The constant thud underneath your feet, the constrained space, and the monotony of going nowhere fast.
It feels like hours have gone by, but it's only been eleven minutes, and you wonder, "Why am I torturing myself?
This thing has got to be considered a cruel and unusual punishment."
Actually, that's exactly what it is, or was.
You see, in the 1800s, treadmills were created to punish English prisoners.
At the time, the English prison system was abysmally bad.
Execution and deportation were often the punishments of choice, and those who were locked away faced hours of solitude in filthy cells.
So social movements led by religious groups, philanthropies, and celebrities, like Charles Dickens, sought to change these dire conditions and help reform the prisoners.
When their movement succeeded, entire prisons were remodeled and new forms of rehabilitation, such as the treadmill, were introduced.
Here's how the original version, invented in 1818 by English engineer Sir William Cubitt, worked.
Prisoners stepped on 24 spokes of a large paddle wheel.
As the wheel turned, the prisoner was forced to keep stepping up or risk falling off, similar to modern stepper machines.
Meanwhile, the rotation made gears pump out water, crush grain, or power mills, which is where the name "treadmill" originated.
These devices were seen as a fantastic way of whipping prisoners into shape, and that added benefit of powering mills helped to rebuild a British economy decimated by the Napoleonic Wars.
It was a win for all concerned, except the prisoners.
It's estimated that, on average, prisoners spent six or so hours a day on treadmills, the equivalent of climbing 5,000 to 14,000 feet.
14,000 feet is roughly Mount Everest's halfway point.
Imagine doing that five days a week with little food.
Cubitt's idea quickly spread across the British Empire and America.
Within a decade of its creation, over 50 English prisons boasted a treadmill, and America, a similar amount.
Unsurprisingly, the exertion combined with poor nutrition saw many prisoners suffer breakdowns and injuries, not that prison guards seemed to care.
In 1824, New York prison guard James Hardie credited the device with taming his more boisterous inmates, writing that the "monotonous steadiness, and not its severity...constitutes its terror," a quote many still agree with.
And treadmills lasted in England until the late 19th century, when they were banned for being excessively cruel under the Prison's Act of 1898.
But of course the torture device returned with a vengeance, this time targeting the unsuspecting public.
In 1911, a treadmill patent was registered in the U.S., and by 1952, the forerunner for today's modern treadmill had been created.
When the jogging craze hit the U.S. in the 1970s, the treadmill was thrust back into the limelight as an easy and convenient way to improve aerobic fitness, and lose unwanted pounds, which, to be fair, it's pretty brian18@example.net.
And the machine has maintained its popularity since.
So the next time you voluntarily subject yourself to what was once a cruel and unusual punishment, just be glad you can control when you'll hop off.
Let me start by asking you a question, just with a show of hands: Who has an iPhone?
Who has an Android phone?
Who has a Blackberry?
Who will admit in public to having a Blackberry?
(Laughter) And let me guess, how many of you, when you arrived here, like me, went and bought a pay-as-you-go SIM card?
Yeah?
I'll bet you didn't even know you're using African technology.
Pay-as-you-go was a technology, or an idea, pioneered in Africa by a company called Vodacom a good 15 years ago, and now, like franchising, pay-as-you-go is one of the most dominant forces of economic activity in the world.
So I'm going to talk about innovation in Africa, which I think is the purest form, innovation out of necessity.
But first, I'm going to ask you some other questions.
You don't have to put your hands up.
These are rhetorical.
Why did Nikola Tesla have to invent the alternating current that powers the lights in this building or the city that we're in?
Why did Henry Ford have to invent the production line to produce these Fords that came in anything as long as they were black?
And why did Eric Merrifield have to invent the dolos?
Blank stares.
That is what a dolos looks like, and in the background, you can see Robben Island.
This is a small dolos, and Eric Merrifield is the most famous inventor you've never heard of.
In 1963, a storm ripped up the harbor in a small South African town called East London, and while he was watching his kids playing with toys made from oxen bones called dolosse, he had the idea for this.
It's a bit like a huge jumping jack, and they have used this in every harbor in the world as a breakwater.
The global shipping economy would not be possible without African technology like this.
So whenever you talk about Africa, you have to put up this picture of the world from space, and people go, "Look, it's the Dark Continent."
Actually, it isn't.
What it is is a map of innovation.
And it's really easy to see where innovation's going on.
All the places with lots of electricity, it isn't.
(Laughter) (Applause) And the reason it isn't is because everybody's watching television or playing Angry Birds.
