All posts by CJPaul

How we should have prepared…

When Dohyeong Kim and I were drafting this paper in December, we had no inkling of the next coronavirus pandemic around the corner. Moral of the story, of course, is be prepared, and that public health needs to be a core function of government!

Kim H, Kim D, Paul CJ, Lee CK. The spatial allocation of hospitals with negative pressure isolation rooms in Korea: are we prepared for new outbreaks? International Journal of Health Policy Management. In Press. doi:10.34172/ijhpm.2020.118

Food Environment of HBCUs

Nice coverage on work I have been part of with Helene Vilme on the food deserts near HBCUs:

Using Geographic Information Systems to Characterize Food Environments Around Historically Black Colleges and Universities: Implications for Nutrition Interventions,” Helene Vilme, Christopher J. Paul, Naomi N. Duke, Santiba D. Campbell, Derrick Sauls, Charles Muiruri, Asheley C. Skinner, Hayden Bosworth, Yussif M. Dokurugu and John P. Fay; Journal of American College Health, June 22, 2020. DOI:

Coverage on NPR:

Ray Eurquhart Oral History

Friends, I’ve had an amazing experience in writing, history, and teaching I’d love to share:

An incredible person and civil rights stalwart, Ray Eurquhart, passed away March 30th, and I remembered fondly getting to know him as a student activist. I interviewed him for an oral history class, but hadn’t looked back at my files. I was surprised then, when I was told my project was listed in the Duke Archives and they were looking to gather materials on Ray for his memorial. Fortunately, I still had my files as the archives (and audio tapes) are current inaccessible, and was moved by Ray’s story as I re-read it, and the way that this undergrad project I did nearly 20 years ago is still growing me. This quality and the fact that it was properly archived, is thanks to the incredible teaching of my dear professor, Charlie Thompson. It goes to show that a true teacher influences their students to grow far and long beyond the classroom.

I hope you might want to read Brother Ray’s story too, and remember this incredible Durham citizen:

Meltdown: Why Our Systems Fail and What We Can Do About It (Review)

Book Review

Meltdown: Why Our Systems Fail and What We Can Do About It

Chris Clearfield and Andrȧs Tilcsik

Penguin Press 2018

In my field of global environmental health, one of the great failures of development funding was the drilling of thousands of wells in Bangladesh to reduce water-borne disease, only to belatedly discover that this “solution” introduced a wholly new disaster from arsenic in the groundwater. Thus, as noble-missioned an organization as UNICEF inadvertently perpetrated  “the largest poisoning in history” by not recognizing systematic risk.

This sort of unintended consequence and systematic failure, even by well intentioned actors, is the type of problem that Chris Clearfield and Andrȧs Tilcsik aim to prevent through better system design in their award-winning book, Meltdown: Why Our systems Fail and What We Can Do About It.

The book starts off with a litany of system failures across industries and scales, from airplanes and nuclear power plants, to Starbucks coffee and cooking our Thanksgiving meal. In our modern world, as both systems and problems become more complex and more intertwined (“coupled”), the possibility and scope of disaster grows.

Fortunately for us, the majority of Meltdown is oriented towards solutions that are relevant from our own kitchen all the way to a war room in prevention problems from becoming disasters. Chris and Andrȧs offer specific, actionable advice and tools to improve our systems for reducing disaster.

Meltdown is an excellent book for anyone curious about making lives, communities, and the world more resilient. The stories are relevant, authentic, and engaging, and lead directly to lessons worth trying out in our own organizations and systems. In world that at times can feel like it is replete with disaster Chris and Andrȧs remind us that we can take small steps in any place to improve the robustness of our systems to stop meltdowns of the large and small.

Long-lasting mosquito nets work (but kids need better protection)

Pleased to report that Dohyeong Kim and I, along with Gi-geun Yang and Anh Pham, have published another long-churning manuscript, and on that I think is quite valuable in enforcing malaria control programs with the use of nets.

This meta-analysis underscores how hard it is to protect children from malaria (by getting them to sleep under nets). Given that today is my daughters 4th birthday, I know how hard it is to get children under five to sleep in their own beds 🎉😯

Yang GG, Kim D, Pham A, Paul CJ. 2018. A Meta-Regression Analysis of the Effectiveness of Mosquito Nets for Malaria Control: The Value of Long-Lasting Insecticide Nets. International Journal of Environmental Research in Public Health 15(3):546.

