COVER STORY

What Next

Four women leaders on transformations in their fields.

Indian female soldiers belonging to the 103 Battalion of the Rapid Action Force, attend a function before their departure to Liberia as a part of the United Nations peacekeeping forces in New Delhi, India, Thursday, Jan. 18, 2007. The group is the first all women team from India to undertake a United Nations peacekeeping assignment. (AP Photo/Mustafa Quraishi)
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Gail R. Wilensky, Michelle Rhee, Karina L. Edmonds and Anu Bhagwati
July 12, 2012, 1 p.m.

Gender Par­ity in Uni­form

The solu­tion to sexu­al-ab­use scan­dals is not to se­greg­ate and cir­cum­scribe wo­men. It’s the op­pos­ite.

By Anu Bhag­wati

The re­cent scan­dal at Lack­land Air Force Base in Texas, where 11 in­struct­ors have been charged with rape, sexu­al as­sault, or sexu­al mis­con­duct in­volving at least 31 fe­male re­cruits, is the latest ex­ample of the U.S. mil­it­ary’s prob­lem with sexu­al pred­at­ors in the ranks. Sexu­al as­saults — more than 19,000 per year, ac­cord­ing to the De­fense De­part­ment — have dev­ast­ated vic­tims and shamed the mil­it­ary for dec­ades. Gen. Ed­ward Rice, re­spons­ible for ba­sic train­ing of all Air Force per­son­nel, even fell back on a dodge used by oth­er mil­it­ary com­mand­ers fa­cing sexu­al-as­sault crises: He told re­port­ers that one solu­tion he was en­ter­tain­ing would se­greg­ate the train­ing of male and fe­male re­cruits. (If we sep­ar­ate and pro­tect our fe­male troops, they will be spared the ab­uses com­mit­ted by their male coun­ter­parts, this think­ing goes.)

The idea doesn’t just reek of a pa­ter­nal­ism and a sex­ism that works against both sexes. It also won’t fix the prob­lem, be­cause se­greg­ated train­ing en­vir­on­ments still ex­per­i­ence high rates of sexu­al as­sault. To truly end rape, weed out sexu­al pred­at­ors, and pro­fes­sion­al­ize the force, the United States needs to take a much more ser­i­ous look at the roles wo­men play in glob­al mil­it­ary and se­cur­ity op­er­a­tions — and ad­apt its force to meet the needs of an in­creas­ingly in­sec­ure and in­ter­con­nec­ted plan­et. This will mean in­creas­ing lead­er­ship re­spons­ib­il­it­ies and front­line as­sign­ments for wo­men throughout the armed forces.

The first case study comes from the U.N., which cre­ated pre­dom­in­antly or all-fe­male peace­keep­ing units as a way to min­im­ize the many sexu­al as­saults com­mit­ted by blue hel­mets against loc­al wo­men and girls around the globe. This plan has had tre­mend­ously pos­it­ive res­ults for glob­al se­cur­ity, and — as a much wel­come side ef­fect — for the U.N.’s repu­ta­tion. Last year, I had the good for­tune to meet Rock­far Sul­tana Ka­hanam, then the com­mand­er of the Bangladesh Fe­male Formed Po­lice Unit, a mostly fe­male peace­keep­ing force provid­ing post-earth­quake se­cur­ity in Haiti. Rock­far told me that all of her of­ficers were wo­men and that her unit was well liked and re­spec­ted, in large part be­cause the Haitian people ten­ded to trust her fe­male peace­keep­ers.

In­deed, wo­men’s par­ti­cip­a­tion in se­cur­ity op­er­a­tions, es­pe­cially in lead­er­ship po­s­i­tions, helps and el­ev­ates every­one in­volved: Loc­al trust in for­eign se­cur­ity pro­viders in­creases; sexu­al as­saults com­mit­ted against loc­al wo­men and girls de­crease; fe­male peace­keep­ers get crit­ic­al ex­per­i­ence that they can in­sti­tu­tion­al­ize in­to best prac­tices for the U.N.; and wo­men be­come key par­ti­cipants in se­cur­ity dis­cus­sions, al­low­ing them to in­flu­ence glob­al out­comes over time.