(Laughter) (Applause) So where it's happening is in Africa.
Now, this is real innovation, not the way people have expropriated the word to talk about launching new products.
This is real innovation, and I define it as problem-solving.
People are solving real problems in Africa.
Why?
Because we have to.
Because we have real problems.
And when we solve real problems for people, we solve them for the rest of the world at the same time.
So in California, everybody's really excited about a little square of plastic that you plug into a phone and you can swipe your credit card, and people say, "We've liberated the credit card from the point of sale terminal."
Fantastic.
Why do you even need a credit card?
In Africa, we've been doing that for years, and we've been doing it on phones like this.
This is a picture I took at a place called Kitengela, about an hour south of Nairobi, and the thing that's so remarkable about the payment system that's been pioneered in Africa called M-Pesa is that it works on phones like this.
It works on every single phone possible, because it uses SMS.
You can pay bills with it, you can buy your groceries, you can pay your kids' school fees, and I'm told you can even bribe customs officials.
(Laughter) Something like 25 million dollars a day is transacted through M-Pesa.
Forty percent of Kenya's GDP moves through M-Pesa using phones like this.
And you think this is just a feature phone.
Actually it's the smartphone of Africa.
It's also a radio, and it's also a torch, and more than anything else, it has really superb battery life.
Why?
Because that's what we need.
We have really severe energy problems in Africa.
By the way, you can update Facebook and send Gmail from a phone like this.
So we have found a way to use the available technology to send money via M-Pesa, which is a bit like a check system for the mobile age.
I come from Johannesburg, which is a mining town.
It's built on gold.
This is a picture I Instagrammed earlier.
And the difference today is that the gold of today is mobile.
If you think about the railroad system in North America and how that worked, first came the infrastructure, then came the industry around it, the brothels -- it's a bit like the Internet today, right? — and everything else that worked with it: bars, saloons, etc.
The gold of today is mobile, and mobile is the enabler that makes all of this possible.
So what are some of the things that you can do with it?
Well, this is by a guy called Bright Simons from Ghana, and what you do is you take medication, something that some people might spend their entire month's salary on, and you scratch off the code, and you send that to an SMS number, and it tells you if that is legitimate or if it's expired.
Really simple, really effective, really life-saving.
In Kenya, there's a service called iCow, which just sends you really important information about how to look after your dairy.
The dairy business in Kenya is a $463 million business, and the difference between a subsistence farmer and an abundance farmer is only a couple of liters of milk a day.
And if you can do that, you can rise out of poverty.
Really simple, using a basic phone.
If you don't have electricity, no problem!
We'll just make it out of old bicycle parts using a windmill, as William Kamkwamba did.
There's another great African that you've heard that's busy disrupting the automobile industry in the world.
He's also finding a way to reinvent solar power and the electricity industry in North America, and if he's lucky, he'll get us to Mars, hopefully in my lifetime.
He comes from Pretoria, the capital of [South Africa], about 50 kilometers from where I live.
So back to Joburg, which is sometimes called Egoli, which means City of Gold.
And not only is mobile the gold of today, I don't believe that the gold is under the ground.
I believe we are the gold.
Like you've heard the other economists say, we are at the point where China was when its boom years began, and that's where we're going.
So, you hear the West talk about innovation at the edge.
Well, of course it's happening at the edge, because in the middle, everybody's updating Facebook, or worse still, they're trying to understand Facebook's privacy settings.
(Laughter) This is not that catchy catchphrase.
This is innovation over the edge.
So, people like to call Africa a mobile-first continent, but actually it's mobile-only, so while everybody else is doing all of those things, we're solving the world's problems.
So there's only one thing left to say.
["You're welcome"] (Laughter) (Applause)
I want you to imagine this for a moment.
Two men, Rahul and Rajiv, living in the same neighborhood, from the same educational background, similar occupation, and they both turn up at their local accident emergency complaining of acute chest pain.
Rahul is offered a cardiac procedure, but Rajiv is sent home.
What might explain the difference in the experience of these two nearly identical men?
Rajiv suffers from a mental illness.
The difference in the quality of medical care received by people with mental illness is one of the reasons why they live shorter lives than people without mental illness.
Even in the best-resourced countries in the world, this life expectancy gap is as much as 20 years.
In the developing countries of the world, this gap is even larger.
But of course, mental illnesses can kill in more direct ways as well.
The most obvious example is suicide.
