1
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The idea of eliminating poverty
is a great goal.

2
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I don't think anyone
in this room would disagree.

3
00:00:10,512 --> 00:00:15,036
What worries me
is when politicians with money

4
00:00:15,060 --> 00:00:17,681
and charismatic rock stars --

5
00:00:17,705 --> 00:00:19,285
(Laughter)

6
00:00:19,309 --> 00:00:20,626
use the words,

7
00:00:20,650 --> 00:00:24,819
" ... it all just sounds so, so simple."

8
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Now, I've got no bucket of money today

9
00:00:30,189 --> 00:00:33,380
and I've got no policy to release,

10
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and I certainly haven't got a guitar.

11
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I'll leave that to others.

12
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But I do have an idea,

13
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and that idea is called
Housing for Health.

14
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Housing for Health works with poor people.

15
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It works in the places where they live,

16
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and the work is done
to improve their health.

17
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Over the last 28 years,

18
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this tough, grinding, dirty work

19
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has been done by literally
thousands of people around Australia

20
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and, more recently, overseas,

21
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and their work has proven

22
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that focused design can improve
even the poorest living environments.

23
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It can improve health

24
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and it can play a part in reducing,
if not eliminating, poverty.

25
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I'm going to start
where the story began --

26
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1985, in Central Australia.

27
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A man called Yami Lester,
an Aboriginal man,

28
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was running a health service.

29
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Eighty percent of what walked
in the door, in terms of illness,

30
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was infectious disease --

31
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third world, developing world
infectious disease,

32
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caused by a poor living environment.

33
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Yami assembled a team in Alice Springs.

34
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He got a medical doctor.

35
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He got an environmental health guy.

36
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And he hand-selected a team
of local Aboriginal people

37
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to work on this project.

38
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Yami told us at that first meeting,

39
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"There's no money," --
always a good start --

40
00:02:09,035 --> 00:02:12,524
" ... no money, you have six months,

41
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and I want you to start on a project --"
which, in his language,

42
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he called "Uwankara Palyanku Kanyintjaku,"

43
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which, translated, is "a plan
to stop people getting sick" --

44
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a profound brief.

45
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That was our task.

46
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First step, the medical doctor went away
for about six months.

47
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And he worked on what were to become
these nine health goals --

48
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what were we aiming at?

49
00:02:43,236 --> 00:02:45,427
After six months of work,
he came to my office

50
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and presented me with
those nine words on a piece of paper.

51
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[The 9 Healthy Living Practices: Washing,
clothes, wastewater, nutrition, crowding,

52
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animals, dust, temperature, injury]

53
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I was very unimpressed.
Big ideas need big words,

54
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and preferably a lot of them.

55
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This didn't fit the bill.

56
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What I didn't see and what you can't see

57
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was that he'd assembled thousands of pages

58
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of local, national
and international health research

59
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that filled out the picture
as to why these were the health targets.

60
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The pictures that came a bit later
had a very simple reason.

61
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The Aboriginal people who were our bosses
and the senior people

62
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were most commonly illiterate,

63
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so the story had to be told in pictures

64
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of what these goals were.

65
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We worked with the community,

66
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not telling them what was going to happen

67
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in a language they didn't understand.

68
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So we had the goals
and each one of these goals --

69
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and I won't go through them all --

70
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puts at the center the person
and their health issue,

71
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and it then connects them

72
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to the bits of the physical
environment that are actually needed

73
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to keep their health good.

74
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And the highest priority,
you see on the screen,

75
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is washing people once a day,
particularly children.

76
00:04:06,310 --> 00:04:08,064
And I hope most of you are thinking,

77
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"What? That sounds simple."

78
00:04:09,414 --> 00:04:13,470
Now, I'm going to ask you all
a very personal question.

79
00:04:13,494 --> 00:04:14,875
This morning before you came,

80
00:04:14,899 --> 00:04:19,070
who could have had a wash using a shower?

81
00:04:20,198 --> 00:04:23,413
I'm not going to ask if you had a shower,
because I'm too polite.

82
00:04:23,437 --> 00:04:24,588
That's it.

83
00:04:24,612 --> 00:04:25,613
(Laughter)

84
00:04:25,637 --> 00:04:27,399
All right, I think it's fair to say

85
00:04:27,423 --> 00:04:30,470
most people here could have had
a shower this morning.

86
00:04:30,494 --> 00:04:32,618
I'm going to ask you to do some more work.

87
00:04:32,642 --> 00:04:35,146
I want you all to select one of the houses

88
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of the 25 houses you see on the screen.

