17:40
TEDxSydney

Paul Pholeros: How to reduce poverty? Fix homes

Filmed:

In 1985, architect Paul Pholeros was challenged by the director of an Aboriginal-controlled health service to "stop people getting sick" in a small indigenous community in south Australia. The key insights: think beyond medicine and fix the local environment. In this sparky, interactive talk, Pholeros describes projects undertaken by Healthabitat, the organization he now runs to help reduce poverty--through practical design fixes--in Australia and beyond.

- Architect
Paul Pholeros was a director of Healthabitat, a longstanding effort to improve the health of indigenous people by improving their living housing. Full bio

The idea of eliminating poverty is a great goal.
00:13
I don't think anyone in this room would disagree.
00:18
What worries me is when politicians with money
00:22
and charismatic rock stars
00:27
use the words,
00:30
it all just sounds so, so simple.
00:32
Now, I've got no bucket of money today
00:38
and I've got no policy to release,
00:42
and I certainly haven't got a guitar.
00:45
I'll leave that to others.
00:47
But I do have an idea,
00:50
and that idea is called Housing for Health.
00:52
Housing For Health works with poor people.
00:55
It works in the places where they live,
00:58
and the work is done to improve their health.
01:01
Over the last 28 years,
01:05
this tough, grinding, dirty work
01:07
has been done by literally thousands of people
01:10
around Australia, and more recently overseas,
01:14
and their work has proven that focused design
01:17
can improve even the poorest living environments.
01:21
It can improve health, and it can play a part
01:25
in reducing, if not eliminating, poverty.
01:28
I'm going to start where the story began, 1985,
01:33
in central Australia.
01:36
A man called Yami Lester, an Aboriginal man,
01:38
was running a health service.
01:41
Eighty percent of what walked in the door,
01:44
in terms of illness, was infectious disease --
01:46
third world, developing world infectious disease,
01:50
caused by a poor living environment.
01:53
Yami assembled a team in Alice Springs.
01:58
He got a medical doctor.
02:02
He got an environmental health guy.
02:05
And he hand-selected a team of local Aboriginal people
02:08
to work on this project.
02:13
Yami told us at that first meeting, there's no money.
02:15
Always a good start, no money.
02:19
You have six months.
02:22
And I want you to start on a project which in his language
02:24
he called "uwankara palyanku kanyintjaku,"
02:26
which, translated, is "a plan to stop people getting sick,"
02:30
a profound brief.
02:35
That was our task.
02:39
First step, the medical doctor went away
02:42
for about six months,
02:44
and he worked on what were to become
02:46
these nine health goals, what were we aiming at.
02:48
After six months of work, he came to my office
02:55
and presented me with those nine words on a piece of paper.
02:57
[Washing, clothes, wastewater, nutrition... ]
03:01
Now, I was very, very unimpressed.
03:02
Come on.
03:06
Big ideas need big words
03:08
and preferably a lot of them.
03:11
This didn't fit the bill.
03:13
What I didn't see and what you can't see
03:15
is that he'd assembled thousands of pages
03:19
of local, national and international health research
03:24
that filled out the picture as to why these
03:27
were the health targets.
03:30
The pictures that came a bit later
03:32
had a very simple reason.
03:35
The Aboriginal people who were our bosses
03:36
and the senior people were most commonly illiterate,
03:38
so the story had to be told in pictures
03:42
of what were these goals.
03:44
We work with the community,
03:46
not telling them what was going to happen
03:48
in a language they didn't understand.
03:50
So we had the goals, and each one of these goals --
03:53
and I won't go through them all —
03:56
puts at the center the person and their health issue,
03:58
and it then connects them
04:02
to the bits of the physical environment
04:04
that are actually needed to keep their health good.
04:07
And the highest priority, you see on the screen,
04:11
is washing people once a day, particularly children.
04:13
Now I hope most of you are thinking,
04:18
"What? That sounds simple."
04:19
Now, I'm going to ask you all a very personal question.
04:21
This morning before you came,
04:25
who could have had a wash using a shower?
04:26
I'm not going to ask if you had a shower,
04:31
because I'm too polite. That's it. (Laughter)
04:33
Okay. All right.
04:36
I think it's fair to say, most people here
04:38
could have had a shower this morning.
04:40
I'm going to ask you to do some more work.
04:42
I want you all to select one of the houses
04:44
of the 25 houses you see on the screen.
04:47
I want you to select one of them and note
04:49
the position of that house
04:50
and keep that in your head.
04:52
Have you all got a house? I'm going to ask you
04:53
to live there for a few months, so make sure you've got it right.
04:56
It's in the northwest of Western Australia, very pleasant place.
04:58
Okay. Let's see if your shower in that house is working.
05:02
I hear some "aw"s and I hear some "aah."
05:07
If you get a green tick, your shower's working.
05:10
You and your kids are fine.
05:13
If you get a red cross,
05:14
well, I've looked carefully around the room
05:16
and it's not going to make much difference to this crew.
05:19
Why? Because you're all too old.
05:22
And I know that's going to come as a shock to some of you,
05:24
but you are.
05:26
Now before you get offended and leave,
05:28
I've got to say that being too old in this case
05:30
means that pretty much everyone in the room, I think,
05:32
is over five years of age.
05:35
We're really concerned with kids naught to five.