Can Ethiopia be resilient?

In my latest paper, I explore the development of Ethiopia’s Climate Resilient Green Economy in the period 2011-2014. Ethiopia, currently is under tremendous political pressure and change, which makes the resilience of its economy and society even more important.

Christopher John Paul & Erika Weinthal (2018) The development of Ethiopia’s Climate Resilient Green Economy 2011–2014: implications for rural adaptation, Climate and Development, DOI: 10.1080/17565529.2018.1442802


Social capital, trust, and adaptation to climate change: Evidence from rural Ethiopia

A key component of my dissertation research has been published in Global Environmental Change in which we find that social capital as measured by trust is indeed associated with increased cooperation, but may however be detrimental to private household-level adaptation.

Here is the abstract: “Climate change is expected to have particularly severe effects on poor agrarian populations. Rural households in developing countries adapt to the risks and impacts of climate change both individually and collectively. Empirical research has shown that access to capital—financial, human, physical, and social—is critical for building resilience and fostering adaptation to environmental stresses. Little attention, however, has been paid to how social capital generally might facilitate adaptation through trust and cooperation, particularly among rural households and communities. This paper addresses the question of how social capital affects adaptation to climate change by rural households by focusing on the relationship of household and collective adaptation behaviors. A mixed-methods approach allows us to better account for the complexity of social institutions—at the household, community, and government levels—which drive climate adaptation outcomes. We use data from interviews, household surveys, and field experiments conducted in 20 communities with 400 households in the Rift Valley of Ethiopia. Our results suggest that qualitative measures of trust predict contributions to public goods, a result that is consistent with the theorized role of social capital in collective action. Yet qualitative trust is negatively related to private household-level adaptation behaviors, which raises the possibility that social capital may, paradoxically, be detrimental to private adaptation. Policymakers should account for the potential difference in public and private adaptation behaviors in relation to trust and social capital when designing interventions for climate adaptation.”

Data replication materials (Stata .do and .dta) are available.

Barriers in malaria policymaking: stakeholder perspectives vs. academic research

In my recent publication, Identifying barriers in the malaria control policymaking process in East Africa: insights from stakeholders and a structured literature review” in BMC Public Health, my coauthors and I combine fieldwork with stakeholders and qualitative analysis of the scientific literature. As part of a large multi-faceted research program on malaria policy led by Randy Kramer, in this paper we specifically explore the barriers in the policy process to achieving effective malaria control. We identify certain points in the policy process (as shown the in figure) when barriers prevent advancement of malaria control policy. We then contrast the concerns of stakeholders (e.g. politics; access to research; access to funds) with the focus of the academic literature (technical challenges; health systems). This paper represents an effort for stakeholder driven research and tools, and notes the importance for bridging academic research with policymaking.

Barriers in the Policy Cycle


Paul CJ, Kramer RA, Lesser A, Mutero CM, Miranda ML, Dickinson K. 2015. Identifying barriers in the malaria control policymaking process in East Africa: insights from stakeholders and a structured literature review. BMC Public Health 15(1): 862.

Social Capital in Post-Disaster Recovery (Book Review)

Social Capital in Post-Disaster Recovery (Review)

Christopher J. Paul, Duke University. March 17, 2015.

Daniel P. Aldrich. 2012. Social Capital in Post-Disaster Recovery. Chicago: University of Chicago Press.

Social capital has been derided as a catchall theory that is imprecise in its mechanisms, unit of analysis, and practical implications. Yet, this book adds to the extensive evidence that suggests social relations play an important role in outcomes such as collective action, civic participation, and in this work, resilience to shocks.1,2

In Social Capital in Post-Disaster Recovery, Daniel Aldrich demonstrates the central role of social capital in promoting recovery across four major disasters, from the 1923 earthquake in Tokyo, the Kobe 1995 earthquake, the Indian Ocean Tsunami of 2004, to Hurricane Katrina in New Orleans in 2005. Aldrich defines social capital as “the networks and resources available to people through their connections to others.” He uses a variety of measures of social capital, from voter turnout to participation in funerals, to evaluate their influence on post-disaster recovery, as measured by population growth and recovery aid.

Continue reading Social Capital in Post-Disaster Recovery (Book Review)