs and trained professionals alike.
Customers can rent or buy handheld power equipment, lawn tractors and mowers, shovels and rakes, gardening tools and more, including brand names Stihl, Honda, Briggs & Stratton, Kawasaki, Kohler and Tecumseh. Even if problems come up during the project, the business offers replacement parts and service to help you finish the job.
If you're looking for an update that will last for many years to come, ornamental ironwork is a durable, tailored and elegant option.
"These are pieces that are going to last for 200 years," says Rob Kapala, president of Rockford Ornamental Iron, Inc., 1817 Michigan Ave., Rockford.
Kapala says demand for iron has increased in recent years at Rockford Ornamental Iron, Inc., for both commercial and residential properties. His family-owned and -operated business specializes in custom wrought iron pieces for fences, driveway gates, railings, balconies and indoor and outdoor spiral staircases. Many first-time customers are surprised by how customizable ironwork can be, says Kapala.
Beyond the customer's vision, every design is fitted exactly to structural and property specifications. Rockford Ornamental Iron, Inc., only takes on projects that comply with safety regulations and are made to fit perfectly in the space.
Every order starts with a free consultation and measurement of the property or installation space. Whether customers have a specific idea in mind or are exploring their options, the staff designers work with them one-on-one to create drafts of the possibilities. After a piece is fabricated at the Rockford facility, the staff installs it on the property. The duration of the process can vary greatly based on its size and complexity and the season of the year.
The staff members at Rockford Ornamental Iron, Inc. use a do-it-all approach to whatever customers bring to them. Even for ideas outside of the norm, the small onsite team can use its flexibility to find a solution.
This accommodating, attentive standard has been a pillar for the 65-year-old company since its beginning. Kapala's father, Fred, founded the company in Loves Park while working two other jobs. It operated on a shoestring until he slowly built it up.
"I've been working since I was 12 years old with my father. This is the only job I've ever had," he says.
After studying architecture in college, Kapala returned home to become partners with his father in 1985. Based on his industrial design studies, he steered the company into expanding beyond iron fixtures and railings and into structural beams and columns. The company adapted to changing demands and expanded its offerings.
Rockford Ornamental Iron, Inc., stands out for its personal touch.
The small details of your yard often have a dramatic impact. Pops of color and lighting complete the look of a total landscape makeover, while a few last-minute additions of plants and furniture styles can transform your outdoor living space without any major construction.
K&W Greenery houses a variety of low-maintenance options to add personality to any yard. A full greenhouse, tree farm and nursery caters to gardening needs, while a selection of outdoor furniture, waterproof rugs, weatherproof lamps, grills and garden accessories can add invaluable functionality. Graffin, daughter of owners Bill and Phyliss Williams, has been working at the plant and outdoor living shop since she was a child. She understands that a variety of options and an expert staff are the keys to finding outdoor pieces that reflect your personal vision while fitting your lifestyle.
Plants are the natural way to liven up your yard. You don't have to be a dedicated and skilled gardener, either. Different garden styles can range in maintenance requirements, size and other elements, including what insects and animals they attract. Know your options before you commit to the wrong plant type, says Graffin.
Summertime drives more vibrant, uplifting blossom hues, but look for ones that can be smoothly incorporated throughout your color scheme.
Brightly colored tropical plants often are misunderstood by new homeowners who may think they require major upkeep. Many species are more adaptable than they seem. K&W Greenery staff members are trying to train customers on how to properly care for tropicals without extra effort. They can be especially beautiful when mixed with annuals outdoors, says Graffin.
Other trends for this season include all-weather wicker furniture, outdoor swing chairs and solar-powered lighting.
K&W Greenery also houses an entire Design & Build Landscape Division for homeowners stressing over major projects. Two full landscape designers are on staff to handle everything, whether it's planting trees and shrubs, creating flowerbeds, designing and installing a brick patio or creating a garden pond.
"It really caters to the higher-end things that people don't know how to get started with," Graffin says.
There's no limit to what you can do with your landscape when you combine your personal vision with the expert advice and high quality products available to us in our region.
This entry was posted on Wednesday, June 29th, 2016 at 11:59 am	and is filed under Home & Garden. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.


On certain days, you can meet characters from the past and hear extraordinary tales from Guernsey's history.
Living History is provided at our sites by the Guernsey History in Action Company. Please consult their website www.ghiac.org or email info@ghiac.org.


Northwest Flower and Garden Show, here I come! I am over the moon with excitement. Its official. I will be speaking at the Northwest Flower and Garden Show in Seattle Washington. I love the Northwest Flower and Garden Show and try to go each year. It's the kickoff event for the garden season here in the pacific northwest. As many of you know, I have been speaking at different events over the last few years. I love to share my passion for gardening whether its food or flowers. This is my first time speaking at the garden show and I am honoured to be chosen.
So what will I speak about? My presentation is on 'How to Create a Successful Kitchen Garden Year Round'. A few years ago we had some tree fall which left us with a huge sunny space full of weeds and heavy clay soil. We transformed this area into a productive kitchen garden. So what is a kitchen garden? No, I am not gardening in the kitchen. Yes, I had someone ask me that. Kitchen garden is a term used for a garden that is more formally laid out compared to an in ground garden. It is also called a potager and is a separate place from the rest of the garden. It's usually a source of fruits, herbs and vegetables. This aptly describes our kitchen garden as we grow vegetables, fruit and herbs in six raised beds in an area separate from the rest of the garden.
Its been a blessing having a kitchen garden. Late afternoons used to go by and I dreaded making dinner as I would run out of menu ideas. Now that I have a kitchen garden, I let the garden tell me whats for dinner. Its based on what is ready to harvest. One day it may be sweet potatoes so I will make a sweet potato and apple baked dish. It's just that easy.
Many of you may wonder about growing year round. Here in the pacific northwest we are blessed with warm winds from the ocean which means we have mild winters, little snow but we may have a few hard frosts. In winter I grow vegetables under hoops covered in plastic. This way I can harvest from the garden all year round. There is nothing better than harvesting in the middle of winter.
I won't say much more but hope you will come and visit the Northwest Flower and Garden Show. The garden show runs from Wednesday, February 22- Sunday, February 26, 2017. I speak on Thursday, February 23 at 6:45pm in the Hood room but will be at the show from Wednesday to Saturday to meet with other gardeners. If you would like to grab a coffee and talk gardening, I am all ears.
For more info about me, you can read my bio here.


