How Design Can Help Fight Poverty: Paul Pholeros at TEDxSydney (Transcript)

Paul Pholeros – TRANSCRIPT

The idea of eliminating poverty is a great goal. I don’t think anyone in this room would disagree. What worries me, just a little, is when politicians with money and charismatic rock stars – use the words, ” … it all just sounds so, so simple.”

Now, I’ve got no bucket of money today and I’ve got no policy to release, and I certainly haven’t got a guitar. I’ll leave that to others. But I do have an idea, and that idea is called Housing for Health. Housing for Health works with poor people. It works in the places where they live, and the work is done to improve their health. The work is much more about work, than words.

Over the last 28 years, this tough, grinding, dirty work has been done – around Australia, and more recently overseas – it’s been done by literally thousands of people, and their work has proven that focused design can improve even the poorest living environments. It can improve health and it can play a part in reducing, if not eliminating, poverty. I’m going to start where the story began – 1985, in Central Australia.

A man called Yami Lester, an Aboriginal man, was running a health service. He saw, walking in the doors of the clinics he controlled, every day eighty percent of what walked in the door, in terms of illness, was infectious disease – third world, developing world infectious disease, caused by a poor living environment. Yami assembled a team in Alice Springs. He got a medical doctor. He got an environmental health guy. And he hand-selected a team of local Aboriginal people to work on this project. He also put into the room a very green, inexperienced architect. More familiar with trying to make some wealth in Sydney, than improve health in Central Australia, and I won’t name the person, because it would be too embarrassing. I won’t get a vote on who was the weakest link in the team.

Yami told us at that first meeting, “There’s no money,” – always a good start – ” … no money, you have six months, and I want you to start on a project -” which, in his language, he called “Uwankara Palyanku Kanyintjaku,” which, translated, is “a strategy for well being” or more simply translated, “a plan to stop people getting sick” – a profound brief. That was our task.

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First step, the medical doctor went away for about six months. And he worked on what were to become these nine health goals – what were we aiming at? After six months of work, he came to my office and presented me with those nine words on a piece of paper.

[The 9 Healthy Living Practices: Washing, clothes, wastewater, nutrition, crowding, animals, dust, temperature, injury]

I was very unimpressed. Big ideas need big words, and preferably a lot of them. This didn’t fit the bill. What I didn’t see and what you can’t see was that he’d assembled thousands of pages of local, national and international health research that filled out the picture as to why these were the health targets. The pictures that came a bit later had a very simple reason.

The Aboriginal people who were our bosses and the senior people were most commonly illiterate, so the story had to be told in pictures of what these goals were. We worked with the community, not telling them what was going to happen in a language they didn’t understand. So we had the goals and each one of these goals – and I won’t go through them all – puts at the center the person and their health issue, and it then connects them to the bits of the physical environment that are actually needed to keep their health good.

And the highest priority, you see on the screen, is washing people once a day, particularly children. And I hope most of you are thinking, “What? That sounds simple.” Now, I’m going to ask you all a very personal question. I want a show of hands, of who in this great house this morning before you came, who could have had a wash using a shower? I’m not going to ask if you had a shower, because I’m too polite. That’s it. (Laughter) We’ll call this the dirty side of the room.

All right, I think it’s fair to say most people here could have had a shower this morning. I’m going to ask you to do some more work. I want you all to select one of the houses of the 25 houses you see on the screen. I want you to select one of them and note the position of that house and keep that in your head. Have you all got a house? I’m going to ask you to live there for a few months, so make sure you’ve got it right. It’s in the northwest of Western Australia, very pleasant place. Let’s see if your shower in that house is working. I hear some “Aw!” and I hear some “Ah!” If you get a green tick, your shower’s working. You and your kids are fine. If you get a red cross, well, I’ve looked carefully around the room and it’s not going to make much difference to this crew.

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Why? Because you’re all too old. I know that’s going to come as a shock to some of you, but you are. And before you get offended and leave, I’ve got to say that being too old, in this case, means that pretty much everyone in the room, I think, is over five years of age. We’re really concerned with kids naught to five. And why? Washing is the antidote to the sort of bugs, the common infectious diseases of the eyes, the ears, the chest and the skin that, if they occur in the first five years of life, permanently damage those organs. They leave a lifelong remnant. That means that by the age of five, you can’t see as well for the rest of your life. You can’t hear as well for the rest of your life. You can’t breathe as well. You’ve lost a third of your lung capacity by the age of five.

And even skin infection, which we originally thought wasn’t that big a problem, mild skin infections naught to five give you a greatly increased chance of renal failure, needing dialysis at age 40. This is a big deal, so the ticks and crosses on the screen are actually critical for young kids. Those ticks and crosses represent the 7,800 houses we’ve looked at nationally around Australia, the same proportion.

What you see on the screen – 35 percent of those not-so-famous houses lived in by 50,000 indigenous people – 35 percent had a working shower. If you’re shocked by that, then ten percent of those same 7,800 houses had safe electrical systems. And 58 percent of those houses had a working toilet. These are by a simple, standard test. In the case of the shower: does it have hot and cold water, two taps that work, a shower rose to get water onto your head or onto your body, and a drain that takes the water away? Not well-designed, not beautiful, not elegant – just that they function.

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And the same tests for the electrical system and the toilets. Housing for Health projects aren’t about measuring failure – they’re actually about improving houses. We start on day one of every project. We’ve learned – we don’t make promises, we don’t do reports. We start work on the first day. We arrive in the morning with tools, tons of equipment, trades, and we train up a local team on the first day to start work.

By the evening of the first day, a few houses in that community are better than when we started in the morning. That work continues for six to 12 months, until all the houses are improved and we’ve spent our budget of 7,500 dollars total per house. That’s our average budget. At the end of six months to a year, we test every house again. It’s very easy to spend money. It’s very difficult to improve the function of all those parts of the house. And for a whole house, the nine healthy living practices, we test, check and fix 250 items in every house. And these are the results we can get with our 7,500 dollars. We can get showers up to 86 percent working, we can get electrical systems up to 77 percent working and we can get 90 percent of toilets working in those 7,500 houses. Thank you.

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