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Exploring the Need for Social Emotional Learning Programs: A New Model for Mental Health and Wellness

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by Karen M. Sarafian

 

Abstract

In their early years, children often experience a number of adverse childhood experiences (ACEs) including verbal, physical, and sexual abuse; violence; neglect; poverty; and parental divorce, incarceration, and addiction (Bjrkenstam et al., 2017; Dube et al., 2001; Fuller-Thomson et al., 2014; Sarafian, 2018a).  These ACEs place children at greater risk of developing academic and behavioral problems, as well as a number of mental health challenges in adolescence and adulthood (Chapman et al., 2007; Sarafian, 2018a).  Committed to providing mental health education and services to those impacted by ACEs, a number of organizations are addressing ACE-related challenges within the context of after-school expanded learning programs designed to teach social emotional learning skills (4-H, 2018; Boys and Girls Clubs of America, n.d.; Yale Center for Emotional Intelligence, 2018).  This paper provides a review of the literature regarding ACEs, their impact, and risks to adolescent and adult psychological health; as well as a brief description of several learning programs designed to combat these ACE-related risks by providing care, support, and instruction in social emotional competencies.  Specifically highlighted is the work of The Sarafian Foundation, a newly established 501(c)3 social enterprise dedicated to reducing ACE-related risks through explicit instruction in and development of the five social emotional competencies: self-awareness, social awareness, self-management, relationship skills, and responsible decision-making (CASEL, 2018). The foundation’s leadership, programs, partnerships, supports and challenges; and efforts to build capacity, scale, and sustainability are examined in relation to its mission of providing accessible and low or no-cost mental health and wellness instruction and resources to children and families (The Sarafian Foundation, 2018).

 

Review of Literature

Across the country administrators, teachers, and staff work tirelessly to teach elementary children the basics of reading, writing, and math.  However, their efforts are often countered by minimal engagement and inattention, anger and impulsive behavior, and low test scores.  Are the students of today unteachable?  Or must education take a new direction, offering more than the core academic curriculum?  With a focus on the whole child; including the attitudes, feelings, and life experiences that make up each individual; educators and community partnering agencies can combat the adverse childhood experiences these students face, and provide them with the social emotional skills necessary for mental health and wellness now and in the future.

Adverse Childhood Experiences

Adverse Childhood Experiences (ACEs) are a set of “non-specific” and “modifiable risk factors” responsible for “an array of mental health outcomes” (Chapman, Dube & Anda, 2007, p. 360).  According to the Center for Behavioral Health Statistics and Quality (CBHSQ) Report, approximately “1 in 8 children (8.7 million) aged 17 or younger” (Lipari & Van Horn, 2017, p. 5) reside with at least one recurrent substance-abusing parent.  Furthermore, these same children may be negatively impacted by parental divorce, violence, incarceration, verbal, physical, and sexual abuse, physical and emotional neglect, and residential instability (Bjrkenstam, et al., 2017; Dube et al., 2001; Fuller-Thomson, et al., 2014; Gonzalez et al., 2016; Overstreet & Matthews, 2011).  In addition, they are likely to grow up witnessing “criminality of household members, parental discord,” and mental illness (Dube et al., 2001, p. 1628).  Researchers suggest that these children are exposed to a greater number of ACEs, and are at greater risk of psychological and behavioral disorders in adolescence and adulthood (Anda et al., 2002; Dube et al., 2001; Chapman et al., 2007).

Psychological and behavioral disorders. 

ACEs can lead to a higher risk of behavioral and psychological disorders; and mental health problems such as depression, anxiety, and substance abuse in adolescence and adulthood (Chapman et al, 2004; Choi et al., 2017; Overstreet & Matthews, 2011).  Children of alcoholics are often sad, anxious, and depressed; and tend to experience low self-esteem, and “insecure-avoidant” attachment as they exhibit difficulty establishing and maintaining relationships (Peleg-Oren et al., 2008, p. 17).  These children are also apt to exhibit academic problems as well as behaviors that are disruptive, aggressive, impulsive, and oppositional (Burlew et al., 2013; Gonzalez et al., 2016; Overstreet et al., 2011; Schroeder et al., 2006).

These behavioral disorders affect high school completion rates, adolescent and young adult substance abuse, incarceration rates, unemployment, and poverty.  Research suggests that depressed teens are twice as likely to drop out of high school than peers who experience mental wellness or who have recovered from depression (Weinstock, 2018).  ACEs are also linked to early onset of drinking (Anda, 2018).  Furthermore, ACEs in childhood “raised the chances of juvenile arrest by 59%” (Bartos, 2016, para. 3).  Finally, researchers have noted that a cumulative effect of ACEs increases the likelihood of adult poverty.  Poverty, in turn, puts children at increased risk of continued poverty, fewer life opportunities, and “an intergenerational effect of these ACEs” (Metzler, et al., 2017, p. 146).

Depressive disorders.  Children who experience ACEs are also at greater risk of developing depressive disorders and attempting suicide later in life.  Researchers, examining the relationship between ACEs and recent onset as well as chronic depressive disorders, have found that ACEs increase vulnerability to depressive disorders “up to decades after their occurrence” (Chapman et al., 2004, p. 217).  Researchers have also noted that suicide attempts tend to be associated with ACE exposure, and the number of ACEs “had a strong, graded relationship to attempted suicide during childhood/adolescence and adulthood” (Choi et al., 2017, p. 253).

Social Emotional Learning

In response to the growing need to address these psychological and behavioral issues, there is greater societal and educational interest in making social emotional learning a priority for elementary, middle, and high school students within classrooms, schools, homes and communities.  According to the Collaborative for Academic and Social Emotional Learning (CASEL), social emotional learning (SEL) is defined as development of five key competencies: self-awareness, social awareness, self-management, relationship skills, and responsible decision-making (“What is sel?,” 2018).  These can be taught in a coordinated framework designed to reduce ACE-related risks.  Within schools, coordinated efforts take the form of stand-alone SEL curriculum, integration of SEL principles across the curriculum, school-wide policies, and implementation of Positive Behavior Interventions and Supports (PBIS, 2018).

Programs.  In 2018, the California Department of Education (CDE) introduced its Guiding Principles for Social Emotional Learning (CDE, 2018).  Publication of these principles provides a pathway for school-community partnerships in provision of mental health and wellness instruction and services in after-school expanded learning programs.  Programs offer leadership and team building activities, community service learning experiences, and wellness resources to children and families. Such partnerships include Boys and Girls Clubs of America (BCGA), 4-H, RULER, and Ayo! CONNECT.

BCGA offers programs from sports and education to the arts and wellness, and character and leadership.  BGCA participants are surrounded by supportive adults who explicitly teach social emotional skills such as responsible decision-making, relationship skills, and social awareness so children follow the “path to great futures” (Boys and Girls Clubs of America, n.d., p. 1).  Specific programs such as “Youth of the Year” and “Million Members, Million Hours of Service” utilize recognition and community service as vehicles for development of relationship and leadership skills (Boys and Girls Clubs of America, n.d., p. 1).

4-H is recognized worldwide in its efforts to develop leadership in young people.  With a focus on community service as well as hands-on experiential learning; 4-H members develop social emotional competencies such as compassion, decision-making, and communication.  In turn, these abilities lead to greater confidence and resilience, as well as other life skills. The 4-H model focuses on positive youth development to ensure long-term goals of greater societal contribution and decreased risk behavior in adolescence and adulthood (Institute for Applied Research in Youth Development, 2013, p. 2).

The Yale Center for Emotional Intelligence uses the evidence-based RULER approach to integrate SEL in schools by teaching students to “recognize, understand, label, express, and regulate emotion” (Yale Center for Emotional Intelligence, 2018, p. 1).  Found to lead to success in school and beyond, these skills are taught across the curriculum and in after-school settings. The program is available to pre-kindergarten through twelfth grade students and families in participating RULER schools and districts.

Case in Point

The Sarafian Foundation, a 501(c)3 social enterprise, has recently launched its inaugural Ayo! CONNECT and Ayo! CONNECTions family workshops in partnership with a local elementary school in the Elk Grove Unified School District in Sacramento County, California.  Ayo, meaning yes in the Armenian language, provides the theme for each twelve-week session.  Participants are taught to say “yes” to mental health and wellness as they learn social emotional skills within the context of an after-school expanded learning program.  Third through fifth grade students and families are encouraged to participate in this free program and learn SEL skills related to empathy, goal-setting, appropriate and productive risk-taking, the body’s reaction to anxiety, and tools for developing mindfulness.

While the foundation’s board of directors is optimistic about initial program success, there are several challenges that must be overcome.  To begin, the necessity to build capacity and expand leadership is critical.  The founders, in establishing the mission and vision for the organization, have the passion to drive the work forward.  But, program demand requires a larger and more diverse network.  The foundation, based on the work of the Sprout Fund’s Remake Learning Playbook (2015), developed its own leadership guide for scale and sustainability.  Utilizing playbook tools; the leadership will convene, catalyze, communicate, coordinate, and champion for mental health and wellness for children and families (Sarafian, 2018b).

The foundation’s leadership is also working to address challenges specific to implementation of its Ayo! CONNECT program.  For example, due to the partner school’s multi-track year-round calendar as well as the voluntary nature of the program, attendance has been inconsistent.  This leads to the potential for curricular gaps that may negatively impact program effectiveness.  Additionally, the program has not yet been piloted with other educational partners.  Differences in demographics, school calendars, and program facilitators may yield contrasting results.  It is therefore necessary to conduct an empirical study of program effectiveness.

Armed with research findings, future plans include program expansion to other schools in Sacramento County and beyond.  In addition to after-school expanded learning programs, the foundation strives to develop other community partnership programs, such as those outlined in the California Department of Education’s Guiding Principles for Social Emotional Learning (CDE, 2018).  Programs will address the lack of available and appropriate mental health services for children by providing low or no-cost opportunities such as weekend retreats and summer camps for children and families impacted by ACEs.

Conclusion

In examination of the literature regarding adverse childhood experiences, it is clear that there is great need for mental health education, programs, and resources for the children in today’s schools and communities.  It is time for children impacted by ACEs to say “no” to substance abuse, depression, incarceration, poverty, and suicide and say “ayo!” or “yes” to mental wellness and prosperity.  The California Department of Education’s Guiding Principles for Social Emotional Learning provide an avenue to development of school-community partnerships.  SEL programs such as The Sarafian Foundation’s Ayo! CONNECT may support reduction in mental health risks, positively impact academic and behavioral performance, and decrease the likelihood of mental disease in adolescence and adulthood.  By taking initial steps to fulfill its mission of providing low or no-cost mental health and wellness programs, The Sarafian Foundation is challenging the status quo of adverse childhood experiences and defining a new normal for children and families.

