Thomas Phifer adds reflective white wing to Corning Museum of Glass in New York

New York architect Thomas Phifer has designed a building featuring an opaque glass exterior for one of the world's most important glass museums (+ slideshow). (more…)


LAND arquitectos rebuild earthquake affected school in chile

the redesign of this school is an homage to victims of the chilean natural disaster, whilst focusing on restoring local identity and improving the learning environment.

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What Does It Take to Ask for Good Healthcare?

A technician tests blood samples for HIV at a clinic run by Medecins Sans Frontieres in Nairobi, Kenya. (AP Photo/Khalil Senosi)

“He said, ‘I’m thinking of joining a society.” Robert Neuwirth, author of Shadow Cities, is describing how his best friend in Kenya told him he was going to die. “He meant a funeral society,” a kind of community group that helps manage funeral costs and sends people to dig the grave.

The friend, a resident of Nairobi’s Kibera slum, was subtly disclosing that he had AIDS. Two years later, he died of what appeared to be oral thrush — an infection survivable with proper care. He was just 28. “You could say he died of stigma,” Neuwirth says, “because offhandedly mentioning the funeral society was as close as he ever came to even admitting he was sick.”

The story is tragic, but not uncommon, as a recent study in Health Affairs makes clear. The study, based on data from a 2012 World Gallup Poll of 58 countries, reveals that most sub-Saharan Africans find their healthcare systems wanting, but prioritize other improvements — such as better jobs and less corruption — ahead of better medical care, even in countries where HIV is common. The finding appears to relate to informal work, democracy, and what researcher August S. Deaton describes as “an overall issue in which international help for health has been sort of imposed on countries that are very poor and don’t have enough options.”

Deaton, an economics and international affairs professor at Princeton, says he and coauthor Robert Tortora didn’t consider informal workers specifically. But the research documents in broad strokes a lower quality of life in world regions where most workers are informal.

Survey organization Gallup has been collecting data from African nations below the Sahara since 2005. The poll that Deaton and his colleagues referenced included “Cantril ladder scores,” which ask participants to rank their lives on a scale of 1 (the worst life imaginable) to 10 (the best possible life). Another question captured the percentage of people who felt themselves to be “in perfect health.” Of all world regions, people in sub-Saharan Africa ranked their well-being lowest. In most African countries, fewer than half described experiencing perfect health. (In Kenya, where Kibera is situated, the figure is 19 percent.)

The surveys, which use questions with a fixed range of responses, can’t offer explanations. Nonetheless, a few observations jump out.

Deaton and Tortora’s results state that only 42.4 percent of all sub-Saharan Africans say that “good [health] care is available.” The figure is the lowest in the world; in other areas, as many as 86.3 percent of people felt they could access good care. The finding squares with a 2013 survey of 34 countries by research group Afrobarometer, which found that over half of Africans did without healthcare at least some of the time. Another Afrobarometer report documents health service satisfaction among just 57 percent of survey-takers.

But the Africans who the Gallup World Poll questioned didn’t prioritize better healthcare. Given a choice of six priorities for government action, healthcare came in behind new jobs, improvements to agriculture, reducing corruption and better education. Just 13 percent of Africans wanted better care; only improvements to electricity was ranked lower. “It seems like they downgrade health, at least in Africa, among their highest priorities,” Deaton says.

Even HIV doesn’t change that. In eight of the nine African countries where more than 5 percent of the population has HIV, survey participants reported that they perceived the healthcare system to be improving. But people in these countries didn’t particularly want healthcare to improve. “We also found a strong negative correlation across countries between prioritizing health care and HIV prevalence,” Deaton and Tortora write, suggesting that high-prevalence countries may experience “spillovers” from HIV-centered care to all-around better healthcare for everyone.

