last summer i sat in a jeep taking in
the view of the expansive green on these
mountains appreciating the opportunity i
had to do research in such a beautiful
part of the world
Chimborazo ecuador but then i realized
we’ve been sitting outside of Matias
house for almost an hour and it was
getting dark and pretty soon it wasn’t
gonna be safe to drive back down the
curvy mountain roads we’d come up to get
there luckily just then we heard
movement in the house and my research
team and I jumped up to go meet Madea
Madea came bursting out of the door
shooing chickens out with her she had a
bucket in her hand and she was headed to
the waterspout she looked stressed and
in a hurry I quickly introduced myself I
said hi I’m Megan I’m a researcher with
the World Bank and Tufts University and
we’re here because we’d like to ask you
some questions about a child nutrition
program you participated in last year
Madea looked at us and up at the
darkening sky and said no no no I just
got home from work I have to take the
cows to graze the land where they graze
is really far from here I feel have to
get dinner ready for the kids I can’t I
don’t have time and I said oh that’s
fine we can come back at a time that’s
more convenient maybe tomorrow tomorrow
tomorrow it’s the same she said and then
she looked at me and took a deep breath
and something relaxed in her demeanor
and she said okay come tomorrow tomorrow
I can talk so the next day when we
returned and the door swung open and the
chickens came out Madea stood in the
doorway and signaled for us to come in
we sat down I had prepared a series of
questions about the food she served her
children to eat and whether she was able
to attend regular health check-ups the
questions aimed to gain a better
understanding of what she wanted to
provide for children and what she was
able to do in practice and why those two
things might be different
Madea the name I give to her to protect
her identity as part of my research but
her story of juggling multiple jobs
tending to animals
to agriculture and raising five children
mostly on her own are real
it’s a moments just like these at the
end of the day when she had to make
really difficult decisions like whether
to spend the extra time boiling water
before she served it to her children or
instead to sue the crying child give
them water straight from the tap it’s
these kinds of decisions and in just
these kinds of moments that affected the
health of her children and many more
Incheon Board awesome so you might be
asking what was i gringa doing in rural
ecuador conducting interviews for me the
answer to that question begins growing
up in Boston sitting around the dinner
table with my parents and older sister
we’d each share stories of our day and
for my parents both social justice
activists those stories would be of
their work organizing a rally down at
the State House for immigrant rights or
of the difficult conversations they were
having on the shop floor getting people
ready for a picket line and what that
would mean for their families my dad
worked for the General Electric
factories in Lynn Massachusetts for 37
years as a union organizer he fought for
social change through the labor movement
in the 70s my mom left college to travel
through Latin America and understand the
experiences people faced in other
countries for her teaching her children
a second language provide them a window
into understanding the diversity she
knew so I first learned to read in
Spanish attending an inner-city public
bilingual school with other children
learning English for the first time
that’s me these are the foundations that
gave me the values and the sense of
responsibility to continue the struggle
for social justice in the world around
me as a researcher at the World Bank
I’ve spent the past four years studying
child nutrition in Chimborazo Ecuador
this is an area that is both mostly
rural and indigenous it’s a place where
mothers and fathers have to walk four
miles to reach their local health
centers often arriving and finding them
understaffed and unable to provide the
services they came for
53% of the population live below the
Ecuadorian poverty line of two dollars
and eighty cents a day and in the most
recent census in 2010 20% of the rural
population did not have any type of
bathroom or latrine in their house all
structural barriers that have serious
implications on child health and
contribute to a really terrible
statistic half of all children under
five in Chimbote also suffer from
chronic malnutrition or stunting
something that is lasting cognitive and
physical impairments for them so when I
first got started working on this issue
I began by listening I visited local
health centers spoke with day care
providers and local nutritionists and
they each repeated to me a similar
challenge they said we can provide
support and services to parents and
children while they’re here but it’s at
home where the behaviors really need to
change and this is where we don’t know
what’s working so together with the
local government we began to brainstorm
how could we enter into homes where
change needed to happen most and in 2014
when we got started on this work one
thing most poor households had was a
cell phone and the local government had
data on their cell phone numbers by
bringing this data to the policy
challenge we were able to enter into