05:39
And why? Washing is the antidote to the sort of bugs,
05:42
the common infectious diseases of the eyes, the ears,
05:48
the chest and the skin
05:51
that, if they occur in the first five years of life,
05:54
permanently damage those organs.
05:57
They leave a lifelong remnant.
06:01
That means that, by the age of five,
06:04
you can't see as well for the rest of your life.
06:07
You can't hear as well for the rest of your life.
06:09
You can't breath as well. You've lost a third
06:12
of your lung capacity by the age of five.
06:13
And even skin infection, which we originally thought
06:16
wasn't that big a problem,
06:19
mild skin infections naught to five give you
06:22
a greatly increased chance of renal failure,
06:24
needing dialysis at age 40.
06:27
This is a big deal, so the ticks and crosses on the screen
06:30
are actually critical for young kids.
06:33
Those ticks and crosses represent the 7,800 houses
06:36
we've looked at nationally around Australia,
06:39
the same proportion.
06:41
What you see on the screen -- 35 percent of those
06:43
not-so-famous houses lived in by 50,000 indigenous people,
06:46
35 percent had a working shower.
06:50
Ten percent of those same 7,800 houses
06:53
had safe electrical systems,
06:57
and 58 percent of those houses
06:59
had a working toilet.
07:03
These are by a simple, standard test:
07:07
In the case of the shower, does it have hot and cold water,
07:10
two taps that work,
07:14
a shower rose to get water onto your head
07:17
or onto your body, and a drain that takes the water away?
07:21
Not well designed, not beautiful, not elegant --
07:23
just that they function.
07:27
And the same test for the electrical system and the toilets.
07:29
Housing for Health projects aren't about measuring failure.
07:33
They're actually about improving houses.
07:36
We start on day one of every project -- we've learned,
07:39
we don't make promises, we don't do reports.
07:43
We arrive in the morning with tools, tons of equipment,
07:46
trades, and we train up a local team on the first day
07:50
to start work.
07:54
By the evening of the first day, a few houses
07:55
in that community are better
07:58
than when we started in the morning.
07:59
That work continues for six to 12 months
08:01
until all the houses are improved
08:04
and we've spent our budget of 7,500
08:05
dollars total per house.
08:08
That's our average budget.
08:10
At the end of six months to a year, we test every house again.
08:12
It's very easy to spend money.
08:16
It's very difficult to improve the function
08:18
of all those parts of the house,
08:21
and for a whole house, the nine healthy living practices,
08:23
we test, check and fix 250 items in every house.
08:26
And these are the results
08:31
we can get with our 7,500 dollars.
08:32
We can get showers up to 86 percent working,
08:35
we can get electrical systems up to 77 percent working,
08:37
and we can get 90 percent of toilets working
08:41
in those 7,500 houses.
08:44
Thank you. (Applause)
08:46
The teams do a great job, and that's their work.
08:55
I think there's an obvious question
09:00
that I hope you're thinking about.
09:02
Why do we have to do this work?
09:05
Why are the houses in such poor condition?
09:08
Seventy percent of the work we do
09:11
is due to lack of routine maintenance,
09:13
the sort of things that happen in all our houses.
09:14
Things wear out.
09:16
Should have been done by state government or local government.
09:18
Simply not done, the house doesn't work.
09:21
Twenty-one percent of the things we fix
09:24
are due to faulty construction,
09:26
literally things that are built upside down and back-to-front.
09:28
They don't work. We have to fix them.
09:31
And if you've lived in Australia in the last 30 years,
09:33
the final cause -- You will have heard always
09:37
that indigenous people trash houses.
09:41
It's one of the almost rock-solid pieces of evidence,
09:43
which I've never seen evidence for,
09:46
that's always ruled out as that's the problem with indigenous housing.
09:48
Well, nine percent of what we spend is damage,
09:51
misuse or abuse of any sort.
09:54
We argue strongly that the people living in the house
09:57
are simply not the problem.
10:01
And we'll go a lot further than that.
10:03
The people living in the house are actually
10:04
a major part of the solution.
10:06
Seventy-five percent of our national team in Australia,
10:09
over 75 at the minute,
10:13
are actually local, indigenous people
10:15
from the communities we work in.
10:17
They do all aspects of the work.
10:19
(Applause)
10:22
In 2010, for example, there were 831,
10:27
all over Australia, and the Torres Strait Islands,
10:31
all states, working to improve the houses
10:34
where they and their families live,
10:37
and that's an important thing.
10:38
Our work's always had a focus on health. That's the key.
10:41
The developing world bug trachoma, it causes blindness.
10:46
It's a developing world illness,
10:49
and yet, the picture you see behind
10:52
is in an Aboriginal community in the late 1990s
10:54
where 95 percent of school-aged kids had active trachoma
10:57
in their eyes doing damage.
11:01
Okay, what do we do?
11:04
Well, first thing we do, we get showers working.
11:06
Why? Because that flushes the bug out.
11:09
We put washing facilities in the school as well,
11:11
so kids can wash their faces many times during the day.
11:13
We wash the bug out.
11:16
Second, the eye doctors tell us that dust scours the eye
11:18
and lets the bug in quick. So what do we do?
11:22
We call up the doctor of dust, and there is such a person.
11:24
He was loaned to us by a mining company.
11:28
He controls dust on mining company sites,
11:30
