Disasters typically strike quickly and cause great harm. Unfortunately, because of the spontaneous and chaotic nature of disasters, the psychological consequences have proved exceedingly difficult to assess. Published reports have often overestimated a disaster's psychological cost to survivors, suggesting, for example, that many if not most survivors will develop posttraumatic stress disorder (PTSD); at the same time, these reports have underestimated the scope of the disaster's broader impact in other domains. We argue that such ambiguities can be attributed to methodological limitations. When we focus on only the most scientifically sound research--studies that use prospective designs or include multivariate analyses of predictor and outcome measures--relatively clear conclusions about the psychological parameters of disasters emerge. We summarize the major aspects of these conclusions in five key points and close with a brief review of possible implications these points suggest for disaster intervention. 1. Disasters cause serious psychological harm in a minority of exposed individuals. People exposed to disaster show myriad psychological problems, including PTSD, grief, depression, anxiety, stress-related health costs, substance abuse, and suicidal ideation. However, severe levels of these problems are typically observed only in a relatively small minority of exposed individuals. In adults, the proportion rarely exceeds 30% of most samples, and in the vast majority of methodologically sound studies, the level is usually considerably lower. Among youth, elevated symptoms are common in the first few months following a high-impact disaster, but again, chronic symptom elevations rarely exceed 30% of the youth sampled. 2. Disasters produce multiple patterns of outcome, including psychological resilience. In addition to chronic dysfunction, other patterns of disaster outcome are typically observed. Some survivors recover their psychological equilibrium within a period ranging from several months to 1 or 2 years. A sizeable proportion, often more than half of those exposed, experience only transient distress and maintain a stable trajectory of healthy functioning or resilience. Resilient outcomes have been evidenced across different methodologies, including recent studies that identified patterns of outcome using relatively sophisticated data analytic approaches, such as latent growth mixture modeling. 3. Disaster outcome depends on a combination of risk and resilience factors. As is true for most highly aversive events, individual differences in disaster outcomes are informed by a number of unique risk and resilience factors, including variables related to the context in which the disaster occurs, variables related to proximal exposure during the disaster, and variables related to distal exposure in the disaster's aftermath. Multivariate studies indicate that there is no one single dominant predictor of disaster outcomes. Rather, as with traumatic life events more generally, most predictor variables exert small to moderate effects, and it is the combination or additive total of risk and resilience factors that informs disaster outcomes. 4. Disasters put families, neighborhoods, and communities at risk. Although methodologically complex research on this facet of disasters' impact is limited, the available literature suggests that disasters meaningfully influence relationships within and across broad social units. Survivors often receive immediate support from their families, relatives, and friends, and for this reason many survivors subsequently claim that the experience brought them closer together. On the whole, however, the empirical evidence suggests a mixed pattern of findings. There is evidence that social relationships can improve after disasters, especially within the immediate family. However, the bulk of evidence indicates that the stress of disasters can erode both interpersonal relationships and sense of community. Regardless of how they are affected, postdisaster social relations are important predictors of coping success and resilience. 5. The remote effects of a disaster in unexposed populations are generally limited and transient. Increased incidence of extreme distress and pathology are often reported in remote regions hundreds if not thousands of miles from a disaster's geographic locale. Careful review of these studies indicates, however, that people in regions remote to a disaster may experience transient distress, but increased incidence of psychopathology is likely only among populations with preexisting vulnerabilities (e.g., prior trauma or psychiatric illness) or actual remote exposure (e.g., loss of a loved one in the disaster). Finally, we review the implications for intervention. There is considerable interest in prophylactic psychological interventions, such as critical incident stress debriefing (CISD), that can be applied globally to all exposed survivors in the immediate aftermath of disaster. Multiple studies have shown, however, that CISD is not only ineffective but in some cases can actually be psychologically harmful. Other less invasive and more practical forms of immediate intervention have been developed for use with both children and adults. Although promising, controlled evaluations of these less invasive interventions are not yet available. The available research suggests that psychological interventions are more likely to be effective during the short- and long-term recovery periods (1 month to several years postdisaster), especially when used in combination with some form of screening for at-risk individuals. Such interventions should also target the maintenance and enhancement of tangible, informational, and social-emotional support resources throughout the affected community. Language: en

https://journals.sagepub.com/doi/pdf/10.1177/1529100610387086

Weighing the Costs of Disaster: Consequences, Risks, and Resilience in Individuals, Families, and Communities