References

4-H. (n.d.)  Leadership. Retrieved from https://4-h.org/parents/benefits/

Anda, R., (2018).  The role of adverse childhood experiences in substance misuse and related behavioral health problems.  Retrieved from https://www.samhsa.gov/capt/sites/default/files/resources/aces-behavioral-health-problems.pdf

Bartos, L., (2016).  Pipeline to prison may start with childhood trauma.  Retrieved from http://www.calhealthreport.org/2016/01/06/pipeline-to-prison-may-start-with-childhood-trauma/

Bjrkenstam, E., Bjrkenstam, C., Jablonska, B., & Kosidou, K. (2017).  Cumulative exposure to childhood adversity, and treated attention deficit/hyperactivity disorder: A cohort study of 543 650 adolescents and young adults in Sweden.  Psychological Medicine. doi:10.1017/S0033291717001933

Boys and Girls Clubs of America. (n.d.)  Programs. Retrieved from https://www.bgca.org/programs

California Department of Education. (2018).  California’s social and emotional learning guiding principles.  Retrieved from https://www.cde.ca.gov/eo/in/documents/selguidingprincipleswb.pdf

Chapman, D. P., Dube, S. R., & Anda, R. F. (2007).  Adverse childhood events as risk factors for negative mental health outcomes.  Psychiatric Annals, 37(5), 359-364.  Retrieved from http://0-web.b.ebscohost.com.pacificatclassic.pacific.edu/ehost/pdfviewer/pdfviewer?vid=2&sid=4ab190da-b630-49b2-834f-d59d209aea74%40sessionmgr103

Collaborative for Academic and Social Emotional Learning. (2018).  What is sel?  Retrieved from https://casel.org/what-is-sel/

Dube, S. R., Anda, R. F., Croft, J. B., Edwards, V. J., Giles, W. H., & Felitti, V. J. (2001).  Growing up with parental alcohol abuse: Exposure to childhood abuse, neglect, and household dysfunction.  Child Abuse & Neglect, 25(12), 1627-1640.  doi:10.1016/S0145-2134(01)00293-9

Fuller-Thomson, E., Mehta, R., & Valeo, A. (2014).  Establishing a link between attention deficit disorder/attention deficit hyperactivity disorder and childhood physical abuse.  Journal of Aggression, Maltreatment & Trauma, 23(2), 188-198.  doi:10.1080/10926771.2014.873510

Hurd, N, & Deutsh, N. (2017).  SEL focused after school programs, The Future of Children, 27(1).  Retrieved from https://files.eric.ed.gov/fulltext/EJ1145092.pdf

Institute for Applied Research in Youth Development, (2013).  The positive development of youth: Comprehensive findings from the 4-H study of positive youth development. Retrieved from https://4-h.org/wp-content/uploads/2016/02/4-H-Study-of-Positive-Youth-Development-Fact-Sheet.pdf

Metzler, M., Merrick, M., Klevins, J., Ports, K., & Ford, D. (2017).  Adverse childhood experiences and life opportunities.  Children and Youth Services Review, 72, 141-149. doi:10.1016/j.childyouth.2016.10.021

Positive Behavior Interventions and Supports. (2018).  PBIS.  Retrieved from https://www.pbis.org

Sarafian, K. (2018a).  Examination of an after-school social emotional learning program for elementary school students (Working Paper 092418V1).

Sarafian, K. (2018b).  The Sarafian Foundation playbook (Working Paper 120518V1).

The Sarafian Foundation. (2018).  About us.  Retrieved from https://www.thesarafianfoundation.org

The Sprout Fund. (2015).  Remake learning playbook.  Retrieved from https://playbook.remakelearning.org

Weinstock, C.P., 2017.  Depressed high school students more likely to drop out.  Retrieved from https://www.psychcongress.com/news/depressed-high-school-students-more-likely-drop-out

Yale Center for Emotional Intelligence. (2018).  RULER. Retrieved from http://ei.yale.edu/ruler/ruler-overview/

Growth Strategy for Belize

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by Ramzan Amiri

 

INTRODUCTION

Belize is a country in Central America bordering the Caribbean Sea. Key neighboring countries include Honduras, Guatemala, and Mexico. The geography of Belize is mainly flat with low mountains in the south. The government system is a parliamentary democracy and a Commonwealth realm; the chief of state is the queen of the United Kingdom, and the head of government is the prime minister. Belize has a mixed economic system which includes a private-enterprise system, combined with centralized economic planning and government regulation. Belize is a member of the Caribbean Community (CARICOM).

Economic reform in Belize has been uneven, institutional weaknesses and lingering policy have constrained dynamic growth in many parts of the economy. Recovery from the recent economic slowdown has been anemic due to limited entrepreneurial activities in the private sector.  Tariff and non-tariff barriers have been burdensome, and the high cost of domestic financing is significantly impacting the private-sector from investment and economic diversification.   The judicial system is influenced by the politicians and corruption has become a common practice (Heritage Foundation, 2018).

Belize has a young population with a median age of 22.7 years with an age structure of 0-14 years at 33.95%, 15-24 years at 20.55%, 25-54 years at 36.62%, and 55 and over at 8.88% (The World Factbook, 2017).  But the school system is not adequate to support the large young population which has resulted in low literacy rate as well as a dropout rate beyond 8th grade to 50% (Pathlight International, 2018).

Belize has opportunities to become a strong economic player in the region due to its small size, which gives them the agility, and its location of bordering with some of the larger Countries, i.e., e. Mexico, Honduras, and Guatemala. Potential is there for trade agreements, maquiladora model of manufacturing/assembly due to Belize’s low salary and a high unemployment rate of the population between the ages of 15-24. According to CIA factbook (The World Factbook, 2017), the unemployment rate of ages 15-24 in Belize is 18.9%, while Mexico has 7.7%, Guatemala has 4.8%, and Honduras at 14.2%. This could be a good opportunity to get some foreign direct investment in from those countries with proper tax incentives and also get young adults employed. Additionally, Belize government does not seem to have a viable long-term definitive plan or a strategy to move the country forward. A10-year economic transformation plan with the help of IMF, World Bank and some of the larger NGOs would create a purpose and meaning for the Government and the People.  Furthermore, with an effective marketing strategy, engaging Belizean and mobilizing them would be a tremendous benefit to the transformation process. This engaged approach will uplift the morale, inspire the population, as well as create a cohesive culture of ownership and pride (Sinek, 2009).

ENVIRONMENT SCAN (SPELIT)

The environmental scan using Social, Political, Economic, Legal, Intercultural, and Technological (SPELIT) framework (Schmieder, 2007) reveals several opportunities to transform Belize to a vibrant and competitive economic powerhouse in the Central American Region.

Following represents my first-hand observation using SPELIT framework as a method of analyzing the business environment. This was accomplished during my recent visit to Belize as part of Pepperdine University Business Policy analysis team and speaking with some of the local business people.

S= SOCIAL

  • Migration continues to transform Belize’s population.
  • About 16% of Belizeans live aboard, while immigrants constitute about 15%.
  • The emigration of a large share of Creoles and the influx of Central American immigrants, many Guatemalans, Salvadorans, and Hondurans, has changed Belize’s Ethnic composition.
  • Mestizos have become the largest ethnic group, and Belize now has more native Spanish speakers than English or Creole speakers, despite English being the official language.
  • All cultures appear to live in harmony

P= POLITICAL

  • Complaints of lengthy bureaucratic delays and corruption serve as disincentives to foreign investments.
  • Belize lacks political risk insurance, and as a practice rarely engages in title insurance on real estate property transactions.

E= ECONOMIC

  • Belize’s economic freedom score ranks 23rd among the 32 countries in the Americas region, and its overall score is below the regional and world averages
  • Economic reform in Belize has been uneven, and more dynamic growth is constrained by lingering policy and institutional weaknesses in many parts of the economy.
  • Burdensome tariff and nontariff barriers and the high cost of domestic financing hinder private-sector development and economic diversification.
  • Tourism is the number one foreign exchange earner in this small economy, followed by export of sugar, bananas, citrus, marine products, and crude oil.

L= LEGAL

  • Governance is weak with high levels of corruption.
  • Unreliable land title certificates have led to numerous property disputes involving foreign investors and landowners.

I= INTERCULTURAL

  • Most Belizeans are of multiracial descent. About 52.9% are Mestizo, 25.9% Creole, 11.3% Maya, 6.1. % Garifuna, 3.9% East Indian, 3.6% Mennonites, 1.2% White, 1% Asian, 1.2% Other and 0.3% Unknown.
  • In the case of Europeans, most are descendants of Spanish and British colonial settlers, whether pure-blooded or mixed with each other.
  • Most Spanish left the nation just after it was taken by the British colonists who, in the same way, left after independence. Beginning in 1958
  • German and Russian Mennonites settled in Belize, mostly in isolated areas.

T= TECHNOLOGY

  • Wi-Fi is a challenge in most parts of Belize. The speed is very slow, and connectivity is unreliable.
  • The government decided in 2016 to install fiber optics connection throughout the country. This is a three-year project and appears to be going well. The installation has taken place in a couple of the larger cities including the Capital, Belmopan.

 

PROBLEM STATEMENT

The key challenge the Belize Government appears to face is stagnant GDP growth which is impacting government from making any infrastructure investment, consequentially, impacting Foreign Direct Invest (FDI).

Some of the key infrastructures that are lacking include educated workforce, supply chain infrastructure, and facilities to support manufacturing or technology industries. The most critical challenge appears to be there is no plan in place by the Government to educate the workforce. 50% of the Belizean children do not attend high school, 40% of the Belizean live in poverty and cannot afford to send their children to school or purchase books, and worst of all 23% of the Belizeans over the age of 15 cannot read or write (Pathlight International, 2018).  One of the schools the Pepperdine Team visited had a library but was locked, and no one knew where the key was. We were told the library had not been used for years. One high school Principal we spoke to about computer class mentioned that they have a few desktop computers, but half of the computers are not working and the few that are working are being used to teach students typing. It appears there is no clear understanding of how these assets they already have should be effectively utilized.

The issue of lack of education is further exasperated with the government policy which supports free education only up to grade 8, with 9th through 12th-grade students having to go through a government approval process for funding. The approval process lacks credibility, and generally poor children are left out.  Furthermore, K-12 schools do not have adequate qualified teachers which unfortunately impacts the entire learning and mentorship culture.