homes and begin to nudge families
towards healthier outcomes for their
children to do this we drew on insights
from behavioral economics and psychology
about human behavior we know that all
people postpone things they believe are
important we can all relate to decisions
we make rationally probably each week in
health and nutrition to eat healthy and
exercise but with the pressures of work
and school family life and inching board
also the context of poverty these
preferences change in moments of stress
it’s not that we’re inherently
irrational individuals but rather at
different moments we have different
preferences research in the field has
shown that in these moments between the
decisions we make and the actions we
take
timely reminders of our initial
preferences can help change behaviors in
economics we call these commitment
devices such as making a plan with
someone who can hold us accountable
powerful emotions can also serve as this
influential nudge in these spaces such
as the encouragement we feel from peer
pressure social norms and also from fear
so we took these insights and we
developed a program that sent text
messages as the nudge twice a week for
about a year the messages were reminders
to bring children in for regular health
check-ups we also provided information
about the importance of nutritional
supplements and vitamins we provided
tips on how parents could practically
integrate a diverse set of foods into
their children’s diets and lastly we
were minded parents to regularly wash
their hands and practice good sanitation
to reduce illness each of these messages
were framed using positive and
encouraging language like this one
medea sometimes being a mom is difficult
but we believe in you
you can do this each message aim to
communicate to parents and caregivers
that they had someone on their team
rooting for them and believing in the
change that they could accomplish so
about a year later through a randomized
controlled trial we went back with a
local survey team and surveyed almost
three thousand households some that
received the text messages and others
that did not and what we found was that
these messages were powerful they led to
statistically significant reductions in
the experience of illness we observed
that households that receive the
messages were ten percentage points less
likely to experience a range of nine
common illnesses among their children we
also observed improvements and
nutritional status weight for height
improved children who had had low weight
for height levels were shifted into a
healthy range so there are two lessons
that I take from this work and I’m
really excited to share here with you
today the first is that none of this
learning would have been possible
without the use of big data and
evaluation
and learn from policy video story is an
important one but if I were to tell that
story to a policymaker they’d often tell
me we’ve heard these stories were from
these towns but either I don’t have the
power to make the change I need or I
don’t know what kinds of solutions would
create an impact but if you give them a
statistic they can use it there is power
in that number data becomes the
megaphone that brings the experiences of
people often shut out of powerful
decision-making spaces into the room you
and your data are part of a growing data
infrastructure collected by governments
and businesses we are beyond the
question of whether we should be
collecting this data instead we already
do and the question now is how will we
use it the challenge is on all of us to
begin to find ways of pulling these
different pieces of data together to
test and learn and improve policies and
ensure that data is the megaphone for
social change the second lesson I take
from this work is something I actually
first learned almost 10 years earlier as
a Peace Corps volunteer serving in the
Dominican Republic in a small town on
the Haitian border in that role I held
hundreds of meetings bringing people
together around problems that needed
solutions and while these meetings were
important what proved to be most
impactful we’re actually the informal
spaces sitting down sharing a meal or a
coffee with people and listening to the
struggles of poverty they faced
listening to small business owners who
were over-indebted and needed help with
basic accounting or listening to
Haitians whose children were shut out of
schools by listening by listening we
could build solutions but what was more
was that through listening we built
relationships based on the vulnerability
of sharing with them and that struggle
to get by these visits and in the case
of Ecuador the text messages help people
accountable to our shared goals but they
also communicated hope they communicated
that someone believed in them and what
we could accomplish to
so the second message about hope it’s
not some silver bullet naive message
that hopeful text messages are the
answer structural barriers remain to be
important determinants for development
outcomes such as access to clean water
and quality health care but what I am
saying is that in these spaces between
the decisions we make about what we
should be doing what we want to be doing
and what we actually do dude in this
space in this margin I found that the
power of hope and human relationships
can make the difference thank you [Applause]