The contributions to this collection use the tools of agrarian political economy to explore the rapid growth and complex dynamics of large-scale land deals in recent years, with a special focus on the implications of big land deals for property and labour regimes, labour processes and structures of accumulation. The first part of this introductory essay examines the implications of this agrarian political economy perspective. First we explore the continuities and contrasts between historical and contemporary land grabs, before examining the core underlying debate around large- versus small-scale farming futures. Next, we unpack the diverse contexts and causes of land grabbing today, highlighting six overlapping mechanisms. The following section turns to assessing the crisis narratives that frame the justifications for land deals, and the flaws in the argument around there being excess, empty or idle land available. Next the paper turns to an examination of the impacts of land deals, and the processes of inclusion and exclusion at play, before looking at patterns of resistance and constructions of alternatives. The final section introduces the papers in the collection.

/pdf/the-new-enclosures-critical-perspectives-on-corporate-land-28qpx1bciu.pdf

The new enclosures: critical perspectives on corporate land deals

This paper presents a new set of integrated poverty and inequality estimates for India and Indian states for 1987-88, 1993-94 and 1999-2000. The poverty estimates are broadly consistent with independent evidence on per-capita expenditure, state domestic product and real agricultural wages. They show that poverty decline in the 1990s proceeded more or less in line with earlier trends. Regional disparities increased in the 1990s, with the southern and western regions doing much better than the northern and eastern regions. Economic inequality also increased within states, especially within urban areas, and between urban and rural areas. We briefly examine other development indicators, relating for instance to health and education. Most indicators have continued to improve in the nineties, but social progress has followed very diverse patterns, ranging from accelerated progress in some fields to slowdown and even regression in others. We find no support for sweeping claims that the nineties have been a period of "unprecedented improvement" or "widespread impoverishment".

Poverty and Inequality in India: A Re-Examination

Health workforce needs-based shortages and skill mix imbalances are significant health workforce challenges. Task shifting, defined as delegating tasks to existing or new cadres with either less training or narrowly tailored training, is a potential strategy to address these challenges. This study uses an economics perspective to review the skill mix literature to determine its strength of the evidence, identify gaps in the evidence, and to propose a research agenda. Studies primarily from low-income countries published between 2006 and September 2010 were found using Google Scholar and PubMed. Keywords included terms such as skill mix, task shifting, assistant medical officer, assistant clinical officer, assistant nurse, assistant pharmacist, and community health worker. Thirty-one studies were selected to analyze, based on the strength of evidence. First, the studies provide substantial evidence that task shifting is an important policy option to help alleviate workforce shortages and skill mix imbalances. For example, in Mozambique, surgically trained assistant medical officers, who were the key providers in district hospitals, produced similar patient outcomes at a significantly lower cost as compared to physician obstetricians and gynaecologists. Second, although task shifting is promising, it can present its own challenges. For example, a study analyzing task shifting in HIV/AIDS in sub-Saharan Africa noted quality and safety concerns, professional and institutional resistance, and the need to sustain motivation and performance. Third, most task shifting studies compare the results of the new cadre with the traditional cadre. Studies also need to compare the new cadre's results to the results from the care that would have been provided--if any care at all--had task shifting not occurred. Task shifting is a promising policy option to increase the productive efficiency of the delivery of health care services, increasing the number of services provided at a given quality and cost. Future studies should examine the development of new professional cadres that evolve with technology and country-specific labour markets. To strengthen the evidence, skill mix changes need to be evaluated with a rigorous research design to estimate the effect on patient health outcomes, quality of care, and costs.

/pdf/health-workforce-skill-mix-and-task-shifting-in-low-income-45abxfnq84.pdf

Health workforce skill mix and task shifting in low income countries: a review of recent evidence

Part I. The State and the Poor: 1. Seeing the state 2. Technologies of rule and the war on poverty Part II. The Everyday State and Society: 3. Meeting the state 4. Participation 5. Governance 6. Political society Part III. The Poor and the State: 7. Protesting the state 8. Postcolonialism, development studies and spaces of empowerment 9. Postscript: development ethics and the ethics of critique.