89
00:04:37,246 --> 00:04:40,652
I want you to select one of them
and note the position of that house

90
00:04:40,676 --> 00:04:42,053
and keep that in your head.

91
00:04:42,077 --> 00:04:43,603
Have you all got a house?

92
00:04:43,627 --> 00:04:46,077
I'm going to ask you to live there
for a few months,

93
00:04:46,101 --> 00:04:47,707
so make sure you've got it right.

94
00:04:47,731 --> 00:04:50,754
It's in the northwest of
Western Australia, very pleasant place.

95
00:04:50,778 --> 00:04:53,990
OK. Let's see if your shower
in that house is working.

96
00:04:55,328 --> 00:04:58,463
I hear some "Aw!" and I hear some "Ah!"

97
00:04:58,487 --> 00:05:01,267
If you get a green tick,
your shower's working.

98
00:05:01,291 --> 00:05:02,577
You and your kids are fine.

99
00:05:02,601 --> 00:05:04,970
If you get a red cross,

100
00:05:04,994 --> 00:05:07,233
well, I've looked carefully
around the room

101
00:05:07,257 --> 00:05:10,433
and it's not going to make
much difference to this crew.

102
00:05:10,457 --> 00:05:12,981
Why? Because you're all too old.

103
00:05:13,005 --> 00:05:16,217
I know that's going to come as a shock
to some of you, but you are.

104
00:05:16,241 --> 00:05:18,120
And before you get offended and leave,

105
00:05:18,144 --> 00:05:19,960
I've got to say that being too old,

106
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in this case, means that pretty much
everyone in the room, I think,

107
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is over five years of age.

108
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We're really concerned
with kids naught to five.

109
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And why?

110
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Washing is the antidote
to the sort of bugs,

111
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the common infectious diseases
of the eyes, the ears,

112
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the chest and the skin

113
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that, if they occur in the first
five years of life,

114
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permanently damage those organs.

115
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They leave a lifelong remnant.

116
00:05:53,123 --> 00:05:55,225
That means that by the age of five,

117
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you can't see as well
for the rest of your life.

118
00:05:57,559 --> 00:06:00,049
You can't hear as well
for the rest of your life.

119
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You can't breathe as well.

120
00:06:01,439 --> 00:06:04,929
You've lost a third of your lung
capacity by the age of five.

121
00:06:04,953 --> 00:06:06,796
And even skin infection,

122
00:06:06,820 --> 00:06:10,376
which we originally thought
wasn't that big a problem,

123
00:06:10,400 --> 00:06:12,625
mild skin infections
naught to five give you

124
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a greatly increased
chance of renal failure,

125
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needing dialysis at age 40.

126
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This is a big deal, so the ticks
and crosses on the screen

127
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are actually critical for young kids.

128
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Those ticks and crosses
represent the 7,800 houses

129
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we've looked at nationally
around Australia,

130
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the same proportion.

131
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What you see on the screen --

132
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35 percent of those not-so-famous houses

133
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lived in by 50,000 indigenous people --

134
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35 percent had a working shower.

135
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Ten percent of those same 7,800 houses
had safe electrical systems.

136
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And 58 percent of those houses
had a working toilet.

137
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These are by a simple, standard test.

138
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In the case of the shower:

139
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does it have hot and cold water,
two taps that work,

140
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a shower rose to get water
onto your head or onto your body,

141
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and a drain that takes the water away?

142
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Not well-designed,
not beautiful, not elegant --

143
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just that they function.

144
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And the same tests
for the electrical system

145
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and the toilets.

146
00:07:21,811 --> 00:07:24,743
Housing for Health projects
aren't about measuring failure --

147
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they're actually about improving houses.

148
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We start on day one of every project.

149
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We've learned -- we don't make promises,
we don't do reports.

150
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We arrive in the morning with tools,
tons of equipment, trades,

151
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and we train up a local team
on the first day to start work.

152
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By the evening of the first day,

153
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a few houses in that community are better
than when we started in the morning.

154
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That work continues for six to 12 months,

155
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until all the houses are improved

156
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and we've spent our budget
of 7,500 dollars total per house.

157
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That's our average budget.

158
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At the end of six months to a year,
we test every house again.

159
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It's very easy to spend money.

160
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It's very difficult to improve

161
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the function of all those
parts of the house.

162
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And for a whole house,
the nine healthy living practices,

163
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we test, check and fix
250 items in every house.

164
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And these are the results we can get
with our 7,500 dollars.