In summary, Belize is not an attractive place for any sort of commercial investments. The country lacks basic infrastructure, and the government policies add another layer of complication for local and foreign businesses.

OBJECTIVES AND ACTION STEPS

Below are four key measurable objectives with specific actions items to consider getting Belize into the global business arena. Timeline and cost will be determined once a strategic team is formed and priorities are defined. The plan would be put in place with the help of IMF and World Bank:

  • Effective Capitalization of Human Resources (measurement: enrollments in secondary school and completion, salary growth, number of skilled jobs filled vs. open)
    • Engage NGOs with specific objectives that align with Belize’s long-term transformation plan
    • Teacher training to be accelerated
    • Update education system and policies
    • Introduce trade schools with courses that align with the industry cluster plan
    • Upgrade immigration policy to attract skilled workers
  • Improve living standards of Belizean (measurement: Income per capita growth) (home ownership by Belizean)
    • Job creation in information technology and manufacturing sectors – high paying jobs generates increase tax as well as internal demand for consumer goods. This will allow Belize to move towards consumer economy leading to additional investments in manufacturing and service sectors.
  • Increase foreign direct investments (FDI) (measurement: $ investment by foreign businesses) (Real Estate development and demand)
    • Work with IMF and World Bank to develop infrastructure in the areas of broadband development to connect with the rest of the world
    • Improve trade policies to attract investment
    • Provide incentives for investment in Commercial Real Estate
  • Develop Industrial Clusters (measurement: number of businesses and employment in the targeted clusters)
    • Define two areas of Industrial clusters where Belize can be known as having skills and capability as most competitive in the region, i.e., technology, high skilled manufacturing capability

RECOMMENDED POLICY CHANGE

A nation’s competitiveness depends on the capacity of its industry to innovate and upgrade (Porter M. E., 2008). The current protectionist trade policy of tariff on products needs to be abolished to increase global competitiveness. Companies generally achieve competitive advantage through the acts of innovation. Protectionist policies hinder innovation and stagnates growth due to limited demand.

ALTERNATIVES

There are no alternatives other than rapid acceleration with the help of government intervention in increasing the money supply. Belize is running at a deficit for quite some time, and at some point, the government will start to miss debt payments which will further deteriorate the ranking of the country.

PARTNERING

  1. Taiwan seems to have a big presence in Belize and participates in student exchange program as well as given grants/loans to Belize government for economic development. In August of 2017, Taiwan gave a grant of US$20 million to Belize and additionally a loan of US$40 million(Ramos, 2017). It appears this relationship can be further solidified if some sort of incentivized long-term economic development agreement can be achieved.
  2. Pathlight International is a California based 501 c3 organization, and their focus has been teacher development as well as helping students with scholarships, transportation, nutritious meals, afterschool academic tutoring, etc. They established their organization in Belize in 2007, since then they have trained over 600 teachers and 50 principals. They also have ongoing training programs for teachers to further enhance the learning environment for students(Pathlight International, 2018). They are currently successfully working in Belize City and Belmopan which can be further expanded to some of the urban areas.
  3. A partnership that appears to be missing is a hands-on third-party economic advisory committee to help Belize government put together a solid path for growth. Belize has a significant number of assets that can be effectively utilized to transform the country into a major economic player in the central/Latin American regions. There are several economic models that can be looked at, i.e., The Bahamas, which has a similar size population and a relatively young country but has a GDP three times the size of Belize. Another, yet extreme example is Singapore, which has a significantly larger population but went through a lot of struggle since their independence in 1965, has a GDP US$ 504.9 Billion, 15 times larger than Belize and income per capita of UD$90,500 as compare to Belize with a GDP of US$ 3.23 billion and income per capita of $8,300. So, the opportunities are there for Belize to focus and make purpose driven strategic plan to become successful.

LESSON LEARNED

  • Strong leadership with a purpose and meaning is critical to engage people and drive growth.
  • People are the biggest asset in a country or an organization. Putting them first is a critical success factor for successful growth.
  • Education and continuous training are essential for a country or an organization to innovate and grow.
  • Protectionist measures are detrimental to competitiveness and drive to excel.
  • The government has a responsibility to adjust fiscal and monetary policies as the global competitive landscape changes. Productive society leads to GDP growth.

REFERENCES

Bohlander, G. a. (2010). Managing Human Resources. Mason: South-Western Cengage Learning.

Heritage Foundation. (2018). Retrieved from The Heritage Foundation: https://www.heritage.org/index/country/belize#

Mell, A. a. (2014). The Rough Guide to Economics. London: Rough Guides Ltd.

Pathlight International. (2018). Retrieved from Pathlight International: https://pathlight.org

Porter, M. E. (2008). On Competition. Boston: Harvard Business School Publishing Corporation.

Ramos, A. (2017, August 09). Taiwan Gives Guatemala over $600 Million in Funding. Amandala, p. 1.

Schmieder, J. a. (2007). The SPELIT Power Matrix. June Schmieder-Ramirez and Leo A. Mallette.

Sinek, S. (2009). Start with Why. New York: Penguin Group.

The World Factbook. (2017, July 01). Retrieved from The World Factbook: http:// www.cia.gov/library/publications/the-world-factbook

 

 

 

 

Belizean Tongues: The Socioeconomics of Language and Education in Belize

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by Rachel Staples Guettler

 

 “In the beginning was the Word, and the Word was with God, and the Word was God.”

John 1:1

 

Introduction

In June 2018 I traveled to Belize as an American-born, English-speaking, doctoral student with the Pepperdine University Graduate School of Education and Psychology to research aspects of a developing country in regards to education, economics, and global leadership.  I recognized an initial feeling of comfort in my travel preparation from the fact that English is the official language of Belize.  Before the trip, I began to research economics and access to educational tools in Belize.  As my research deepened, I began to reflect upon the possible discomfort many Belizean natives from non-English speaking cultures may experience because of English being the official language of the country.

Once in Belize, speaking directly with local Belizeans, I found that every Belizean I met, who told me they were indeed born in Belize, also said that English was not their native language or not their mother tongue.  Additionally, an ex-patriot who has been living in Belize for several years after moving from the US told me he chose to move to Belize because it is the only Central American country on the Caribbean Ocean with English as the official language (Personal Communication, June 13, 2018).  Having studied vocal pedagogy for many years, I know that the voice is an instrument of culture, communication, identity, and connection to others (Love & Ansaldo, 2010).  Thus, I began to wonder about the influence of globalization and language policy on Belizean educational structures and on access to educational tools in Belize with the added challenges stemming from a global rise in minority language endangerment (Olster, 1999).

Language is a powerful tool in society, it has the power to shape a person’s identity, and it has the power to shift the economy (Manning, 2006; Nichols, 2006; Olster, 1999).  Manning (2006) argues, “The subject of linguistics, the idealized speaker-hearer, a native speaker with a perfect knowledge of a language, resembles the subject of economics, the rational actor with an encyclopedic knowledge of commodities” (p. 271).  Economists, Levitt & Dubner (2005), emphasize the importance of using an inquisitive economic lens, specifically focusing on what people value, how incentives drive people’s choices, and how value-incentives influence economic trends.  Belize is a country rich in language diversity with many minority languages spoken there, which are not only an integral part of communication but also represent cultural spirituality, ritual, dance, historical value, community, and so much more (Patten, 2001; Thompson, 2004).  When a person is born and reared from birth to speak the same language spoken in the person’s home, that language is the person’s native language or “mother tongue” no matter what the official language is in the country where the person’s resides (Love & Ansaldo, 2010, p. 589).

Minority languages are under threat from the widespread global influence of standardization through majority languages, and minority languages need political and cultural support to stand the test of time in an increasingly globalized world (Moore, 2006; Olster, 1999; Yamamoto, Brenzinger, & Villalón, 2008).  Olster (1999) laments, “linguists predict that at least half of the world’s 6,000 or so languages will be dead or dying by the year 2050” (p. 16).  There are many activist groups and organizations with a mission to help and save endangered languages urging more use for minority languages in public spaces and domains (Yamamoto, Brenzinger, & Villalón, 2008).  The National Science Foundation in conjunction with the National Endowment for the Humanities created by the US Congress in 1950 has a “Documenting Endangered Languages” project, which has already funded a project specifically working with Mayan women from the Guatemalan Highland region to provide access and encouragement of the endangered Mayan “Ixil” language (Moore, 2006, p. 303).

Many scholars argue that pressure for groups of people to become bilingual or multilingual can be complex, challenging, and in some cases detrimental to cultural groups, personal identities, and can ultimately influence a cultural group’s ability to thrive (Love & Ansaldo, 2010; Ravindranath, 2009; Rubinstein, 1979).  Globalization and economics can influence languages and cultures, causing shifts in language use, and oftentimes creating environments where many minority languages are at risk of becoming endangered (Olster, 1999).  When an area has many different people who speak many different languages, the heritage, the culture, and the identity of the diverse groups of people in that region can experience negative impacts by the government and official language policy changes (Patten, 2001).  This paper utilizes the “SPELIT Power Matrix methodology” (Schmieder-Ramirez & Malette, 2007, p. 3) to analyze the social, political, economic, legal, intercultural, and technological aspects of language, education, and socioeconomics in Belize.

SPELIT Analysis: Social and Intercultural

Schmieder-Ramirez & Malette (2007) encourage researchers to explore “social cultural norms” (p. 6), as well as “how people interact with one another and how the structures they create impact how they interact with one another” (p. 33).  Schmieder-Ramirez & Malette also encourage culturally diverse groups to move away from the unhealthy denial, defensiveness, and minimization of “ethnocentrism” into healthier intercultural “ethnorelativism” (p. 97) through patterns of accepting, adapting, and integrating with other’s cultural differences.  Thus, my research on the socioeconomics of education and language in Belize explores how the government’s choice to structure a majority language like English as the official language policy of the country does impact how groups of people in Belize interact with each other through education, the economy, and conflicting social norms.

Tourists from all over the world travel to Belize to experience the ancient Mayan ruins, the diverse plant and animal species, the Caribbean coastal landscapes and jungles, and to research the indigenous and immigrant cultures, food, history, and heritage found in Belize (Thompson, 2004; Medina, 1998; Medina, 2003).  Belize has a history of diversity from the indigenous Mayan people, to the 16th, 17th, and 18th century Spanish, British, and French colonies (Medina, 1998).  The diverse history of Belize also stems from the influence of the neighboring countries of Guatemala, Mexico, and the maritime border country Honduras (Thompson, 2004).  Furthermore, the Belizean population’s diversity is influenced the by the cultures of the Mayan, Garifuna, Mestizo, African Creole, German and Canadian Mennonites, as well as the influence of globalization, industry development, and tourism bringing people, cultures, and languages from all over the world (Cox, Driedger, & Tucker, 2013; Medina, 2003; Thompson, 2004).