Lest we think of the U.N. as too soft an in­sti­tu­tion for com­par­is­on, let’s also take a look at les­sons learned from coun­ter­insur­gency op­er­a­tions in Ir­aq and Afgh­anistan. Be­cause of the need to re­spect loc­al cul­tur­al norms about gender, Amer­ic­an wo­men have been ex­posed to ground com­bat un­think­able to pre­vi­ous gen­er­a­tions of wo­men in uni­form. Wo­men have filled a need not only in hu­man­it­ari­an ef­forts and civil-af­fairs cap­ab­il­it­ies (win­ning “hearts and minds”) but have also worked along­side spe­cial op­er­at­ors and in­fan­try­men. They have the com­bat-hero­ism awards to show for it.

In many cases, Afghan vil­la­gers have been more likely to trust, open up to, and re­veal in­tel­li­gence to the Mar­ine Corps’ Fe­male En­gage­ment Teams than to their male coun­ter­parts. These FET Mar­ines have been so suc­cess­ful in U.S. op­er­a­tions in Afgh­anistan that our NATO al­lies fol­lowed suit by de­ploy­ing sim­il­ar teams of their own.

The glob­al po­ten­tial here is end­less. Se­cur­ity con­tract­ors, also ac­cused of crim­in­al activ­ity over­seas ran­ging from sexu­al as­sault to murder of ci­vil­ians, could pro­fes­sion­al­ize their forces and po­ten­tially reap a profit from the loc­al de­mand for wo­men as se­cur­ity pro­viders. And don’t over­look the per­vas­ive sexu­al ex­ploit­a­tion and sex traf­fick­ing of wo­men and girls by ser­vice mem­bers, de­fense con­tract­ors, U.N. per­son­nel, and com­mer­cial se­cur­ity work­ers world­wide, which have promp­ted con­gres­sion­al in­vest­ig­a­tions, ma­jor me­dia cov­er­age, and even an ex­ec­ut­ive or­der by former Pres­id­ent George W. Bush that made “pat­ron­iz­ing a pros­ti­tute” il­leg­al un­der mil­it­ary law. Con­tinu­ing scan­dals like the one in­volving Secret Ser­vice and mil­it­ary per­son­nel earli­er this year in Cart­agena, Colom­bia, il­lus­trate a deeply en­trenched prob­lem. Wo­men’s in­creased pres­ence in se­cur­ity op­er­a­tions would min­im­ize the sexu­al ex­ploit­a­tion and traf­fick­ing of wo­men, girls, and boys by glob­al se­cur­ity forces.

When sexu­al as­sault per­vades a mil­it­ary in­sti­tu­tion, a large part of the solu­tion lies in nor­mal­iz­ing the pres­ence of wo­men in uni­form and in­creas­ing their lead­er­ship op­por­tun­it­ies. This can only be done by drastic­ally in­creas­ing the num­bers of wo­men en­ter­ing the mil­it­ary, ex­pos­ing uni­formed men to uni­formed wo­men at all ranks, and open­ing up as­sign­ments cur­rently closed to wo­men, as many of our al­lies (such as Aus­tralia and Canada) have already done. Amer­ica’s mil­it­ary lead­er­ship needs to start think­ing dif­fer­ently now, or we can ex­pect to see many more Lack­lands.

Anu Bhag­wati, a former Mar­ine Corps cap­tain, is ex­ec­ut­ive dir­ect­or of Ser­vice Wo­men’s Ac­tion Net­work.

Made by the USA

Amer­ica’s na­tion­al labs are cook­ing up new ideas.

By Karina L. Ed­monds

Engineer Takafumi Ueno, of 4R Energy Corp., a Nissan Motor Co.'s joint venture with Suminoto Corp., shows Nissan Leaf's four lithium-ion batteries placed in a box which are used as an electricity storage for a solar-assisted EV charging system at Nissan's global headquarters in Yokohama, Monday, July 11, 2011. Nissan is testing a super-green way to recharge its Leaf electric vehicle using solar power, part of a broader drive to improve electricity storage systems. 4R Energy Corp. plans to offer eletricity storage systems like the one at Nissan headquarters for business and public facilities as a commercial product by 2016. (AP Photo/Koji Sasahara) ASSOCIATED PRESS

Can you ima­gine a world where sol­ar pan­els are in­teg­rated in­to our clothes to power our mo­bile devices while we send com­mands with a wink of an eye? If his­tory is any in­dic­a­tion, this can be the fu­ture.

Tech­no­logy has pro­gressed hand in hand with the ma­ter­i­als avail­able to so­ci­ety. From the Stone Age to the In­dus­tri­al Re­volu­tion to clean-en­ergy in­nov­a­tions, hu­man­ity has used what’s avail­able to press for­ward with bet­ter solu­tions to ur­gent prob­lems. Some 500,000 years ago, for ex­ample, hu­mans used flint, wood, and stone to dis­cov­er fire. With a few com­mon ma­ter­i­als, they found something that would forever change the world.