But the HIV experience may also point out why Africans don’t prioritize government improvements to healthcare. The study notes that international NGOs have increasingly focused on providing health services in sub-Saharan Africa — despite surveys revealing Africans aren’t particularly interested in it. “We’re doing something that we seem to want to do,” Deaton says, indicating international actors. “And it’s not clear that they” — African people — “necessarily want to do that.”

Deaton finds this survey result unsurprising. “I think this gap has come up several times,” he says. “So I don’t think it’s a question of whether it’s really there or not.”

While NGO health services may simply be crowding out public demand for improved public services, the preponderance of foreign aid-funded care connects to a different problem: deficient democracy. This, too, may tie into sub-Saharan Africa’s informal economies. Unlike democratically elected governments, NGOs can’t be voted out for failing to respond to the wills of the people they serve. The result, to some extent, is the loss of a feedback loop that would tie healthcare activities to public desires.

That deficit may connect to poor healthcare and to informal work. One reason that NGOs, rather than governments, handle essential functions in African nations is a lack of taxation, a characteristic that defines informal economics. Additionally, state-run benefits programs providing health insurance and public aid are often specifically for people in formal employment, a slim minority of the African population. “Breaking out of informality is increasingly seen as one of the main development challenges,” reads an International Labour Organization study titled “The informal economy in Africa: Promoting transition to formality.” The ILO proposes a solution that seems to square with decreasing unaccountable aid: Include more people in the formal economy, where democratic governments can provide services that conform more closely to perceived public needs.

Africans might embrace that more than they do NGO-based healthcare. A 2014 Afrobarometer survey of 34 African countries documented an overall eagerness for democracy — including several countries where people describe a “deficit of democracy,” or a public desire greater than what political elites are offering.

While Neuwirth agrees with better government, he says social empowerment is necessary, too. His book describes a total lack of adequate health NGOs in Kibera, and generally evinces the idea that few locals believed they could ask for more than the poor services they already received. Deaton adds to the point, writing that “after centuries of high morbidity, [people in the region] may not believe that the government (or anyone else) is capable of providing any meaningful relief.”

Amidst imperfect NGO and government services, disenfranchisement can end in avoidable death — even when healthcare is available. Some positive changes are slowly accreting despite the imperfections. But in pursuit of the best life possible, the entanglement of democracy, healthcare and informal economics implies there is much work to be done.


airbnb’s pavilion at SingaPlural takes guests on a trip around the world

using 3D projection mapping, the unadorned volume is transformed as guests are shown the interiors of four different listings from across the globe.

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Nike x Sacai capsule collection aims to make sportswear more feminine

Sports brand Nike has collaborated with Japanese fashion studio Sacai to launch a capsule collection of women's performance sportswear that incorporates pleats and lace (+ slideshow). (more…)


feltmark’s wald lamp is a simple, holistic sum of individual parts

'wald' uses only the wall socket to create a seamless, simple lamp for the home or office.

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Proposal No. 6 by Jeremie Maret

Proposal No. 6 extends the concept of its Zurich predecessor to Berlin by allowing visitors to stay overnight alongside the displayed artwork. A Zurich gallery occupies a space in Berlin to promote its new mobile exhibition concept.

Proposal No. 6 by THE PROPOSAL

Proposal No. 6 extends the concept of its Zurich predecessor to Berlin by allowing visitors to stay overnight alongside the displayed artwork. A Zurich gallery occupies a space in Berlin to promote its new mobile exhibition concept.

carbon3D’s CLIP technology enables fast, layerless printing

carbon3D demonstrates a 3D printing development, named 'CLIP', that harnesses light and oxygen to rapidly and continuously fabricate objects from a pool of resin.

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Anaheim’s New Transit Hub Isn’t a Failure Yet

The Anaheim Regional Transportation Intermodal Center opened late last year. (Photo by Samuel Bernstein)

It’s only been three months since an intermodal station opened in downtown Anaheim, and already the local press seems ready to write it off.