the view of the expansive green on these
mountains appreciating the opportunity i
had to do research in such a beautiful
part of the world
Chimborazo ecuador but then i realized
we’ve been sitting outside of Matias
house for almost an hour and it was
getting dark and pretty soon it wasn’t
gonna be safe to drive back down the
curvy mountain roads we’d come up to get
there luckily just then we heard
movement in the house and my research
team and I jumped up to go meet Madea
Madea came bursting out of the door
shooing chickens out with her she had a
bucket in her hand and she was headed to
the waterspout she looked stressed and
in a hurry I quickly introduced myself I
said hi I’m Megan I’m a researcher with
the World Bank and Tufts University and
we’re here because we’d like to ask you
some questions about a child nutrition
program you participated in last year
Madea looked at us and up at the
darkening sky and said no no no I just
got home from work I have to take the
cows to graze the land where they graze
is really far from here I feel have to
get dinner ready for the kids I can’t I
don’t have time and I said oh that’s
fine we can come back at a time that’s
more convenient maybe tomorrow tomorrow
tomorrow it’s the same she said and then
she looked at me and took a deep breath
and something relaxed in her demeanor
and she said okay come tomorrow tomorrow
I can talk so the next day when we
returned and the door swung open and the
chickens came out Madea stood in the
doorway and signaled for us to come in
we sat down I had prepared a series of
questions about the food she served her
children to eat and whether she was able
to attend regular health check-ups the
questions aimed to gain a better
understanding of what she wanted to
provide for children and what she was
able to do in practice and why those two
things might be different
Madea the name I give to her to protect
her identity as part of my research but
her story of juggling multiple jobs
tending to animals
to agriculture and raising five children
mostly on her own are real
it’s a moments just like these at the
end of the day when she had to make
really difficult decisions like whether
to spend the extra time boiling water
before she served it to her children or
instead to sue the crying child give
them water straight from the tap it’s
these kinds of decisions and in just
these kinds of moments that affected the
health of her children and many more
Incheon Board awesome so you might be
asking what was i gringa doing in rural
ecuador conducting interviews for me the
answer to that question begins growing
up in Boston sitting around the dinner
table with my parents and older sister
we’d each share stories of our day and
for my parents both social justice
activists those stories would be of
their work organizing a rally down at
the State House for immigrant rights or
of the difficult conversations they were
having on the shop floor getting people
ready for a picket line and what that
would mean for their families my dad
worked for the General Electric
factories in Lynn Massachusetts for 37
years as a union organizer he fought for
social change through the labor movement
in the 70s my mom left college to travel
through Latin America and understand the
experiences people faced in other
countries for her teaching her children
a second language provide them a window
into understanding the diversity she
knew so I first learned to read in
Spanish attending an inner-city public
bilingual school with other children
learning English for the first time
that’s me these are the foundations that
gave me the values and the sense of
responsibility to continue the struggle
for social justice in the world around
me as a researcher at the World Bank
I’ve spent the past four years studying
child nutrition in Chimborazo Ecuador
this is an area that is both mostly
rural and indigenous it’s a place where
mothers and fathers have to walk four
miles to reach their local health
centers often arriving and finding them
understaffed and unable to provide the
services they came for
53% of the population live below the
Ecuadorian poverty line of two dollars
and eighty cents a day and in the most
recent census in 2010 20% of the rural
population did not have any type of
bathroom or latrine in their house all
structural barriers that have serious
implications on child health and
contribute to a really terrible
statistic half of all children under
five in Chimbote also suffer from
chronic malnutrition or stunting
something that is lasting cognitive and
physical impairments for them so when I
first got started working on this issue
I began by listening I visited local
health centers spoke with day care
providers and local nutritionists and
they each repeated to me a similar
challenge they said we can provide
support and services to parents and
children while they’re here but it’s at
home where the behaviors really need to
change and this is where we don’t know
what’s working so together with the
local government we began to brainstorm
how could we enter into homes where
change needed to happen most and in 2014
when we got started on this work one
thing most poor households had was a
cell phone and the local government had
data on their cell phone numbers by
bringing this data to the policy
challenge we were able to enter into
homes and begin to nudge families