165
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We can get showers
up to 86 percent working,

166
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we can get electrical systems
up to 77 percent working

167
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and we can get 90 percent
of toilets working

168
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in those 7,500 houses.

169
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(Applause)

170
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Thank you.

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(Applause)

172
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The teams do a great job,
and that's their work.

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I think there's an obvious question

174
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that I hope you're thinking about.

175
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Why do we have to do this work?

176
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Why are the houses in such poor condition?

177
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Seventy percent of the work we do
is due to lack of routine maintenance --

178
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the sort of things that happen
in all our houses.

179
00:09:05,261 --> 00:09:09,144
Things wear out, should have been done
by state government or local government,

180
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simply not done, the house doesn't work.

181
00:09:12,378 --> 00:09:16,269
Twenty-one percent of the things we fix
are due to faulty construction --

182
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literally things that are built
upside down and back to front.

183
00:09:19,318 --> 00:09:21,167
They don't work, we have to fix them.

184
00:09:22,081 --> 00:09:27,681
And if you've lived in Australia
in the last 30 years, the final cause --

185
00:09:27,705 --> 00:09:31,360
you will have heard always
that indigenous people trash houses.

186
00:09:31,384 --> 00:09:34,822
It's one of the almost
rock-solid pieces of evidence

187
00:09:34,846 --> 00:09:36,861
which I've never seen evidence for,

188
00:09:36,885 --> 00:09:40,345
that's always reeled out as "That's
the problem with indigenous housing."

189
00:09:40,369 --> 00:09:42,539
Well, nine percent
of what we spend is damage,

190
00:09:42,563 --> 00:09:44,234
misuse or abuse of any sort.

191
00:09:46,120 --> 00:09:49,165
We argue strongly that the people
living in the house

192
00:09:49,189 --> 00:09:50,820
are simply not the problem.

193
00:09:51,384 --> 00:09:53,182
And we'll go a lot further than that;

194
00:09:53,206 --> 00:09:57,019
the people living in the house
are actually a major part of the solution.

195
00:09:57,749 --> 00:10:01,114
Seventy-five percent
of our national team in Australia --

196
00:10:01,138 --> 00:10:03,591
over 75 at the minute --

197
00:10:03,615 --> 00:10:07,943
are actually local, indigenous people
from the communities we work in.

198
00:10:07,967 --> 00:10:09,721
They do all aspects of the work.

199
00:10:10,192 --> 00:10:15,929
(Applause)

200
00:10:15,953 --> 00:10:19,811
In 2010, for example, there were 831,

201
00:10:19,835 --> 00:10:22,408
all over Australia,
and the Torres Strait Islands,

202
00:10:22,432 --> 00:10:26,891
all states, working to improve the houses
where they and their families live,

203
00:10:26,915 --> 00:10:29,174
and that's an important thing.

204
00:10:29,198 --> 00:10:32,308
Our work's always had a focus on health.

205
00:10:32,332 --> 00:10:33,498
That's the key.

206
00:10:34,434 --> 00:10:37,894
The developing world bug,
trachoma, causes blindness.

207
00:10:37,918 --> 00:10:40,284
It's a developing-world illness,

208
00:10:40,308 --> 00:10:42,137
and yet, the picture you see behind

209
00:10:42,161 --> 00:10:45,957
is in an Aboriginal community
in the late 1990s,

210
00:10:45,981 --> 00:10:49,981
where 95 percent of school-aged
kids had active trachoma

211
00:10:50,005 --> 00:10:51,960
in their eyes, doing damage.

212
00:10:53,142 --> 00:10:54,418
OK, what do we do?

213
00:10:54,442 --> 00:10:57,745
Well, first thing we do,
we get showers working.

214
00:10:57,769 --> 00:10:59,610
Why? Because that flushes the bug out.

215
00:10:59,634 --> 00:11:01,975
We put washing facilities
in the school as well,

216
00:11:01,999 --> 00:11:04,736
so kids can wash their faces
many times during the day.

217
00:11:04,760 --> 00:11:06,649
We wash the bug out.

218
00:11:06,673 --> 00:11:10,514
Second, the eye doctors tell us
that dust scours the eye

219
00:11:10,538 --> 00:11:11,855
and lets the bug in quick.

220
00:11:11,879 --> 00:11:13,088
So what do we do?

221
00:11:13,112 --> 00:11:16,612
We call up the doctor of dust,
and there is such a person.

222
00:11:16,636 --> 00:11:18,562
He was loaned to us by a mining company.