Immigration, tourism, and globalization has influenced Belize and continues to impact education and the many minority groups in Belize, some of which claim to be Belizean natives such as the Maya, Garifuna, Mestizo, and Creole (Rubinstein, 1979; Medina, 1998; Medina, 2003).  The Mayan people have a particular spiritual intimacy with their native language, and Mayan rituals must be performed in the Mayan tongue by someone who “speaks and understands” the language (Medina, 1998, p. 361).  For example, the Maya recognize a “cosmological core that has persisted across centuries, [which] continues to link the living with their ancestors and divine forces, and that is transmitted and activated through the use of Mayan languages” (Medina, 1998, p. 361).  However, some scholars argue, “Mayan ethnicity, language, and traditional economic strategies are rendered disadvantageous for school achievement by historical, social, cultural, and economic forces” (Crooks, 1997).

As tourism and globalization have permeated Belize, many people, cultures, and languages face the threats of widespread use of majority languages such as English (Medina, 1998; Nichols, 2006; Ravindranath, 2009).  The Garifuna people also believe their native language is an essential part of their heritage encompassing their music, dance, religious practices, what they eat, and food preparation which is celebrated annually during the national holiday in Belize, “Garifuna Settlement Day” (Ravindranath, 2009, p. 14).  However, even with a day dedicated to the Garifuna people in Belize, there are still some cultural groups in Belize that go so far as “to choose to remain insulated in their culture and language” (Spang, 2014, p. 61).  Moreover, Belizean social norms vary between groups, and each group can experience the influence of majority languages, such as English and Spanish, in different ways (Nichols, 2006).

SPELIT Analysis: Political

Schmieder-Ramirez & Malette (2007) encourage researchers to frame the analysis of political influence in groups by regarding “competing interests, views, assumptions, and values” (p. 55).  My research explores these competing interests, views, assumptions, and values of the diverse Belizean people, the influence of colonization, and the influence of a tourism economy in a developing country in Central America.  The people of Belize are diverse, the languages spoken in Belize are diverse, and the structure of power and values follow suit in their diversity.

Various languages are a part of the diverse cultural groups of Belize:  the Mayan languages of the Mayan-Yucatec, Mayan-Mopan, and Mayan-Kekchi speakers; Spanish speakers; Kriol or Creole speakers; Garifuna speakers; the Mennonite language of the low-German dialect of Plautdietsch; English; and many more languages from various ethnic groups, dialects, and socioeconomic statuses (Medina, 1998; Rubinstein, 1979; Thompson, 2004).  However, even with all the diversity of people, culture, and language spoken in Belize, the Belizean Ministry of Education declared English to be the official language of the country (Rubinstein, 1979; Ravindranath, 2009).

The language policy is in alignment with the 1862 British colonization of the country, but in a 2010 census, more than 37% of Belizeans reported not being able to speak English well conversationally, much less academically (Nixon, 2015).  Patten argues, “Language policy is an issue of considerable ethical, political, and legal importance in jurisdictions around the world” (2001, p.691).  Furthermore, minority languages are impacted and have a higher risk of becoming endangered or even extinct when language policy establishes the official language of a country as a majority language, such as English (Olster, 1999; Patten, 2001).

There is linguistic controversy over countries that declare a majority language like English to become the official language, especially in a country like Belize possessing a wide variety of cultural groups, languages spoken, and heritages preserved (Patten, 2001; Ravindranath, 2009; Nichols, 2006).  Crooks (1997) emphasizes, “The vitality of a language is challenged when individual speakers abandon it and shift to a new tongue” (p. 61).  The controversy of language policy is especially important when exploring the language taught in public school classrooms, not only from a mere educational standpoint but also from a social perspective (Patten, 2001).  Scholars concede that in Belize, “English is the primary language of instruction; students are expected to be proficient by the end of primary school.  Primary teachers are encouraged to recognize that students come to the classroom with a variety of languages and are urged to build on these experiences to improve instruction” (Nixon, 2015).

Official language policy that influences languages taught in schools has a significant impact on a student’s cognitive development, and impacts how a student may begin to judge his or her ancestors, community, and other students based upon skill or lack of skill in the language taught versus skill in the native tongue (Crooks, 1997; Nichols, 2006’ Rubinstein, 1979).  Rubinstein (1979) explores these complex sociolinguistic aspects of English instruction for Spanish-speaking Mestizo children and Belizean Creole-speaking children in his research of seven schools in Corozal Town, Belize:

“First, the child is likely to be classed as slow or lazy in school if he/she fails to keep apace of his/her classmates in the acquisition of English language skills. This classification carries with it a whole range of implications: the child’s belief in the importance of his/her efforts vis-a-vis the school environment and his/her self- evaluation may ultimately result in school failure or school leaving. Second, for those students who do stay in school through standard 6 (eighth grade), the real control they are able to exercise over English is often minimal and quickly lost” (p. 585).

Additionally, minority languages suffer from the risk of becoming endangered or extinct if they are not passed down from generation to generation, spoken by children, or shared in written word, which is similar to the ways that plant and animal species can suffer from becoming endangered or extinct from the effects of globalization, tourism, and industry development (Olster, 1999).  Furthermore, since the British colony was established in Belize, there has been a duality of church and governmental control on the educational system, which causes even greater controversy because the diverse people in Belize also have an even greater diversity within their religions, belief systems, and denominations (Rubinstein, 1979).

Moore (2006) urges governments to support official language policy that allows minority languages to continue to be taught to children so they can speak it with others on a regular basis as well as being able to write in the language or the language will decline.  Moore specifically emphasizes preserving language in written form is the most imperative, and that languages that are not written are the languages that eventually become “lost” or “dead” (Moore, 2006, p. 313).  Teaching children to speak, read, and write a language can even revive it, such as in the example of the 19th-century Palestinian movement to reintroduce Hebrew teaching in all Israeli schools and now Hebrew is the most common language of the citizens in that region (Olster, 1999).  However, language revitalization through schools may not be a realistic option for Belizeans. Often young Belizeans must leave school or choose to leave school years before high school graduation to enter the workforce.  Moreover, Belizean schools have little governmental support, poorly educated teachers, social structures that have negative attitudes towards education taught in English, and poverty creating challenges of lacking resources, textbooks, and supplies (Crook, 1997).

SPELIT Analysis: Economic, Legal, and Technological

Schmieder-Ramirez & Malette (2007) emphasize to researchers that economic analysis must explore the “factors that affect the production and consumption of resources needed to operate” (p. 63).  In a diverse country, operations vary between individuals, families, cultural groups, religions, and communities, of which all are governed by the legal boundaries set by the policy, which either creates or takes away access to technology or tools for learning and development.  This research explores the production and consumption of the majority language use in minority language settings in Belize, the legal nature of language in Belize, and the over-arching results of technological access in Belize due to language and education policy.

Scholars contend that language has value, is a commodity, effects trade, influences labor market trends, and is a significant factor of economics (Chiswick & Miller, 2003; Li, 2013; Manning, 2006).  Additionally, scholars argue that people who adapt and become proficient enough in the official language may use their native language less often and may have a greater chance at earning more money in that labor market (Chiswick & Miller, 2003).  Poverty, especially in remote areas of Belize, also influences education, access to educational tools, and the use of the English language in public areas, schools, and in the home (Crooks, 1997).

Scholars argue that even in towns such as Placencia, Belize, where I stayed during the doctoral delegation with Pepperdine University, there is an “uneven distribution of wealth, an influx of wealthier outsiders and tourists, a sometimes controversial real estate boom, and socio-economic frictions resulting from rapid change and growth” (Spang, 2014, p. 13).  In a personal interview I had with a local Belizean, anthropologist, organic farmer, and creator of Taste Belize Tours, Dr. Lyra Spang Ph.D., she shared with me how many Belizeans become stuck in a “cycle of poverty” because of lacking access to education, to basic educational tools, and due to minimal government funding for education (Personal communication, June 12, 2018).  She also shared with me how different cultural groups value different aspects of Belizean life from food grown to land choice.  For example, the Mayan people strategically built their homes, villages, and temples in the more remote inland areas away from the more populated coastal areas (Medina, 1998).  This Mayan, inland-living preference is also why it is challenging to track exactly when the Mayan people came to Belize since the British colonies did not always travel as deeply into the jungle areas where Mayan villages could be found, and there are many conflicts in the literature regarding who was first to populate areas of Belize (Thompson, 2004).  In other words, Mayans value remote areas and desire to settle in remote areas.  The cultural value of historically building Mayan communities in remote areas in Belize has put Mayan children at a disadvantage because schools in remote areas have less access to educational resources and tools (Crooks, 1997).

Tourism is also a significant contributor to the Belizean market, and Medina (2003) explores how the Belizean tourism economy has influenced changes in indigenous culture and cultural preservation efforts.  Historically and presently, the Mopan and Kekchi Mayans have faced injustice and marginalization as the lands where they claim they are indigenous to have become developed from agriculture to ecotourism with governmental strategy to capitalize on Mayan culture in the name of ecotourism efforts to grow the economy through the leveraging of the Mayan culture and Mayan ruins (Medina, 1998).  Furthermore, Medina (1998) explains that:

In pursuit of this strategy, Belize joined with El Salvador, Guatemala, Honduras, and several states of southern Mexico in 1992 to launch the Mundo Maya or “Maya World” project. This joint public-private sector project discursively and practically constructs regional ‘Maya’ space which reflects the expanse of’ Maya civilization’ during the Maya Classic and Post-Classic periods and incorporates contemporary Maya groups as the continuing manifestation of that ancient culture. Within the regional space of Maya World — unlike the national space of Belize — the nativeness of Mopan and Kekchi as Maya is unquestioned. Further, the Maya World project constructs them as ‘native’ for an audience — tourists — to whom Maya culture and civilization have already been represented as monolithic and singular” (p. 155).