towards healthier outcomes for their
children to do this we drew on insights
from behavioral economics and psychology
about human behavior we know that all
people postpone things they believe are
important we can all relate to decisions
we make rationally probably each week in
health and nutrition to eat healthy and
exercise but with the pressures of work
and school family life and inching board
also the context of poverty these
preferences change in moments of stress
it’s not that we’re inherently
irrational individuals but rather at
different moments we have different
preferences research in the field has
shown that in these moments between the
decisions we make and the actions we
take
timely reminders of our initial
preferences can help change behaviors in
economics we call these commitment
devices such as making a plan with
someone who can hold us accountable
powerful emotions can also serve as this
influential nudge in these spaces such
as the encouragement we feel from peer
pressure social norms and also from fear
so we took these insights and we
developed a program that sent text
messages as the nudge twice a week for
about a year the messages were reminders
to bring children in for regular health
check-ups we also provided information
about the importance of nutritional
supplements and vitamins we provided
tips on how parents could practically
integrate a diverse set of foods into
their children’s diets and lastly we
were minded parents to regularly wash
their hands and practice good sanitation
to reduce illness each of these messages
were framed using positive and
encouraging language like this one
medea sometimes being a mom is difficult
but we believe in you
you can do this each message aim to
communicate to parents and caregivers
that they had someone on their team
rooting for them and believing in the
change that they could accomplish so
about a year later through a randomized
controlled trial we went back with a
local survey team and surveyed almost
three thousand households some that
received the text messages and others
that did not and what we found was that
these messages were powerful they led to
statistically significant reductions in
the experience of illness we observed
that households that receive the
messages were ten percentage points less
likely to experience a range of nine
common illnesses among their children we
also observed improvements and
nutritional status weight for height
improved children who had had low weight
for height levels were shifted into a
healthy range so there are two lessons
that I take from this work and I’m
really excited to share here with you
today the first is that none of this
learning would have been possible
without the use of big data and
evaluation
and learn from policy video story is an
important one but if I were to tell that
story to a policymaker they’d often tell
me we’ve heard these stories were from
these towns but either I don’t have the
power to make the change I need or I
don’t know what kinds of solutions would
create an impact but if you give them a
statistic they can use it there is power
in that number data becomes the
megaphone that brings the experiences of
people often shut out of powerful
decision-making spaces into the room you
and your data are part of a growing data
infrastructure collected by governments
and businesses we are beyond the
question of whether we should be
collecting this data instead we already
do and the question now is how will we
use it the challenge is on all of us to
begin to find ways of pulling these
different pieces of data together to
test and learn and improve policies and
ensure that data is the megaphone for
social change the second lesson I take
from this work is something I actually
first learned almost 10 years earlier as
a Peace Corps volunteer serving in the
Dominican Republic in a small town on
the Haitian border in that role I held
hundreds of meetings bringing people
together around problems that needed
solutions and while these meetings were
important what proved to be most
impactful we’re actually the informal
spaces sitting down sharing a meal or a
coffee with people and listening to the
struggles of poverty they faced
listening to small business owners who
were over-indebted and needed help with
basic accounting or listening to
Haitians whose children were shut out of
schools by listening by listening we
could build solutions but what was more
was that through listening we built
relationships based on the vulnerability
of sharing with them and that struggle
to get by these visits and in the case
of Ecuador the text messages help people
accountable to our shared goals but they
also communicated hope they communicated
that someone believed in them and what
we could accomplish to
so the second message about hope it’s
not some silver bullet naive message
that hopeful text messages are the
answer structural barriers remain to be
important determinants for development
outcomes such as access to clean water
and quality health care but what I am
saying is that in these spaces between
the decisions we make about what we
should be doing what we want to be doing
and what we actually do dude in this
space in this margin I found that the
power of hope and human relationships
can make the difference thank you [Applause]
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