and he came out, and within a day it worked out
11:32
that most dust in this community was
11:35
within a meter of the ground, the wind-driven dust,
11:37
so he suggested making mounds to catch the dust
11:40
before it went into the house area
11:43
and affected the eyes of kids.
11:45
So we used dirt to stop dust.
11:47
We did it. He provided us dust monitors.
11:50
We tested and we reduced the dust.
11:53
Then we wanted to get rid of the bug generally.
11:55
So how do we do that?
11:57
Well, we call up the doctor of flies,
11:59
and yes there is a doctor of flies.
12:01
As our Aboriginal mate said,
12:04
"You white fellows ought to get out more."
12:06
(Laughter)
12:08
And the doctor of flies very quickly determined
12:10
that there was one fly that carried the bug.
12:13
He could give school kids in this community
12:17
the beautiful fly trap you see above in the slide.
12:20
They could trap the flies, send them to him in Perth.
12:23
When the bug was in the gut, he'd send back
12:26
by return post some dung beetles.
12:28
The dung beetles ate the camel dung,
12:30
the flies died through lack of food,
12:32
and trachoma dropped.
12:35
And over the year, trachoma dropped
12:36
radically in this place, and stayed low.
12:39
We changed the environment, not just treated the eyes.
12:42
And finally, you get a good eye.
12:46
All these small health gains
12:50
and small pieces of the puzzle make a big difference.
12:53
The New South Wales Department of Health,
12:56
that radical organization,
12:57
did an independent trial over three years
12:59
to look at 10 years of the work we've been doing
13:02
in these sorts of projects in New South Wales,
13:05
and they found a 40-percent reduction
13:07
in hospital admissions for the illnesses
13:11
that you could attribute to the poor environment.
13:14
A 40-percent reduction.
13:17
(Applause)
13:19
Just to show that the principles we've used
13:27
in Australia can be used in other places,
13:29
I'm just going to go to one other place, and that's Nepal,
13:31
and what a beautiful place to go.
13:34
We were asked by a small village of 600 people
13:36
to go in and make toilets where none existed.
13:39
Health was poor.
13:43
We went in with no grand plan, no grand promises
13:46
of a great program, just the offer to build
13:48
two toilets for two families.
13:50
It was during the design of the first toilet
13:52
that I went for lunch, invited by the family
13:56
into their main room of the house.
13:58
It was choking with smoke.
14:00
People were cooking on their only fuel source, green timber.
14:02
The smoke coming off that timber is choking,
14:06
and in an enclosed house, you simply can't breathe.
14:08
Later we found the leading cause of illness and death
14:11
in this particular region is through respiratory failure.
14:15
So all of a sudden we had two problems.
14:19
We were there originally to look at toilets
14:21
and get human waste off the ground. That's fine.
14:23
But all of a sudden now there was a second problem.
14:25
How do we actually get the smoke down? So two problems,
14:28
and design should be about more than one thing.
14:31
Solution: Take human waste, take animal waste,
14:34
put it into a chamber, out of that extract biogas,
14:38
methane gas.
14:41
The gas gives three to four hours cooking a day --
14:43
clean, smokeless and free for the family.
14:46
(Applause)
14:50
I put it to you, is this eliminating poverty?
14:55
And the answer from the Nepali team who is working
14:58
at the minute would say, don't be ridiculous,
15:01
we have three million more toilets to build
15:04
before we can even make a stab at that claim.
15:06
And I don't pretend anything else.
15:09
But as we all sit here today,
15:12
there are now over 100 toilets built
15:14
in this village and a couple nearby.
15:16
Well over 1,000 people use those toilets.
15:18
Yami Lama, he's a young boy.
15:22
He's got significantly less gut infection
15:25
because he's now got toilets,
15:28
and there isn't human waste on the ground.
15:29
Kanji Maya, she's a mother and a proud one.
15:33
She's probably right now cooking lunch for her family
15:37
on biogas, smokeless fuel.
15:41
Her lungs have got better, and they'll get better
15:44
as time increases, because she's not cooking in the same smoke.
15:46
Surya takes the waste out of the biogas chamber
15:49
when it's shed the gas, he puts it on his crops.
15:52
He's trebled his crop income,
15:55
more food for the family and more money for the family.
15:57
And finally Bishnu,
16:01
the leader of the team, has now understood
16:02
that not only have we built toilets,
16:06
we've also built a team,
16:08
and that team is now working in two villages
16:11
where they're training up the next two villages
16:13
to keep the work expanding.
16:16
And that, to me, is the key.
16:18
(Applause)
16:19
People are not the problem.
16:24
We've never found that.
16:28
The problem: poor living environment,
16:29
poor housing, and the bugs that do people harm.
16:31
None of those are limited by geography,
16:36
by skin color or by religion. None of them.
16:39
The common link between all the work we've had to do
16:44
is one thing, and that's poverty.
16:47
Nelson Mandela said, in the mid-2000s,
16:51
not too far from here, he said that
16:54
like slavery and Apartheid, "Poverty is not natural.
16:56
It's man-made and can be overcome and eradicated
17:01
by the actions of human beings."
17:05
I want to end by saying it's been the actions
17:08
of thousands of ordinary human beings
17:12
doing, I think, extraordinary work,
17:15
that have actually improved health,
17:19
and, maybe only in a small way, reduced poverty.
17:21
Thank you very much for your time.
17:25
(Applause)
17:27
Translated by Joseph Geni
Reviewed by Morton Bast