While the people of Belize are a diverse population consisting of a variety of languages, ethnicities, and religious affiliations, the legal aspects of the language policy in Belize is such that the language spoken in schools in Belize is far from diverse and is homogeneously in English (Crooks, 1997; Nixon, 2015; Rubinstein, 1979).  In Belizean schools with students from various backgrounds, cultures, religious beliefs, and native language, school instruction has been impacted since British colonization and, “a ruling of the Ministry of Education making English the only allowable language of instruction in Belizean schools” (Rubinstein, 1979, p. 584).  Furthermore, policy influences access to technology such as trained versus untrained teachers, textbooks, and funds for education (Crooks, 1997).  Belizeans in remote areas such as the Toledo District note that there are not many trained teachers or educational tools, but tourism is thriving in the area due to the Toledo Ecotourism Association’s Village Guest House Program giving tourists access to learn about remote Mayan villages (Crooks, 1997).  The socioeconomic standard here is a paradox with tourists learning about Mayan culture while simultaneously Mayan children do not have equal access to strong educational opportunities.

Alternatives

What are the alternatives to these conflicts of interest from the economic gain of tourism and globalization to educational loss for Belizean cultures?  What are the alternatives to the education policy set by the government in Belize?  Scholars argue in support of strategizing through avenues of ecotourism in ways that bring tourists in a respectful way to learn from and celebrate a minority group while also preserving the culture and language, with careful effort to avoid exploitation (Medina, 2002; Spang, 2014).  Economies that are thriving from tourism can find ways to integrate their culture with outsiders in ways that help others learn what is unique about their society, spiritual practices, food, and language (Medina, 2003).  If each group that claims to be native in Belize could have designated, national celebration days such as Garifuna Settlement Day, this could also draw tourism specifically tailored around the celebration of a minority culture and language, thus creating pathways for preservation (Ravindranath, 2009).

Another policy alternative could come from the legal and political spectrum of Belize with petitioning that the Ministry of Education enforce equality in resources and access to the educational systems for students in the heavily populated coastal areas as well as the more remote, inland farm areas.  Too many remote villages, cultures, and people in Belize are denied access to educational development (Crooks, 1997).  Policy change must happen so that the people in these areas can have social justice and equal access.  Furthermore, language policy changes that allow schools to teach students not only in English but also support teaching in the native languages represented in the classroom by offering opportunities for cultural celebration, historical exploration, and language study in efforts to preserve the minority languages in the area.

Lastly, an educational policy that creates pathway opportunities for students to develop skills to become teachers could result in developing teachers with real training and expertise to continue to develop current and future students.  Teachers in Belize without real educational training are a major issue in the Belizean educational system (Crooks, 1997).  If students could have an option to train as a student-teacher, instead of leaving school to work, this option could create new prospects to develop Belizean people from the classroom as students to the classroom as teachers.  Furthermore, these educational pathways could be developed such that students are empowered to learn how to teach in a variety of languages to a diverse student population.

Conclusion

In conclusion, lawmakers must begin to recognize how education and language policy can influence changes in social groups, which can thus influence economic trends (Patten, 2001).  The cycle of poverty in Belize needs to end, and social justice for Belizeans in imperative.  The diverse people and languages in Belize need to be celebrated, not just by tourists, but also by the Belizean people and Belizean government on a national scale.  Such language policy changes could be vital in protecting from the threat of language endangerment or extinction to the people that help to make Belize a historically diverse country.  Adopting policies that address language endangerment could be the conduit for this imperative change by developing Belizeans through respectful ecotourism targeted at cultural awareness and preservation, as well as education and language policy changes that create access to educational tools for the development and preservation of language diversity.  Belize is a melting pot of cultures, and each deserving equality, social justice, recognition, and empowerment.  Belize must preserve and maintain the unique cultural diversity that is the foundation of its history.  Finally, the Belizean people must unite in efforts to be strategic in educational and language policy that supports the development and preservation of language diversity, attracting many culturally curious people from across the globe.

REFERENCES

Chiswick, B. R., & Miller, P. W. (January 01, 2003). The complementarity of language and other human capital: immigrant earnings in Canada. Economics of Education Review, 22, 5, 469-480.

Cox, C., Driedger, J. M., & Tucker, B. V. (August 01, 2013).  Mennonite Plautdietsch (Canadian Old Colony).  Journal of the International Phonetic Association, 43, 2.

Crooks, D. L. (September 01, 1997). Biocultural Factors in School Achievement for Mopan Children in Belize. American Anthropologist, 99, 3, 586-601.

Levitt, S. D. & Dubner, S. J. (2005) Freakonomics. New York, New York:  Harper Collins Publishers.

Li, Q. (March 01, 2013). Language and urban labor market segmentation: Theory and evidence. Journal of Urban Economics, 74, 1, 27-46.

Top of Form

Love, N., & Ansaldo, U. (November 01, 2010).  The native speaker and the mother tongue.  Language Sciences, 32, 6, 589-593.

Nichols, R. L. (March 01, 2006).  Struggling with language: Indigenous movements for linguistic security and the politics of local community.  Ethnicities, 6, 1, 27-51.

Nixon, J. (2015). Belize Colonial Language Education Policy. In F. V. Tochon (Ed.), Language Education Policy Studies (online). Madison, WI: University of Wisconsin—Madison.

Retrieved from: http://www.languageeducationpolicy.org.

Manning, P. (January 01, 2006).  Words and things, goods and services: Problems of translation between language and political economy.  Language and Communication, 26, 3, 270-284.

Bottom of Form

Medina, L. K. (September 01, 1998).  History, culture, and place- Making: ‘Native’ status and Maya identity in Belize.  Journal of Latin American Anthropology, 4, 1, 134-165.

Medina, L. K. (January 01, 2003).  Commoditizing culture: Tourism and Maya Identity. Annals   of Tourism Research, 30, 2, 353-368.

Moore, R. E. (January 01, 2006). Disappearing, Inc.: Glimpsing the sublime in the politics of access to endangered languages. Language and Communication, 26, 3, 296-315.

Patten, Alan (2001).  Political Theory and Language Policy.  Political Theory 29(5): 691–715.

Ostler, R. (August 01, 1999).  Disappearing Languages. Futurist, 33, 7.

Ravindranath, M. (December 22, 2009).  Language Shift and the Speech Community: Sociolinguistic Change in a Garifuna Community in Belize. Publicly Accessible Penn Dissertations. 33.

Rubinstein, R. (August 01, 1979).  The cognitive consequences of bilingual education in northern Belize. American Ethnologist, 6, 3, 583-601.

Schmieder-Ramirez, J. H., & Mallette, L. A. (2007). The SPELIT power matrix: Untangling the organizational environment with the SPELIT leadership tool.  Place of publication not identified: publisher not identified.

Spang, L. H. (2014).  A real Belizean: Food, identity and tourism in Belize (Order No. 3642857).

Available from ProQuest Dissertations & Theses Global. (1609197732). Retrieved from https://lib.pepperdine.edu/login?url=https://search-proquest com.lib.pepperdine.edu/docview/1609197732?accountid=13159.

Thomson, P. A. B. (2004). Belize: A concise history. Oxford: Macmillan Caribbean.

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Global Leadership Reflection of Belize: Ya Da Fu We (Belizean Independence)

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by Ed Eng

 

1. Introduction/background

Belize is home to a very functional democracy, with great emphasis on order, education, and the inclusion of all social classes in one democratic process.  The country is a good example to its regional neighbors, able to carry out peaceful, cooperative elections, with a strong emphasis on participation.  This political stability has contributed greatly to the country’s positive relationships with regional neighbors and with countries around the world.  The stable and cooperative nature of Belize and its economy make for a healthy cooperative environment.  However, in order to attract high-growth startups and investments to the country, the Belize government should consider adopting alternative approaches to bring in new investment, develop a robust pipeline of skilled workers, and grow the middle class.  This paper will begin with an environmental scan to assess strengths and opportunities in Belize, followed by a discussion of the main leadership challenge facing the government, and finally, a set of proposed recommendations for policy changes and action plan to strategically grow the economy.

2. Environment of the issue (SPELIT)

In this section, I will be using the SPELIT Power Matrix as the framework for my environmental analysis to assess the strengths and opportunities for change.  This methodology was chosen over other tools because it includes a focus on the human dimension as well as other strategic factors (Schmieder-Ramirez & Mallette, 2007).

Social

There are distinct degrees of socioeconomic inequality based on wealth, power, and status.  This unequal standing is further stratified according to skin color and ethnicity. At the top echelon, there are lighter-skinned Creoles, mestizos, and newly arrived North Americans, East Indians, and Middle Easterners.  These higher-level groups retain control of the two political parties and the retail trade sector.  At the lower levels, there are darker-skinned Creoles and Garifuna who are largely unemployed.  The Maya and Garifuna display the enduring character traits of the indigenous people.  The Maya are subdivided into the Mopan and Ketchi peoples.  Both groups have exorbitantly high levels of poverty and participate insignificantly in the political and socioeconomic realms.  The violent crimes that happen most often are murder, manslaughter, and rape.  The most widespread property crimes are robbery, burglary, and theft (“Culture of Belize – history, people, women, beliefs, food, customs, family, social, marriage,” n.d.).

Belizeans in urban areas expect the government to assist them in raising their children and support early education.  In contrast, child rearing in rural communities is aided by family and relatives.  By statue, a child has to attend primary school up to age fourteen.  However, only 40 percent of primary school students progress on to secondary schools because of poor test performance in the national school examination and for lack funds for tuition fees and textbooks.  Overall, less than 1 percent of the population qualifies for higher education.  A national university that was commenced in 1987 only offers a limited number of programs and has fewer than 500 students (“Belize School System – Flags, Maps, Economy, History, Climate, Natural Resources, Current Issues, International Agreements, Population, Social Statistics, Political System,” n.d.).

Belizeans use the healthcare systems in Guatemala and Mexico for medical services because of the insufficiency of health facilities and inadequacy of trained professions to deliver quality services.  Many locals also turned to old-fashioned remedies like plants and other and inherited rituals (“Healthcare in Belize – International Living Countries,” n.d.).

Political

The government is ratified by a parliamentary democracy and exercises the executive, legislature, and judiciary branches of authority.   However, the political parties have essentially eliminated the power of the legislature in preference for a cabinet of ministers.  The two main parties are the Peoples United Party and the United Democratic Party and both draw support across all ethnic groups and social classes.  All members of the government foster openness to the public and encourage their constituents to engage with them (“Belize POLITICAL DYNAMICS – Flags, Maps, Economy, History, Climate, Natural Resources, Current Issues, International Agreements, Population, Social Statistics, Political System,” n.d.).