It might surprise some of you here, as it did me, when I discovered that suicide is at the top of the list of the leading causes of death in young people in all countries in the world, including the poorest countries of the world.
But beyond the impact of a health condition on life expectancy, we're also concerned about the quality of life lived.
Now, in order for us to examine the overall impact of a health condition both on life expectancy as well as on the quality of life lived, we need to use a metric called the DALY, which stands for a Disability-Adjusted Life Year.
Now when we do that, we discover some startling things about mental illness from a global perspective.
We discover that, for example, mental illnesses are amongst the leading causes of disability around the world.
Depression, for example, is the third-leading cause of disability, alongside conditions such as diarrhea and pneumonia in children.
When you put all the mental illnesses together, they account for roughly 15 percent of the total global burden of disease.
Indeed, mental illnesses are also very damaging to people's lives, but beyond just the burden of disease, let us consider the absolute numbers.
The World Health Organization estimates that there are nearly four to five hundred million people living on our tiny planet who are affected by a mental illness.
Now some of you here look a bit astonished by that number, but consider for a moment the incredible diversity of mental illnesses, from autism and intellectual disability in childhood, through to depression and anxiety, substance misuse and psychosis in adulthood, all the way through to dementia in old age, and I'm pretty sure that each and every one us present here today can think of at least one person, at least one person, who's affected by mental illness in our most intimate social networks.
I see some nodding heads there.
But beyond the staggering numbers, what's truly important from a global health point of view, what's truly worrying from a global health point of view, is that the vast majority of these affected individuals do not receive the care that we know can transform their lives, and remember, we do have robust evidence that a range of interventions, medicines, psychological interventions, and social interventions, can make a vast difference.
And yet, even in the best-resourced countries, for example here in Europe, roughly 50 percent of affected people don't receive these interventions.
In the sorts of countries I work in, that so-called treatment gap approaches an astonishing 90 percent.
It isn't surprising, then, that if you should speak to anyone affected by a mental illness, the chances are that you will hear stories of hidden suffering, shame and discrimination in nearly every sector of their lives.
But perhaps most heartbreaking of all are the stories of the abuse of even the most basic human rights, such as the young woman shown in this image here that are played out every day, sadly, even in the very institutions that were built to care for people with mental illnesses, the mental hospitals.
It's this injustice that has really driven my mission to try to do a little bit to transform the lives of people affected by mental illness, and a particularly critical action that I focused on is to bridge the gulf between the knowledge we have that can transform lives, the knowledge of effective treatments, and how we actually use that knowledge in the everyday world.
And an especially important challenge that I've had to face is the great shortage of mental health professionals, such as psychiatrists and psychologists, particularly in the developing world.
Now I trained in medicine in India, and after that I chose psychiatry as my specialty, much to the dismay of my mother and all my family members who kind of thought neurosurgery would be a more respectable option for their brilliant son.
Any case, I went on, I soldiered on with psychiatry, and found myself training in Britain in some of the best hospitals in this country.
I was very privileged.
I worked in a team of incredibly talented, compassionate, but most importantly, highly trained, specialized mental health professionals.
Soon after my training, I found myself working first in Zimbabwe and then in India, and I was confronted by an altogether new reality.
This was a reality of a world in which there were almost no mental health brian18@example.net.
In Zimbabwe, for example, there were just about a dozen psychiatrists, most of whom lived and worked in Harare city, leaving only a couple to address the mental health care needs of nine million people living in the countryside.
In India, I found the situation was not a lot better.
To give you a perspective, if I had to translate the proportion of psychiatrists in the population that one might see in Britain to India, one might expect roughly 150,000 psychiatrists in India.
In reality, take a guess.
The actual number is about 3,000, about two percent of that number.
It became quickly apparent to me that I couldn't follow the sorts of mental health care models that I had been trained in, one that relied heavily on specialized, expensive mental health professionals to provide mental health care in countries like India and Zimbabwe.
I had to think out of the box about some other model of care.
It was then that I came across these books, and in these books I discovered the idea of task shifting in global health.
The idea is actually quite simple.
The idea is, when you're short of specialized health care professionals, use whoever is available in the community, train them to provide a range of health care interventions, and in these books I read inspiring examples, for example of how ordinary people had been trained to deliver babies, diagnose and treat early pneumonia, to great effect.
And it struck me that if you could train ordinary people to deliver such complex health care interventions, then perhaps they could also do the same with mental health care.