223
00:11:18,586 --> 00:11:21,256
He controls dust on mining company sites.

224
00:11:21,280 --> 00:11:23,083
And he came out and, within a day,

225
00:11:23,107 --> 00:11:25,298
it worked out that most dust
in this community

226
00:11:25,322 --> 00:11:28,572
was within a meter of the ground,
the wind-driven dust --

227
00:11:28,596 --> 00:11:31,477
so he suggested making mounds
to catch the dust

228
00:11:31,501 --> 00:11:35,223
before it went into the house area
and affected the eyes of kids.

229
00:11:35,247 --> 00:11:38,790
So we used dirt to stop dust.

230
00:11:38,814 --> 00:11:41,582
We did it. He provided us dust monitors.

231
00:11:41,606 --> 00:11:44,062
We tested and we reduced the dust.

232
00:11:44,086 --> 00:11:46,287
Then we wanted to get rid
of the bug generally.

233
00:11:46,311 --> 00:11:47,461
So how do we do that?

234
00:11:47,485 --> 00:11:52,219
Well, we call up the doctor of flies --
and, yes, there is a doctor of flies.

235
00:11:52,728 --> 00:11:54,282
As our Aboriginal mate said,

236
00:11:54,306 --> 00:11:56,417
"You white fellows ought to get out more."

237
00:11:56,441 --> 00:11:58,671
(Laughter)

238
00:11:58,695 --> 00:12:01,800
And the doctor of flies
very quickly determined

239
00:12:01,824 --> 00:12:05,902
that there was one fly
that carried the bug.

240
00:12:05,926 --> 00:12:08,349
He could give school kids
in this community

241
00:12:08,373 --> 00:12:11,551
the beautiful fly trap you see
above in the slide.

242
00:12:11,575 --> 00:12:14,111
They could trap the flies,
send them to him in Perth.

243
00:12:14,635 --> 00:12:16,088
When the bug was in the gut,

244
00:12:16,112 --> 00:12:19,079
he'd send back by return post
some dung beetles.

245
00:12:19,103 --> 00:12:21,396
The dung beetles ate the camel dung,

246
00:12:21,420 --> 00:12:23,166
the flies died through lack of food,

247
00:12:23,190 --> 00:12:24,499
and trachoma dropped.

248
00:12:24,523 --> 00:12:30,336
And over the year, trachoma dropped
radically in this place, and stayed low.

249
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We changed the environment,
not just treated the eyes.

250
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And finally, you get a good eye.

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All these small health gains

252
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and small pieces of the puzzle
make a big difference.

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The New South Wales Department of Health,

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that radical organization,

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did an independent trial over three years

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to look at 10 years of the work
we've been doing

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in these sorts of projects
in New South Wales.

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And they found a 40 percent reduction
in hospital admissions

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for the illnesses that you could attribute
to the poor environment --

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a 40 percent reduction.

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(Applause)

262
00:13:15,845 --> 00:13:18,567
Just to show that the principles
we've used in Australia

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can be used in other places,

264
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I'm just going to go
to one other place, and that's Nepal.

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And what a beautiful place to go.

266
00:13:24,350 --> 00:13:27,711
We were asked by a small
village of 600 people

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to go in and make toilets
where none existed.

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Health was poor.

269
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We went in with no grand plan,

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no grand promises of a great program,

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just the offer to build
two toilets for two families.

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It was during the design
of the first toilet

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that I went for lunch,

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invited by the family
into their main room of the house.

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It was choking with smoke.

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00:13:50,898 --> 00:13:54,473
People were cooking
on their only fuel source, green timber.

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00:13:54,497 --> 00:13:56,594
The smoke coming off
that timber is choking,

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00:13:56,618 --> 00:13:59,318
and in an enclosed house,
you simply can't breathe.

279
00:14:00,048 --> 00:14:03,938
Later we found the leading cause
of illness and death

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in this particular region
is through respiratory failure.

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So all of a sudden, we had two problems.

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We were there originally
to look at toilets

283
00:14:11,777 --> 00:14:14,075
and get human waste
off the ground, that's fine.

284
00:14:14,099 --> 00:14:17,013
But all of a sudden now
there was a second problem:

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How do we actually get the smoke down?

286
00:14:18,886 --> 00:14:22,922
So two problems, and design should
be about more than one thing.

287
00:14:22,946 --> 00:14:26,516
Solution: Take human waste,
take animal waste,

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00:14:26,540 --> 00:14:29,898
put it into a chamber,
out of that, extract biogas,

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00:14:29,922 --> 00:14:31,561
methane gas.