The national army supplies protection against Guatemala, which in the past, has threatened to invade the country and claim its stake of Belizean territory.  The army also provides drug prohibition efforts and aids in disaster endeavors.  The police force is the first line of defense against all crime. However, the police are perceived to be only active in urban communities and the limited number of villages with police stations (“Culture of Belize – history, people, women, beliefs, food, customs, family, social, marriage,” n.d.).

Economical

The services industry is the largest sector in the country, contributing a total of $718 million in 1996, equivalent to 57 percent of the gross domestic product (GDP).  The dominant industry in the private sector remains agriculture, with fishing and logging in a distant second and third respectively.  The government promotes international trade and encourages export of food production in the country.  The main food items of sugar, citrus and bananas accounted for 86 percent of exports in 1996 and made up almost 80 percent of foreign exchange earnings (“Culture of Belize – history, people, women, beliefs, food, customs, family, social, marriage,” n.d.).

However, the prevalent heritage of colonialism in the modern economy is displayed in the large holdings of land owned by foreigners for real estate speculation.  This near-monopoly resulted in only 15 percent of the land left are available for agriculture purposes.  The government has never had a comprehensive land development and reallocation policies (“Belize GROWTH AND STRUCTURE OF THE ECONOMY – Flags, Maps, Economy, History, Climate, Natural Resources, Current Issues, International Agreements, Population, Social Statistics, Political System,” n.d.).

Legal

The judiciary system is a leftover of the British system, and appeals can still proceed as far as the Privy Council in London.  Locally, the formal functioning of the system is at risk due to a lack of judges, law administrators, and prosecutors, resulting in a logjam of cases (“Culture of Belize – history, people, women, beliefs, food, customs, family, social, marriage,” n.d.).

Intercultural

Christianity is the main religion in Belize.  Most of the people are Roman Catholics or Baptists.  There are also some Moslems and Hindus.  The authority of churches comes from State laws, which allows for the legal incorporation of churches, thus freeing them from paying taxes.  Ministers are state-sanctioned marriage officers, and the state anoints them to co-manage the majority of primary schools (Gregory, 1975).

Artists make a living by selling their works at exhibitions supported by wealthy Belizeans who display art for their private pleasure. The National Arts Council also promotes training and the display of various forms of art.  Foreign scientists from North America do almost all the scientific research in the country.  Studies in the fields of Maya archaeology and natural history are major contributors to understanding the significance of Belize within the subregion.  There is a potentially rich source of oral literature, but very few are preserved in writing. The best graphic arts are painting and sculpture that build on a rich practice of the use of wood.  International plays are performed in schools and sporadically for the public (“Culture of Belize – history, people, women, beliefs, food, customs, family, social, marriage,” n.d.).

Technological

Belize Telemedia Limited (BTL) monopolized telecommunication services at excessive rates in the eighties and nineties.  To encourage competition, the government assisted Speednet in getting its licenses to operate in Belize as an alternative provider in 2005.  In a relatively short time, Speednet became the choice of Belizean professionals with its lower rates, better service, and less bureaucratic structure.  In 2009, the Belize government nationalized BTL, which is now the main competitor of Speednet.  Both companies now offer a full range of telecommunication services including dial-up and high-speed internet access, cellular roaming, and other basic telephone services (Breaking Belize News, 2015).

3. Leadership Problem Statement

To compete in a global economy, investing in higher education and equipping citizens with training to compete for jobs in emerging sectors are essential to a nation’s prosperity.  However, the lack of reliable broadband infrastructure and limited social mobility has left Belize vulnerable, with unrealized potential.  Belize’s lack of readiness for the digital economy is further crippled by their lack of higher educational system, resulting in a lack of skilled workforce.  While the government of Belize has committed to raising the standard of living for locals and attracting foreign investments, they have not been able to draw the growth sectors that have spurred jobs and transformed economies.  The problem statement then becomes what can the Belize government do to attract the growth sectors that have spurred jobs and transformed economies in other emerging countries?  In the following sections, I will be recommending a growth strategy using Uber as an economic partner guided by relevant economic theories and conclude with an action plan for implementation.

4. Recommendations for Policy Changes

The Belize government should consider adopting the following policy changes to develop a robust pipeline of skilled workers, attract foreign investments, and grow the middle class to enhance the overall quality of life for the citizens of Belize.

Adopt a new labor law for foreign investors.

Pass a law that requires foreign investors to hire 20 percent of workers locally in an apprentice program.  This is similar to the United States’ “First Source” program, based on the principle that private companies that receive public dollars should help local residents find work.  This policy would create an ecosystem that would expand the labor force and strengthen its culture through a more productive workforce.

Attract strategic partnerships.

Belize needs a strategic partner who is willing to invest in developing countries.  Uber, with all the well-publicized toxic culture of sexual harassment that ultimately led to the ouster of its Chief Executive Officer (CEO), is also famously known for its appetite for risk-taking, even at the expense of taking a loss just to be the first to market in areas of high growth (Dickey, 2017).  This propensity to accept a risk to be the pioneer in a country fits in well with the Belizean economy and hard-working citizens of Belize.  Being the pioneer and leader in a new strategic location is considered a competitive advantage to Uber and Belize should take advantage of this risk-taking culture.

Reconceptualize the Belizean education system.

From a long-term perspective, Belize must adopt the worldview toward education that a degree from a four-year university is considered higher education.  The current educational system In Belize regards a high school education a successful gateway to the workforce.  While this might be the norm in Belize, it is not creating a work-ready workforce to compete globally, or access opportunities to advance.  The middle class already values education; the government needs to invest more in education and to build the human capital infrastructure to redefine the middle class and take advantage of new investments coming into Belize.

Private-Public Partnerships (PPP). 

To attract these high-growth sectors to Belize, the Belize government must intervene and provide the necessary incentives for these companies to invest in Belize.  This view is consistent with the Keynesian Economic Model which supports the view that government is in a better position than market forces when it comes to creating a robust economy.  Government spending would increase consumer demand in the economy, leading to added business activity and even more spending, which would, in turn, increase the overall economic activity, the natural result of which would be deflation and a reduction in unemployment (Mell & Walker, 2014).

Building large scalable sectors in Belize require a strong strategic partner who is willing to invest in developing countries.  This perspective is compatible with the Endogenous Growth Theory, which postulates that that improvements in productivity can be tied directly to faster innovation and more investments in human capital.  As such, they advocate for government and private sector institutions to nurture innovation initiatives while offering incentives for individuals and businesses to be more creative.  Under this theory, knowledge-based industries play a particularly important role — especially telecommunications, software and other high-tech industries as they are becoming ever more influential in developed and emerging economies.  A key tenet to the endogenous growth theory is that there are increasing returns to scale from capital investment especially in infrastructure and investment in education and health and telecommunications (Mell & Walker, 2014).

Uber, with all the well-publicized toxic culture of sexual harassment that ultimately led to the ouster of its Chief Executive Officer (CEO), is also famously known for its appetite for risk-taking, even at the expense of shareholder profits just to be the first to market in areas of high growth.  This propensity to accept a risk to be the pioneer in an emerging country fits in well with the hard-working citizens of Belize.  Being the pioneer and leader in a new strategic location is considered a competitive advantage to Uber and Belize should take advantage of this risk-taking culture.  This is similar to the Ricardian Model of Comparative Advantage, used to explain why countries engage in international trade even when one country’s workers are more efficient at producing every single good than workers in other countries (Mell & Walker, 2014).  In Uber’s strategic plan, being first to a market means having a comparative advantage in that country.  With its innovative culture and willingness to invest in emerging countries even in money-losing situations, Uber also has the cash and technology to uplift and transform the Belize economy by expanding this middle class.  An industry cannot grow without an active and skilled workforce.  The government must work in unison with Uber to welcome, support and promote its entry into Belize.

This private-public partnership is supported by the Linear Stages of Growth Model, which posits that an injection of capital, creating superior technology, and growing the labor force lead to economic development and industrialization (Mell & Walker, 2014).

5. Action Steps

The Belize government can first create the incentives to attract Uber by outsourcing its fleet of public buses.  Most of the middle class rely on public transportation to get around in the city.  It is the cheapest form of transportation to go from point A to point B in the quickest time.  The buses current used for public transportation are old, converted school buses.  The Belize government can allow Uber to be the exclusive operator of the buses in exchange for Uber’s investment to replace all the buses with state-of-the-art new ones and a sum of cash to be used for loans to support nascent small businesses, and train workers in specialized jobs in emerging sectors.

Step two of the implementation is a two-step phase process focus on growing a robust pipeline of skilled workers.  To tap into one of the most important growth sectors in the country-tourism, the government can allow Uber to convert all taxi-drivers to Uber contract drivers as long as that on an hourly basis; the Uber drivers will be making more than what they were earning previously as a taxi driver.  With Uber’s GPS and on-demand technology, more taxi drivers will be mobilized, saving on gas, and total earnings will be higher, resulting in higher output.  Currently, the taxi association was formed by the taxi drivers to give them a form of structure and rights; Uber can help them create their own management structure and teach them about maintenance and other skilled trades in the public transportation arena using Uber’s technology.

Finally, the working class of Belize is large, diverse and included the traditional middle class made up of civil servants, skilled manual workers, taxi drivers, and other commercial employees unified by a belief system that emphasized cultural uprightness, upward social mobility, and the importance of education.   Uber can rebrand its name in Belize to “Uber Ya Da Fu We” (We the People), to rally the Belizeans around the partnership, and show off the Belizean pride to the rest of the world.

For Uber, once the brand is accepted by Belize, they can expand their product lines such as Uber X for the wealthy, VIPs and dignitaries, and lock out any future competitors coming in and replicate the model in other emerging countries.

6. Conclusion

While the goal is to help every emerging country compete on a world stage, I want to begin by helping Belize adopt economic policies that could potentially transform their economy and improve the quality of life of its citizens.  By doing research on Belize, gathering information by talking to various Belizeans, and reflecting on my international experience, I felt in love with the Belizean culture especially the pride they have for their country.  This international policy class has enriched my life through an experiential, hands-on approach.  The cultural interaction with the Belizeans has given me meaning for what it means to serve and affect a community.

Nation building is a community project.  I hope to come back to Belize in the near future and contribute by donating my time and expertise to improve the quality of life for its people.