Now we have that same op­por­tun­ity — in clean en­ergy. Without cost-ef­fect­ive sil­ic­on-wafer man­u­fac­tur­ing, we couldn’t have today’s cell phones, laptops, iPods, and oth­er port­able devices. The same can also be said for clean-en­ergy in­nov­a­tions, from bet­ter cath­odes for bat­ter­ies, mem­branes for fuel cells, or al­gae for bio­fuels.

The En­ergy De­part­ment is in­vest­ing in the sci­ence that will drive eco­nom­ic growth in the years ahead, spurred by our na­tion­al labor­at­or­ies and uni­versit­ies. Over the past dozen years, the de­part­ment has in­ves­ted in both ba­sic R&D and ap­plied com­mer­cial­iz­a­tion ef­forts that are de­liv­er­ing real be­ne­fits for Amer­ic­an com­pan­ies and the eco­nomy.

Take bat­tery tech­no­logy. Ar­gonne Na­tion­al Labor­at­ory has con­duc­ted re­search that has res­ul­ted in more than a 50 per­cent in­crease in en­ergy-stor­age ca­pa­city over con­ven­tion­al cath­ode ma­ter­i­als used in lith­i­um-ion bat­ter­ies, of­fer­ing the longest-last­ing en­ergy avail­able in the smal­lest, light­est pack­age. As a res­ult, bet­ter-per­form­ing elec­tric vehicles are hit­ting the road.

Fuel cells, which can be used for everything from power gen­er­a­tion to trans­port­a­tion, are also in de­vel­op­ment. Cur­rently, plat­in­um is the most ef­fi­cient elec­trocata­lyst for the cells, but plat­in­um-based cata­lysts are ex­pens­ive and not es­pe­cially dur­able. To ad­dress this prob­lem, Brookhaven Na­tion­al Labor­at­ory has de­veloped new ones that have high activ­ity, sta­bil­ity, and dur­ab­il­ity, while con­tain­ing only about one-tenth the plat­in­um of the con­ven­tion­al cata­lysts used in fuel cells — sig­ni­fic­antly re­du­cing over­all costs.

At Pa­cific North­w­est Na­tion­al Labor­at­ory and at DOE’s Bioen­ergy Re­search Cen­ters, sci­ent­ists have found that al­gae have sev­er­al ad­vant­ages over oth­er bio­fuel sources. Be­cause they con­sume car­bon di­ox­ide, al­gae can feed off the car­bon emis­sions from power plants. And be­cause they can di­gest ni­tro­gen and phos­phor­ous, they can also grow in (and treat) mu­ni­cip­al wastewa­ter. Even­tu­ally, al­gae-based bio­fuels can be an al­tern­at­ive to the fossil fuels used for trans­port­a­tion — and can pos­sibly re­duce de­pend­ence on im­por­ted oil.

These are just a few of the amaz­ing sci­entif­ic dis­cov­er­ies that can spur en­tirely new in­dus­tries we have yet to ima­gine. Who knows? Fire has already been dis­covered, but clean-en­ergy tech­no­lo­gies have the same po­ten­tial to change everything.

Karina L. Ed­monds is the En­ergy De­part­ment’s point per­son for help­ing the private sec­tor ad­opt new en­ergy tech­no­lo­gies and col­lab­or­ate with the gov­ern­ment’s na­tion­al labor­at­or­ies.

The Right In­cent­ives

Pay for per­form­ance is stand­ard in the private sec­tor. Why not in schools?

By Michelle Rhee

Teacher Martha Cedeno reads a story to her first grade class at Miramonte Elementary School in Los Angeles after the campus re-opened with all-new slate of teachers and administrators on Thursday, Feb. 9, 2012. The campus was closed for two days by Los Angeles Unified School District to replace the staff after two teachers where charged with lewd acts on students. (AP Photo/Los Angeles Times, Ifran Khan, Pool) ASSOCIATED PRESS

When we think about in­nov­a­tion in our schools, what may come to mind are smart boards, tab­lets, and oth­er high-tech devices. Something more fun­da­ment­al, however, can play an even great­er role in bring­ing pro­gress in­to our classrooms: re­form­ing teach­er com­pens­a­tion.