ARTIC (the much-needed acronym for Anaheim Regional Transportation Intermodal Center) is “an iconic, LEED Platinum Design Hub that brings together the services of OCTA, Metrolink, Amtrak, Anaheim Resort Transportation, Megabus, Greyhound, taxis, bikes, and other public/private transportation providers,” according to its website.

But in local headlines? It “Fails to Live up to Expectations,” according to the Orange County Register, “Has Glitter But Not Ridership Gold” according to Voice of OC, and is a “$۱۸۸ Million Station to Nowhere” according to OC Weekly.

This isn’t your usual right-of-center grumbling about Agenda 21; the outlets’ politics range from libertarian to alt-weekly. Some of their critiques are regional — taking on Anaheim’s Disney-fied identity and even the long shadow of high-speed rail. (ARTIC was originally planned as the mega-train’s Orange County terminus, but the state dropped Anaheim from Phase One maps in 2012). But some follow a national trend, targeting ridership forecasts that have turned out to be less than accurate.

“When Anaheim officials were selling the public on ARTIC … they said nearly 3,000 train boardings would take place starting with opening day in 2014,” Adam Elmahrek of Voice of OC wrote in February. According to Orange County Transportation Authority data from December, he added, daily boardings during the station’s first month averaged less than 800. Meanwhile, planners allegedly overestimated ridership as far back as 2009.

“The station is quickly proving itself to be the over-promised and under-delivered project we always knew it to be, but it is unfortunate that it has to cost $4.7 million annually to prove,” an Orange County Register editorial stated last month, citing Voice of OC’s data.

A City of Anaheim spokesperson did not return multiple requests for comment by deadline. But according to Voice of OC, officials claim the “opening day” numbers highlighted by press reports were actually supposed to represent first-year figures, and say the station shouldn’t be written off just yet.

Albert Kaneshiro with HOK, the firm that designed ARTIC, agrees with that last statement.

Regarding whether the station is underutilized, he says: “I think it’s too early to say after two months.”

Historically, Orange County has been rigidly suburban, a place where even the churches are built for cars. Ridership might be lagging now, but it could still pick up. And according to Kaneshiro, the station’s grand aesthetic — hangar-sized shell, open floor plan, vaulted interior — is meant as a cultural nudge in that direction, inviting residents to step out of their cars.

“The City of Anaheim stressed that it wanted an iconic intermodal facility that would transform how public transportation was perceived,” he says.

Another voice of support comes from Steve Wicke with the region’s Sierra Club chapter.

“We want to get public transportation going here,” he says, referring to both Los Angeles and Orange counties. “We want to get as many cars off the road as possible, and we’re in favor of as much [alternative transit] as we can get.”

But the hub does come at a hefty cost of $188 million in federal, state and municipal funds. When a capital project of that magnitude seems to deliver so much less than promised, residents’ frustration is understandable.

Anaheim’s bad press isn’t alone. In an article pegged to California high-speed rail last August, Grist’s Nathanael Johnson took on the fact that “public sector megaprojects” often rely on inaccurate data — and go over budget 90 percent of the time. And car-centric DOTs, with their notoriously padded traffic projections, aren’t the only culprit — according to a study published in Transport Reviews last year, “inaccuracy remains problematic for road, rail and roll projects alike.”

Johnson makes an interesting argument, that although we tend to see only public-sector corruption in trends like this, they also reflect our societal unwillingness to pay for infrastructure.

“Just about the only way to build infrastructure in this country is via deceit, but that’s only because we’ve been unwilling to pay for common goods,” he writes.

That may or may not be true in Anaheim — obviously regional politics are at play, and the price tag does seem high to justify a hub, without the addition of much new transportation as yet. But the critiques come at a time when California is desperately trying to shift, modally. Anaheim’s new monument to rail won’t be the last expensive capital project to under-deliver as California commuters fail to keep pace, but that doesn’t mean that they won’t catch up.

For now, Kaneshiro’s sentiment seems wise: Give them more than two months.


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Architect Mahmood Fallahian

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