 

REFERENCES

Agrawal, N. (2017, May 1). Kalanick is caught on video berating a driver. Retrieved from http://www.latimes.com/la-fi-uber-updates-ceo-caught-on-video-berating-1498057858-html

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Culture of Belize – history, people, women, beliefs, food, customs, family, social, marriage. (n.d.). Retrieved from http://www.everyculture.com/A-Bo/Belize.html

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Fowler, S. (2017, February 19). Reflecting on one very, very strange year at Uber.  Retrieved from https://www.susanjfowler.com/blog/2017/2/19/

Gregory, J.R.. (1975, May 27).  The modification of an interethnic boundary in Belize. Retrieved from https://anthrosource.onlinelibrary.wiley.com/doi/pdf/10.1525/ae.1976.3.4.02a00080

Healthcare in Belize – International Living Countries. (n.d.). Retrieved from https://internationalliving.com/countries/belize/health-care-in-belize/

International Agreements, Population, Social Statistics, Political System. (n.d.). Retrieved from https://photius.com/countries/belize/society/belize_society_school_system.html

Levitt, S. D., Dubner, S. J., & Harper Audio (Firm), OneClick Digital (Firm). (2012). Freakonomics: [a rogue economist explores the hidden side of everything]. New York, NY: HarperCollins.

Levitt, S. D., & Dubner, S. J. (2010). Superfreakonomics: Global cooling, patriotic prostitutes, and why suicide bombers should buy life insurance. New York, NY: William Morrow.

Marshall, A. (2018, February 9). Uber and Waymo abruptly settled for $245 Million.

Retrieved from https://www.wired.com/story/uber-waymo-lawsuit-settlement/

Mehrotra, K. (2017, May 10). Uber Greyball investigation expands to multiple U.S. cities.

Retrieved from https://www.bloomberg.com/news/articles/2017-05-10/

Mell, A., & Walker, O. (2014).  The rough guide to economics. Rough Guides Ltd: London.

Schmieder-Ramirez, J. H., & Mallette, L. A. (2007). The SPELIT power matrix: Untangling the organizational environment with the SPELIT leadership tool. Place of publication not identified: BookSurge Publishing.

 

 

mHealth: Achieving Equitable Healthcare In Emerging Countries Using Mobile Technologies

/in /by

by Theresa Dawson

 

Abstract

Access to quality healthcare plays a critical role in the economic growth of developing countries. The growing field of mobile technology in healthcare, known as mHealth, has potential for enhancing the healthcare delivery systems of these emerging markets. The benefits and value propositions of mHealth are illustrated in global use case models. The healthcare system of Belize, a developing country, is examined utilizing a SPELIT analysis (Schmeider-Ramirez & Malette, 2007) of the social, political, economic, legal, intercultural, and technological aspects as well as the World Health Organization Health Services development framework. Economic policy changes are recommended, and the addition of an mHealth strategy to the Belize national healthcare vision is proposed.

Background

Global health challenges are significant barriers to global economic development in developing countries, particularly disease and lack of prevention, epidemics, and the spread of communicable disease, combined with a shortage of healthcare workers. The quality of citizens’ health and well-being affects the human capacity needed for a country to progress (Vital Wave, 2009). Indeed, common indicators of a country’s development, as measured by the United Nations Human Development Index (2016), include assessments of a country’s birth and death rates, life expectancy, health, and education. As part of an initiative to develop solutions to meet these challenges, since 2010 the World Health Organization (WHO) has formally asked for manufacturers, institutions, universities, and individuals to submit innovative health technology solutions for low and middle-income countries (WHO, 2016). This has resulted in a comprehensive compilation of innovative technologies and worldwide use cases for solutions using mobile communications that have potential to improve and meet healthcare needs in those countries with inadequate resources (WHO, 2015). Consequently, the use of mobile communications to deliver health-related services has resulted in the field of mobile health known as mHealth. Thus, mHealth is beginning to play a key role in transforming the global healthcare delivery system by providing technological solutions to enhance healthcare provisions in developing countries.

What is mHealth?

mHealth refers to the use of mobile technologies for facilitating the delivery of healthcare services. There are 900 global mHealth products and services, and this global mHealth market is expected to exceed 30 billion in U.S. dollars (Lauler, 2013). Key areas of mHealth employment include improved access, education and awareness, remote data collection, disease tracking, remote monitoring and treatment support, and communication and training for healthcare workers (Gorski et al., 2016; Vital Wave, 2009). The 2009 United Nations and Vodafone mHealth report (Vital Wave, 2009) described worldwide evidentiary mHealth use cases. Gorski et al. (2016) posit that such use cases are important in illustrating strategies and sustainable value propositions for mHealth implementation.

As an example, distance and access can be a barrier to care. Many citizens in rural areas must travel long distances for healthcare. Lack of transportation, travel, and wait time makes seeking health services in urban areas challenging. Using hotlines, connecting doctors to patients via phone, text, video, or utilizing screening applications for patients to self-monitor their condition can alleviate and reduce time traveling and waiting for health services. This approach provides a broader reach in serving and meeting the needs of those requiring medical care.

When short messaging service (SMS) was used in Africa for campaigns to provide HIV/aids awareness, the improved awareness helped individuals understand conditions of disease and alternatives for prevention and treatment. Subsequently, there was an increase of

40% of citizens who elected to undergo testing for HIV, seeking treatment as needed, thus reducing the spread of the disease (Vital Wave, 2009).

In Uganda, healthcare workers used personal devices to collect data for the Uganda Health Information Network (Vital Wave, 2009). Because those that live in rural areas may not visit health facilities regularly, data collection in the field is important to assess need and efficacy of healthcare services provided by the government. Additionally, tracking disease and outbreaks using mobile phones and web-based technology can help in decision making for containment and prevention of outbreaks.

Remote monitoring plays an important role in preventing complications for chronic diseases by assisting with adherence to treatment plans that might otherwise put a patient at risk for complications. Specifically, healthcare workers can call patients to monitor their medication regime, or patients can use their phone to remind themselves to take medications or to record and track their blood sugar or blood pressure. This recorded data can be provided to the local health clinic for patient monitoring. Remote monitoring can be especially effective for a disease like tuberculosis (TB), where proper medication compliance can cure the disease. In South Africa, healthcare workers used SMS monitoring for TB medication compliance resulted in a 90% medication regime compliance, over 20% to 60% without the reminder (Vital Wave, 2009).

Finally, training a healthcare workforce is critical, and mobile technology can be used to provide information and education for healthcare professionals. In Coban, Guatemala a nursing school used a combination of mobile phones, landlines, and telegraphic devices that transmit handwriting, to train nurses residing in a rainforest (Innovation and Technology for Development Centre, 2014). Mobile technology can allow workers to communicate with one another to provide additional support for diagnosis and treatment. Utilization of mobile apps and use of artificial intelligence can provide reinforcement and empower patients to take responsibility to monitor their own health.

Why mHealth in Emerging Countries?

While quality healthcare is often difficult to obtain in developing countries, cell phones and wireless devices are becoming more commonly used, according to the International Telecommunication Union (ITU). The ITU reports there are over six billion wireless subscribers with over 70% of them residing in low- and middle-income countries (WHO, 2011). The growth of this technology, particularly in low-income settings, can compensate for the lack of infrastructure that hinders access to quality healthcare. Wireless technology can connect patients to healthcare workers, help patients monitor their own conditions, and allow healthcare workers to communicate with one another. There is great potential in using this technology as a solution for providing improved global health resources and for facilitating patient centered care.

mHealth as a Solution for Improving Equitable Healthcare Access in Belize

Belize, a Central American country with a population of approximately 360,000, is located on the Caribbean coast of Central America.  Belize borders Mexico in the north and Guatemala to the west and south. The Caribbean Sea is to the east. Forest covers 60% of the country, making the terrain difficult to access. Agriculture such as bananas and sugar cane are located in the low-lying areas. Offshore, the Belize Barrier Reef is the second longest barrier reef in the world. Belize achieved full independence from British Colonial rule in 1981 (Central Intelligence Agency [CIA], 2018). Male and female distribution is equal and approximately 55% of the population lives in rural areas. The population is young with just 6% over the age of 60 (Ministry of Health, 2014).

In Belize there has been increased report of non-communicable diseases, such as diabetes mellitus type2, heart disease, cardiovascular disease, cancer, and depression. The leading causes of death are heart disease and complications related to diabetes (Ministry of Health, 2014). These preventable and treatable diseases are contributing to a reduction of overall life expectancy. Additionally, there are incidences of communicable diseases such as dengue, vector borne malaria, and HIV (Ministry of Health, 2014). These problems are associated with high costs and an increasing need for healthcare workers.

The use of mHealth as a solution for potentially improving the healthcare delivery system in the country of Belize was explored using a social, political, economic, legal, intercultural, and technological (SPELIT) approach (Schmeider-Ramirez & Malette, 2007), to examine the environment of the issue of healthcare access in Belize. Incorporated into the SPELIT analysis was the use of a strategic healthcare analysis tool, the World Health Organization (WHO) System Assessment Framework (WHO, 2018). The WHO framework is comprised of essential building blocks required for an effective healthcare delivery system. These system building blocks include leadership and governance, healthcare financing, health workforce, medical technology, service delivery, and health information systems.

Environment of the Issue (SPELIT)

Social determinants of Belize healthcare
Where an individual resides and grows up are social elements that impact one’s health and well-being. Poverty, access to clean water, quality of housing, education, and lifestyle choices all have an effect on health. According to the World Fact Book, approximately 41% of Belizeans live below the poverty line (CIA, 2018), and the Caribbean Development Bank’s (2009) poverty report emphasizes that in Belize there is a high correlation between lack of income and health and well-being. Over half of the population lives in rural areas, 99% have access to drinking water, and 90% have access to improved sanitation conditions (CIA, 2018). While education plays a role for disease prevention, health literacy is also a key to wellness. Many Belizeans have limited access to education, as high costs prohibit them from attending high school; therefore, formal education and science-backed information about health and wellness is often lacking.

While there are private medical care associations in Belize, the government implements a national insurance plan overseen by the Ministry of Health. This national insurance plan provides affordable healthcare to the citizens of Belize. National funding is concentrated on urban areas, and these areas are served by hospitals. Those living in poor and remote areas have fewer resources and might be served by a small health center with a nurse as the primary point of care, with a weekly visiting physician (Belize Ministry of Health, 2014). There is additionally the presence of non-governmental organizations that provide healthcare services to underserved areas (Pan American Health Organization, 2009).

Physicians are trained in the UK, Cuba, US, Guatemala, and Mexico. There are offshore medical schools, and the University of Belize has a nursing school. Locally trained professionals are in high demand and are often recruited to practice out of the country. As a result, the government has formed agreements with Cuba and Nigeria to supply nurses to Belize (Belize.com, 2018; Pan American Health Organization, 2009).