The most crit­ic­al factor that af­fects stu­dent achieve­ment is teach­er qual­ity. It mat­ters more than gad­gets, class size, or the con­di­tion of the build­ing. Yet the out­dated and ri­gid way we pay teach­ers doesn’t re­flect the im­port­ance of the pro­fes­sion.

Con­sider a real-life ex­ample. The start­ing salary for a teach­er in Colum­bus, Ohio, is $42,333. Teach­ers there, like in most states, are com­pensated in lock­step, based on time served. After three years on the job, teach­ers re­ceive a salary boost of about $1,700 a year. So it typ­ic­ally takes 13 years to earn a $60,000 salary, re­gard­less of wheth­er a teach­er works ex­tra hours, takes on ad­ded re­spons­ib­il­it­ies, or teaches a hard-to-staff sub­ject in a high-needs school. And, most im­port­ant, the pay rises wheth­er or not teach­ers help stu­dents make aca­dem­ic gains.

Now, ima­gine a world in which ex­cel­lence in the classroom is re­war­ded with salary in­creases and bo­nuses. Ima­gine a world where highly ef­fect­ive teach­ers can earn $60,000 — or much more — in just a few years. Dis­tricts across the coun­try can do this right now, and they can use fed­er­al funds, through the Edu­ca­tion De­part­ment’s Title II pro­gram. This money is avail­able to both states and school dis­tricts for pro­grams that im­prove teach­er qual­ity. Too of­ten, though, re­cip­i­ents use the cash in in­ef­fect­ive ways, sup­port­ing gen­er­ic pro­fes­sion­al-de­vel­op­ment pro­grams that aren’t tailored to teach­ers’ needs. Poli­cy­makers and state and dis­trict ad­min­is­trat­ors should re­think such prac­tices and look to Title II fund­ing to help build com­pens­a­tion sys­tems that re­ward and re­tain great teach­ers.

Since the money is there, it’s reas­on­able to ask why states and dis­tricts aren’t already us­ing it in this com­mon­sense way. There are two reas­ons. First, fed­er­al funds that are in­ten­ded to help dis­tricts re­ima­gine their sys­tems are in­stead of­ten used to ex­pand ex­ist­ing pro­grams, typ­ic­ally without ad­equate con­sid­er­a­tion of wheth­er those pro­grams are serving schools well. The second reas­on is even more prob­lem­at­ic and will take more polit­ic­al muscle to turn around. In many states, laws ham­string dis­tricts by man­dat­ing that pay scales be based on a teach­er’s length of ser­vice or de­grees earned — neither of which is strongly linked to stu­dent learn­ing — in­stead of job per­form­ance. Where such policies stand in the way of re­form, we have to re­place them with new laws. Flor­ida, In­di­ana, and Michigan have changed their laws to re­quire that ad­min­is­trat­ors factor a teach­er’s job per­form­ance in­to his or her salary.

I’ve seen per­form­ance pay work. In Wash­ing­ton, D.C., when I was chan­cel­lor, we launched a sys­tem in which highly ef­fect­ive teach­ers can get paid up to $130,000. As a res­ult, I saw com­mit­ted edu­cat­ors stay in the classroom, where they are so badly needed, rather than move in­to more-luc­rat­ive fields.

Michelle Rhee, the former Wash­ing­ton, D.C., pub­lic schools chan­cel­lor, is founder and CEO of Stu­dents­First, a na­tion­al bi­par­tis­an edu­ca­tion-re­form group.

Big Idea in a Small Place

How bio­mark­ers could trans­form medi­cine.

By Gail R. Wi­lensky

The SCOUT(TM) DS diabetes screening system is being designed to detect individuals at risk for diabetes and pre-diabetes by measuring AGE skin biomarkers using fluorescent light. A study of the prototype published in the May 2007 issue of Diabetes Care showed it significantly outperformed both the Fasting Plasma Glucose (FPG) test and the A1C conventional blood tests used to screen for the disease. Slated for market introduction in 2008, SCOUT DS is developed by VeraLight, Inc., of Albuquerque, New Mexico (USA). (PRNewsFoto/VeraLight, Inc.) PR NEWSWIRE

When Na­tion­al Journ­al asked me what I thought was the most prom­ising in­nov­a­tion in health care, I first tried to think, prob­ably like most people, of a new in­stru­ment or a hand­held device that might help doc­tors get us well quick­er or keep us in our homes longer as we age. But now, I sub­mit something dif­fer­ent: the in­creas­ing use of bio­mark­ers, usu­ally gene- or pro­tein-based com­pounds, to in­dic­ate the pres­ence or risk of dis­ease or to fight it on a more tar­geted basis — which means more cost-ef­fect­ively. These are big is­sues for an aging, over­weight pop­u­la­tion.