Bruno and Linda Schroeder have lived in Ocean Springs for over 30 years. Linda is a native of Ohio and Bruno hails from Texas. They delight in the charm of Ocean Springs and are always ready to extol its unique character to others.
The remodeled 1930's bungalow reflects the elegant simplicity of their tastes and life style. A spacious yard, flower beds and an ample deck at the rear of the house affirm their appreciation of outdoor life. A porch complete with swing graces the front of their home and affords a view of their tree-lined street. The location near downtown offers visitors easy access to the quaint charms of Ocean Springs.
Ocean Springs is centrally located for day trips to other nearby attractions.
 Bellingrath Gardens in nearby Theodore, Alabama is less than an hour away.


Bring the Gourmet Rewards Gift Basket along to the office to share an assortment of sweet and savory treats with your co-workers. This basket is filled with crackers, pecan cookies, fudge crackers, wafer cookies, chocolate chip cookies, almonds, mustard, sweet cheese sticks, chocolate squares, peanut brittle and chocolate noirs. A great way to boost the morale of your employees, the Gourmet Rewards Gift Basket is sure to be a hit with the whole team.


text:
Compassion, not wisecracks, for the man in the tree
Originally published March 23, 2016 at 5:12 pm Updated March 24, 2016 at 10:07 am
Seattle's man in the tree wasn't that funny.
The Seattle Times editorial board
LAST summer, someone shared a video of what appeared to be a drunk policeman swaying and falling on a train in India. It went viral, generating millions of online views and countless jokes.
It wasn't that funny after all.
Earlier this week, reports came that the policeman actually had a brain injury from a massive stroke that contorted his face and left him partially paralyzed. He blacked out on the train after working an extra long shift.
The policeman's wife reportedly fell into depression and also became sick, after her formerly distinguished husband became a laughing stock.
That cautionary tale emerged shortly before a man climbed a tree in downtown Seattle Tuesday and came down Wednesday, becoming yet another Internet sensation.
Even though the man in Seattle appeared to have signs of mental illness and was in a dangerous situation, it was an irresistible opportunity for a chuckle. In the blink of a shutter, he went from a person in trouble to a hashtag, feeding social media's insatiable appetite for fresh material.
Page views are the currency of media, so news helicopters provided round-the-clock coverage. Attention snowballed, drawing coverage from international news outlets, as his behavior became more troubling and scary.
Kudos to Seattle police, firefighters and medics for their patience and considerate response to a person in trouble."
Kudos to Seattle police, firefighters and medics for their patience and considerate response to a person in trouble, despite the temporary inconvenience he caused. Though even they couldn't resist a pun or two on Twitter.
Quirkiness is fun, but mental illness is not.
Every year, nearly 60 million Americans experience a mental-health condition, touching one in four adults, according to the National Alliance on Mental Illness.
That means it's a matter of when — not if — friends and family will have some sort of episode. When that happens, we ought to remember the man in the tree and hope our loved ones are treated with more dignity and compassion.
Editorial board members are editorial page editor Kate Riley, Frank A. Blethen, Ryan Blethen, Brier Dudley, Mark Higgins, Jonathan Martin, Thanh Tan, William K. Blethen (emeritus) and Robert C. Blethen (emeritus).


Since the beginning, Toyboy Warehouse has focused on creating a space free from all existing social connotations about age-gap relationships, allowing fun of all kinds, and facilitating users to build a genuine connection with one another.
Toyboy Warehouse continues to build an environment where women can be confident of their genuine appeal to younger men and where men can meet and interact with the gorgeous older women they desire without fear of rejection or judgement.
Randy Rabbits is a discrete casual relationship site so whatever you are searching for whether it's a secret liaison, a no strings encounter, perhaps a one night stand or just some local fun, this site is for you.
You can search adult personals in all regions of the United Kingdom with advanced, distance by miles, postcode searching.
Soon after the site launched the word began to spread..wildfire.
Like their backgrounds, the reasons why older women like dating younger men are just as varied.
Over the subsequent years Toyboy Warehouse has continued to be the UK's largest cougar dating agency specifically for older women and younger men.
During this time Toyboy Warehouse has proudly connected thousands of couples, many of who are still together today.
Toyboy Warehouse speaks from the success of the hundreds of relationships and thousands of connections that have been formed between older women and younger men over the years.
The women of Toyboy Warehouse are an incredibly diverse group of individuals.
We have had brilliant opportunities including meeting various casting directors, directors, auditioning for new TV series, and even meeting Peter Kay.
După ce a trimis o telegramă în care îşi anunţă fericirea de a‑i fi acceptată cererea în căsătorie soseşte la casa Herdelenilor şi George Pintea, acceptat cu bucurie de către toţi, deşi în noaptea următoare "Pentru a se iubi cu doamna Lang, Titu îl duce pe soţul acesteia la petrecerea vânătorilor din cârciuma lui Neumann, de unde ştia că învăţătorul evreu nu se va depărta până în zori.