Political aspects of Belize healthcare

The government of Belize is a parliamentary democracy (National Assembly) under a constitutional monarchy with a system of English common law (CIA, 2018). The Ministry of Health, located in the capital city of Belmopan, is run by a Chief Executive Officer who works with a Director of Health Services to oversee the Belize healthcare system. Services are organized by region, overseen by a Regional Manager and Deputy Regional manager. The National Health Information Steering Committee leads the strategy and advises the Ministry of Health. This committee is comprised of 13 members of the Ministry of Health and various government officials (Belize Ministry of Health, 2010). This Steering Committee makes decisions about health needs of citizens, issues of public and private healthcare delivery, government healthcare policies, regulations, and service quality standards (Ministry of Health, 2014).

Economic factors affecting Belize healthcare. Major economic industries are agriculture, tourism, and fisheries. The service industry and tourism account for 55% of the country’s GDP (Ministry of Health, 2014). High unemployment, debt, and a trade imbalance contribute to the economic issues that account for the cause of poverty. The country lacks training programs for job creation; it lacks infrastructure support for education, community development, and social programs (CIA, 2018).

Approximately 5.8% of the GDP is spent on healthcare (CIA, 2018).  The total health expenditure is primarily from public sources. The Belize Health Care Sector reform program was a 30 million (U.S. dollars) project intended to provide universal health access to all citizens (Belize Ministry of Health, 2014). While this universal healthcare plan was intended to make healthcare accessible for all citizens of Belize, there is an inequitable distribution of resources, with rural regions receiving less investment.

Legal considerations for Belize healthcare.  There are legislative proposals pending for regulating medical and dental care, including nursing, midwifery, and distribution of pharmaceuticals and medical equipment. The legislation is intended to provide the Ministry of Health with the constitutional authority for regulating the health care system (Ministry of Health, 2014). While there was a national e-government policy formulated in 2008, it appears there are no national laws or regulations for electronic health systems that establish a system of privacy protections for consumers.

Intercultural influences of Belize healthcare. Belize is comprised of an ethnically diverse population containing four ethnic groups: Creole, Maya, Garinagu, and Mestizo (CIA, 2018). Culture plays a part in the high incidences of non-communicable diseases such as diabetes and hypertension, as these are related to diet and lack of awareness of nutrition and its effects on disease.

Current use of healthcare technology. In 2004, the government invested in a Health Information System, an IT solution with a goal to expand health information to rural areas and to improve data and reporting of information. Utilizing an electronic medical record system allows portability of healthcare information among the regions (Belize Ministry of Health, 2010).  However, challenges such as weak IT support, lack of standards, and poor interoperability have rendered this system inefficient. Wasden (2014) reports that to take advantage of mHealth in providing service delivery, a market needs an electronic health record system. He further posits that integrating electronic healthcare records to communicate within a system with hospitals and physicians is a prerequisite for a successful mHealth strategy. While the system is not efficient, it is a strength that Belize has the infrastructure in place and is working towards effective use of the electronic system. Furthermore, 63% of Belizeans have mobile phones and 44% are internet users (CIA, 2018), making use of mobile technology for healthcare delivery to be a feasible option.

Problem Statement

Belize suffers from healthcare deficiencies, including a rise in the incidence of non communicable diseases such as diabetes, heart attack, stroke, and depression. Furthermore, Belizeans have poor awareness and education about the prevention and consequences for these diseases. Consequently, there is needed improvement in overall education, particularly in the areas of health awareness, nutrition, and disease prevention. In addition, there is an inequality in healthcare access for all citizens, with those in rural and poor areas lacking consistent access to physicians, nurses, and medicine. Finally, a shortage of healthcare workers results in an infrastructure that cannot meet the needs of the people.

Key Economic Principles That Have an Effect on the Quality of Healthcare in Belize

Production, resources, and scarcity. Healthcare can be viewed as a service that can be produced, with resources being personnel required for delivery of those services. Production of health care workers in Belize is limited to a few in-country training institutions and import of workers from other countries. By not supporting a high school educational system, the government is in effect limiting the number of students that can enter the university system to produce a pool of needed health care resources in the communities of Belize. The shortage of healthcare workers, or scarcity of personnel resources, results in unmet needs of the Belizean people. Furthermore, by not supporting healthcare workers with an efficient system, workers are enticed to practice in other countries.

Human capital. Human capital refers to the knowledge and skills of people. The knowledge and skills provide economic value. Human capital is related to economic growth as measured by investment in education, resulting in higher earnings and higher spending (Nickolas, 2018). Health expenditures are also an investment in human capital (Chang & Ying, 2005). To improve health, it is important to reduce the disparity of quality health services in the country. Lee, Kiyu, Millman, and Jimenez (2007) state that research shows a strong correlation between a strong national health system and health outcomes. They posit that strong human and social capital can be created by developing a national health care system strategy of strengthening communities through service delivery in health care centers and clinics and by improving education in schools.

Investing in education and an equal distribution of health care access will improve disease prevention and life expectancy, thereby preserving human capital for working and contributing to the economy. Establishing mHealth education and training programs for building a workforce will be an investment in human capital.

Efficiency and equity. Economic maximization of resources can be viewed according to efficiency and equity. Efficiency is a means to the greatest production, and equity is how those resources are distributed fairly across a population (Parkin, 2017). The quality resources for health education, diagnosis, and treatment in Belize are not only lacking but not used efficiently and equally in urban and rural areas. Most healthcare professionals are located in urban areas, and there are gaps in staffing and distribution of medical equipment in the regions (Pan American Health Organization, 2009).

The WHO states that there is inequity in healthcare in emerging countries. There is not a fair and equal distribution of healthcare services throughout the world, and in particular, those in emerging countries suffer from a shortage of healthcare workers. Belize should include reduction of healthcare inequalities as a goal of the country’s health policy and strategy in order to maximize service delivery, focus on prevention, and reduce overall costs associated with disease.

Alternatives

The use of mHealth is a viable alternative and adjunct to the current healthcare delivery system of Belize. There are many key benefits to the implementation of a mobile health access program, specifically in the areas of access, quality, education, and training. For those patients that live in remote areas, where education about a condition or access to care is difficult to obtain, health and wellness information can be delivered via mobile phones. Accordingly, physician services can be delivered via mobile solutions such as monitoring of blood sugars associated with diabetes or blood pressure levels associated with hypertension. Moreover, data can be collected at the nearest health center and integrated into an electronic health record system to monitor patient status. Subsequently, quality of care can improve when sharing of information between patients and healthcare professionals is done efficiently and securely. Access to electronic information can additionally help to make better diagnostic and treatment decisions. Equally important, mobile health tools can provide learning and training for healthcare professionals. These mobile health approaches can allow patients to be educated and to take control over managing their health, thus decreasing risks associated with a chronic disease.

Objectives and Action Needed for Implementation

Involvement of Key Leaders and Stakeholders

There are multiple stakeholder interests for mHealth implementation in Belize. For the patient, improved care and taking responsibility of care is needed. For the healthcare provider, delivering quality care efficiently is paramount. For the government, equitable delivery of a national health system is a priority. For the mobile tech companies, there is great potential in emerging countries for providing equipment services and platforms.

For mHealth to be a viable solution for an emerging country such as Belize, it will be important to engage these healthcare stakeholders to develop a national strategy. Support will be needed from the Ministry of Health, given the government’s role in overseeing the national health care system. Support will also be needed from private healthcare companies, health educators at the universities, health care center workers, and regional overseers. Additionally, support from the Belize telecommunication providers such as Speednet or BTL Belize Telemedia Limited could not only assist with network connectivity, but these companies have a customer base and knowledge of consumer habits that will allow them the ability to market any new mHeatlh technologies with a large distribution network (Accenture, 2014). Additionally, mHealth technology companies are eager to enter and invest in emerging markets to provide products that focus on disease prevention, education, and data collection.

Action Steps

An mHealth implementation plan in Belize can be strategically designed using resources from the WHO’s (2012) “National eHealth Strategy Toolkit.” This toolkit provides a strategic framework for developing and implementing healthcare technology solutions on a national level. First and foremost, it will be important for the government to develop a national vision for mHealth. The Ministry of Health will be required to implement leadership and invest in technology and workforce training. It will be essential that the Ministry of Health forms alliances with technology companies and health workers to provide healthcare services using mobile devices. For example, mobile devices such as smartphones and tablets can be given to healthcare workers. Once a national strategy is developed, the government, private sector, and organizations working to bring development to Belize can pilot an mHealth program and move to a scalable solution for equitable healthcare.

 

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Global Leadership: Sustainable Tourism

/in /by

by Richard Simpson

Abstract

This paper explores the positive and negative impact of tourism on the Belizean natural resources and residents. Ecotourism is important to the survival of the natural resources and the Belizean tourism industry. Tourism that is sustainable benefits the natural resources, the tourists who seek out such resources, and the locals who provide the tourism services. Belize must pay close attention to the increasing impact of tourism. Developing a fee structure that goes directly to maintaining the natural resources and enforcing regulations is one significant step that can be taken to ensure ecotourism is successful in Belize. Tourism is important to the Belize economy, and the survival of the ecosystems that attract so much of the tourism to the country is critical. Read more

Navigating a Sea of Distrust: A Case Study of Trust Failures in the Placencia Peninsula

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by Patricia Coaley

On July 31, 2013, a non-binding Memorandum of Understanding (MOU) between the Government of Belize (GOB) and Norwegian Cruise Line (NCL) was entered, highlighting the value and importance of a new tourism project in Harvest Caye . Read more

Assessing the Dialectic in the Academic Literature Between Culturally-Dependent and Universal Leadership Attributes

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by Dwight Stirling

Research on global leadership has focused in recent years on situational determinants of leadership, a thread of inquiry aimed at elucidating contextualized approaches effective in one culture or another (Hanges, 2016). Read more

Two Million Slaves

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By Matthew T. Lambro

The FBI reports that sex trafficking is “the most overlooked and under investigated form of child sex abuse facing American society today” (2010). Sexually exploited children do not specifically rank as a priority. The FBI’s number one national security requirement is protecting America from a terror attack (FBI, 2015). Read more

Leveraging The College Admissions Process To Benefit Students Through International Service Learning

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by Leslie Smith, M.Ed.

Abstract

The pressure to perform, compete, and excel for the purpose of building a robust college resume designed specifically to impress college admissions officers has a significant effect on many students. Read more