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About the Speaker:

Paul Pholeros - Architect
Paul Pholeros was a director of Healthabitat, a longstanding effort to improve the health of indigenous people by improving their living housing.

Why you should listen

"Change comes slowly," said architect Paul Pholeros. Which is why he spent more than 30 years committedly working on urban, rural, and remote architectural projects throughout his native Australia and beyond. In particular, he focused on improving the living environments of poor people, understanding that environment plays a key and often overlooked role in health.

An architect himself, Pholeros met his two co-directors in the organization Healthabitat in 1985, when the three were challenged by Yami Lester, the director of an Aboriginal-controlled health service in the Anangu Pitjatjantjara Lands in northwest South Australia, to "stop people getting sick." The findings from that project guided their thinking, as Pholeros and his partners worked to improve sanitation, connect electricity, and provide washing and water facilities to indigenous communities. Above all, the team focused on engaging these local communities to help themselves--and to pass on their skills to others. In this way, a virtuous circle of fighting poverty was born.

Since 2007, Healthabitat has expanded its work beyond Australia, working on similar projects in the Kathmandu Valley in Nepal. In 2011, the firm was awarded the international UN Habitat and Building and Social Housing Foundation's World Habitat Award, and a Leadership in Sustainability prize from the Australian Institute of Architects. In 2012, Healthabitat was one of the six Australian representatives at the Venice International Architectural Biennale.

Paul Pholeros passed away on February 1, 2016. 

More profile about the speaker
Paul Pholeros | Speaker | TED.com