Seeing the State: Governance and Governmentality in India

This paper outlines the potential offered by technological progress in the information and communication technologies (ICTs) industries for the health sector in developing countries, presents some examples of positive experiences in India, and considers the difficulties in achieving this potential. The development of ICTs can bring about improvements in health in developing countries in at least three ways: as an instrument for continuing education they enable health workers to be informed of and trained in advances in knowledge; they can improve the delivery of health and disaster management services to poor and remote locations; and they can increase the transparency and efficiency of governance, which should, in turn, improve the availability and delivery of publicly provided health services. These potential benefits of ICTs do not necessarily require all the final beneficiaries to be reached directly, thus the cost of a given quantum of effect is reduced. Some current experiments in India, such as the use of Personal Digital Assistants by rural health workers in Rajasthan, the disaster management project in Maharashtra and the computerized village offices in Andhra Pradesh and Pondicherry, suggest creative ways of using ICTs to improve the health conditions of local people. However, the basic difficulties encountered in using ICTs for such purposes are: an inadequate physical infrastructure; insufficient access by the majority of the population to the hardware; and a lack of the requisite skills for using them. We highlight the substantial cost involved in providing wider access, and the problem of resource allocation in poor countries where basic infrastructure for health and education is still lacking. Educating health professionals in the possible uses of ICTs, and providing them with access and "connectivity", would in turn spread the benefits to a much wider set of final beneficiaries and might help reduce the digital divide.

/pdf/information-and-communication-technologies-and-health-in-low-5cibmh1fyg.pdf

Information and communication technologies and health in low income countries: the potential and the constraints

The explicit adoption of a neoliberal reform programme in mid 1991 by the Indian Government was the start of a period of economic Liberalization. This book surveys the actual experience of the last decade to argue that this strategy has had damaging consequences from the point of view of employment poverty alleviation and equity.

The Market that failed : a decade of neoliberal economic reforms in India

Declining fertility rates have changed the age structure of India’s population, resulting in a “bulge” in the working age-group. This “demographic dividend” has improved the dependency ratio leading to the hypothesis that the bulge in working population will lead to an acceleration in growth. However, recent employment figures indicate that the absorption of the Indian youth into the labour force is not as high as one would expect. This is perhaps due to the poor employability of the workforce, which is severely affected by a deficit in educational attainment and health. This needs to be remedied in order to take advantage of the opportunity for growth that the demographic dividend is supposed to give India.

The 'Demographic Dividend' and Young India's Economic Future

The view that the Indian economy would be less adversely affected by the global economic crisis because of limited integration and other inherent strengths has proved to be wrong. The economic boom in India that preceded the current downturn was dependent upon greater global integration in three ways: greater reliance on exports particularly of services; increased dependence on capital inflows, especially of the short-term variety; and the role these played in underpinning a domestic credit-fuelled consumption and investment boom. These in turn made the growth process more vulnerable to internally and externally generated crises, as is now becoming clear.

/pdf/the-costs-of-coupling-the-global-crisis-and-the-indian-4wrxdeptbb.pdf

The costs of ‘coupling’: the global crisis and the Indian economy

This Debate contribution describes the promotion of digital rather than cash payments as a form of the financialization of finance, in its role as a payments system, with reference to recent Indian experience. The arguments in favour of reducing cash usage must be seen relative to the costs of digital payments, for both society and individuals. The drastic demonetization episode in India, which removed 86 per cent of the value of notes in circulation at one stroke in November 2016, was partly justified in terms of forcing a shift to cashless transactions. However, such a shift requires that adequate infrastructure be in place in terms of banking and connectivity, both of which are currently lacking in India. The article also identifies other concerns with digital transactions including higher costs and the possibilities of loss of privacy, fraud, identity theft and surveillance. The obsession with digital transactions as a marker of social and material progress is misplaced; it may become yet another means by which finance extracts rentier incomes out of relatively poor populations.

C. P. Chandrasekhar

Papers

Information and communication technologies and health in low income countries: the potential and the constraints

The Market that failed : a decade of neoliberal economic reforms in India

The 'Demographic Dividend' and Young India's Economic Future

The costs of ‘coupling’: the global crisis and the Indian economy

The Financialization of Finance? Demonetization and the Dubious Push to Cashlessness in India