Bio­mark­ers are not new. Phys­i­cians already use hemo­globin A1c to meas­ure gluc­ose levels for dia­bet­ics and PSAs, or pro­state-spe­cif­ic an­ti­gens, a pro­tein that (some­what un­re­li­ably) sug­gests a risk of de­vel­op­ing pro­state can­cer. Oth­er mark­ers can be used to in­dic­ate wheth­er a dis­ease ex­ists, how the dis­ease will de­vel­op, or the prob­able ef­fect of a treat­ment. They may also mod­ern­ize drug de­vel­op­ment by help­ing to pre­dict what kind of pa­tients will be­ne­fit from new drug re­gi­mens, re­du­cing the time and money it takes for drugs to be tested and ap­proved.

The really prom­ising bio­mark­ers, however, are the ones that are still be­ing de­veloped — to treat can­cer, heart dis­ease, and po­ten­tially even neur­o­lo­gic­al dis­eases such as Alzheimer’s.

We have prob­ably heard the most about how bio­mark­ers might help doc­tors de­tect can­cer earli­er and choose the best drug for a par­tic­u­lar pa­tient, ac­count­ing not only for the tu­mor type but also his or her own bio­mark­ers. The pres­ence or ab­sence of es­tro­gen re­cept­ors or HER-2/neu (hu­man epi­derm­al growth factor re­cept­or 2) as a guide to the ap­pro­pri­ate treat­ment of breast can­cer re­ceived a lot of at­ten­tion in re­cent years, but there are now bio­mark­ers for colorectal, gast­ric, blood, lymph­at­ic, lung, and skin can­cers as well.

Re­search­ers are also in­vest­ig­at­ing ways that bio­mark­ers can dia­gnose strokes, which would al­low for earli­er and less in­vas­ive treat­ment. Be­cause heart dis­ease (in­clud­ing strokes) and can­cers are the most com­mon causes of death in the United States, these ad­vances have great po­ten­tial.

Bio­mark­ers of­fer a lot of prom­ise, but po­ten­tial bar­ri­ers ex­ist. The data are com­plex and fre­quently re­quire new mod­el­ing to help us un­der­stand what they mean. But sci­ent­ists are mak­ing pro­gress us­ing enorm­ous data sets. Se­quen­cing the hu­man gen­ome was a $3 bil­lion pro­ject that took 10 years. New pro­jects aim to cost $1,000 per gen­ome. The IT re­quire­ments to pro­cess these data are also for­mid­able. What’s more, dif­fer­ent com­puter sys­tems — between dif­fer­ent hos­pit­als, and some­times even those with­in a single hos­pit­al — can’t talk to each oth­er. Even the De­fense De­part­ment and the Vet­er­ans Af­fairs De­part­ment, the two agen­cies with the most ad­vanced elec­tron­ic med­ic­al re­cords, can’t yet share in­pa­tient data (al­though they can now share oth­er types of data). And, of course, re­search­ers — and the com­pan­ies that spon­sor them — of­ten have few in­cent­ives to share in­form­a­tion.

Fi­nally, for the coun­try to learn how to treat bet­ter and to spend smarter, pa­tients, prac­ti­tion­ers, and in­surers will have to ad­just their views about ap­pro­pri­ate treat­ment strategies: Ex­pens­ive, but fre­quently less in­vas­ive, ther­apies should be en­cour­aged (i.e., with low co-pays) for those who might ex­per­i­ence sig­ni­fic­ant clin­ic­al gains and should be dis­cour­aged (i.e., with high co-pays) for those with a low like­li­hood of clin­ic­al be­ne­fit. Get­ting agree­ment on the lat­ter will be tough for the United States — al­though it’s com­mon­place for the rest of the world — even without good bio­mark­ers at hand. Good, cred­ible, ob­ject­ive data that sup­port these treat­ment de­cisions will be crit­ic­al. This is the func­tion of the newly cre­ated Pa­tient-Centered Out­comes Re­search In­sti­tute that was in­cluded in the Af­ford­able Care Act. In­creas­ing the fin­an­cial sup­port for this cen­ter would be es­pe­cially help­ful.

Gail R. Wi­lensky, Ph.D., is a seni­or fel­low at Pro­ject HOPE; a former ad­min­is­trat­or of HCFA, now CMS; and a former chair of the Medi­care Pay­ment Ad­vis­ory Com­mis­sion.

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