290
00:14:31,585 --> 00:14:34,986
The gas gives three to four
hours cooking a day --

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clean, smokeless and free for the family.

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00:14:38,674 --> 00:14:43,818
(Applause)

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00:14:43,842 --> 00:14:46,726
I put it to you:
is this eliminating poverty?

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00:14:46,750 --> 00:14:51,162
And the answer from the Nepali team
who's working at the minute would say,

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don't be ridiculous --

296
00:14:52,361 --> 00:14:54,433
we have three million
more toilets to build

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00:14:54,457 --> 00:14:57,308
before we can even make
a stab at that claim.

298
00:14:57,332 --> 00:15:00,291
And I don't pretend anything else.

299
00:15:00,315 --> 00:15:02,973
But as we all sit here today,

300
00:15:02,997 --> 00:15:04,833
there are now over 100 toilets built

301
00:15:04,857 --> 00:15:07,270
in this village and a couple nearby.

302
00:15:07,294 --> 00:15:10,743
Well over 1,000 people use those toilets.

303
00:15:10,767 --> 00:15:13,942
Yami Lama, he's a young boy.

304
00:15:13,966 --> 00:15:18,270
He's got significantly less gut infection
because he's now got toilets,

305
00:15:18,294 --> 00:15:20,654
and there isn't human waste on the ground.

306
00:15:22,040 --> 00:15:25,357
Kanji Maya, she's a mother,
and a proud one.

307
00:15:25,381 --> 00:15:29,824
She's probably right now
cooking lunch for her family

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00:15:29,848 --> 00:15:32,293
on biogas, smokeless fuel.

309
00:15:32,317 --> 00:15:33,563
Her lungs have got better,

310
00:15:33,587 --> 00:15:35,563
and they'll get better as time increases,

311
00:15:35,587 --> 00:15:37,768
because she's not cooking
in the same smoke.

312
00:15:37,792 --> 00:15:40,394
Surya takes the waste
out of the biogas chamber

313
00:15:40,418 --> 00:15:43,335
when it's shed the gas,
he puts it on his crops.

314
00:15:43,359 --> 00:15:46,057
He's trebled his crop income,

315
00:15:46,081 --> 00:15:48,996
more food for the family
and more money for the family.

316
00:15:49,020 --> 00:15:53,774
And finally Bishnu,
the leader of the team,

317
00:15:53,798 --> 00:15:56,961
has now understood that not only
have we built toilets,

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00:15:56,985 --> 00:15:59,137
we've also built a team,

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00:15:59,161 --> 00:16:01,793
and that team is now
working in two villages

320
00:16:01,817 --> 00:16:04,290
where they're training up
the next two villages

321
00:16:04,314 --> 00:16:06,144
to keep the work expanding.

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00:16:06,168 --> 00:16:07,793
And that, to me, is the key.

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(Applause)

324
00:16:12,508 --> 00:16:15,212
People are not the problem.

325
00:16:16,609 --> 00:16:18,196
We've never found that.

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00:16:18,220 --> 00:16:20,915
The problem: poor living environment,

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00:16:20,939 --> 00:16:23,907
poor housing and the bugs
that do people harm.

328
00:16:25,137 --> 00:16:30,876
None of those are limited by geography,
by skin color or by religion.

329
00:16:30,900 --> 00:16:32,278
None of them.

330
00:16:33,087 --> 00:16:35,540
The common link between all
the work we've had to do

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00:16:35,564 --> 00:16:37,435
is one thing, and that's poverty.

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00:16:39,410 --> 00:16:43,187
Nelson Mandela said, in the mid-2000s,
not too far from here,

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00:16:43,211 --> 00:16:49,492
he said that like slavery and apartheid,
"Poverty is not natural.

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00:16:49,516 --> 00:16:53,375
It is man-made and can be
overcome and eradicated

335
00:16:53,399 --> 00:16:55,523
by the actions of human beings."

336
00:16:56,864 --> 00:16:58,173
I want to end by saying

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00:16:58,197 --> 00:17:04,354
it's been the actions of thousands
of ordinary human beings

338
00:17:04,378 --> 00:17:07,603
doing -- I think -- extraordinary work,

339
00:17:07,627 --> 00:17:10,271
that have actually improved health,

340
00:17:10,295 --> 00:17:13,416
and, maybe only in a small way,
reduced poverty.

341
00:17:13,440 --> 00:17:15,112
Thank you very much for your time.

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00:17:15,136 --> 00:17:21,841
(Applause)