Well today, I'm very pleased to report to you that there have been many experiments in task shifting in mental health care across the developing world over the past decade, and I want to share with you the findings of three particular such experiments, all three of which focused on depression, the most common of all mental illnesses.
In rural Uganda, Paul Bolton and his colleagues, using villagers, demonstrated that they could deliver interpersonal psychotherapy for depression and, using a randomized control design, showed that 90 percent of the people receiving this intervention recovered as compared to roughly 40 percent in the comparison villages.
Similarly, using a randomized control trial in rural Pakistan, Atif Rahman and his colleagues showed that lady health visitors, who are community maternal health workers in Pakistan's health care system, could deliver cognitive behavior therapy for mothers who were depressed, again showing dramatic differences in the recovery rates.
Roughly 75 percent of mothers recovered as compared to about 45 percent in the comparison villages.
And in my own trial in Goa, in India, we again showed that lay counselors drawn from local communities could be trained to deliver psychosocial interventions for depression, anxiety, leading to 70 percent recovery rates as compared to 50 percent in the comparison primary health centers.
Now, if I had to draw together all these different experiments in task shifting, and there have of course been many other examples, and try and identify what are the key lessons we can learn that makes for a successful task shifting operation, I have coined this particular acronym, SUNDAR.
What SUNDAR stands for, in Hindi, is "attractive."
It seems to me that there are five key lessons that I've shown on this slide that are critically important for effective task shifting.
The first is that we need to simplify the message that we're using, stripping away all the jargon that medicine has invented around itself.
We need to unpack complex health care interventions into smaller components that can be more easily transferred to less-trained individuals.
We need to deliver health care, not in large institutions, but close to people's homes, and we need to deliver health care using whoever is available and affordable in our local communities.
And importantly, we need to reallocate the few specialists who are available to perform roles such as capacity-building and supervision.
Now for me, task shifting is an idea with truly global significance, because even though it has arisen out of the situation of the lack of resources that you find in developing countries, I think it has a lot of significance for better-resourced countries as well.
Why is that?
Well, in part, because health care in the developed world, the health care costs in the [developed] world, are rapidly spiraling out of control, and a huge chunk of those costs are human resource costs.
But equally important is because health care has become so incredibly professionalized that it's become very remote and removed from local communities.
For me, what's truly sundar about the idea of task shifting, though, isn't that it simply makes health care more accessible and affordable but that it is also fundamentally empowering.
It empowers ordinary people to be more effective in caring for the health of others in their community, and in doing so, to become better guardians of their own health.
Indeed, for me, task shifting is the ultimate example of the democratization of medical knowledge, and therefore, medical power.
Just over 30 years ago, the nations of the world assembled at Alma-Ata and made this iconic declaration.
Well, I think all of you can guess that 12 years on, we're still nowhere near that goal.
Still, today, armed with that knowledge that ordinary people in the community can be trained and, with sufficient supervision and support, can deliver a range of health care interventions effectively, perhaps that promise is within reach now.
Indeed, to implement the slogan of Health for All, we will need to involve all in that particular journey, and in the case of mental health, in particular we would need to involve people who are affected by mental illness and their caregivers.
It is for this reason that, some years ago, the Movement for Global Mental Health was founded as a sort of a virtual platform upon which professionals like myself and people affected by mental illness could stand together, shoulder-to-shoulder, and advocate for the rights of people with mental illness to receive the care that we know can transform their lives, and to live a life with dignity.
And in closing, when you have a moment of peace or quiet in these very busy few days or perhaps afterwards, spare a thought for that person you thought about who has a mental illness, or persons that you thought about who have mental illness, and dare to care for them.
Thank you.
(Applause) (Applause)
The idea of eliminating poverty is a great goal.
I don't think anyone in this room would disagree.
What worries me is when politicians with money and charismatic rock stars -- (Laughter) use the words, " ... it all just sounds so, so simple."
Now, I've got no bucket of money today and I've got no policy to release, and I certainly haven't got a guitar.
I'll leave that to others.
But I do have an idea, and that idea is called Housing for Health.
Housing for Health works with poor people.
It works in the places where they live, and the work is done to improve their health.
Over the last 28 years, this tough, grinding, dirty work has been done by literally thousands of people around Australia and, more recently, overseas, and their work has proven that focused design can improve even the poorest living environments.
It can improve health and it can play a part in reducing, if not eliminating, poverty.
I'm going to start where the story began -- 1985, in Central Australia.
A man called Yami Lester, an Aboriginal man, was running a health service.
Eighty percent of what walked in the door, in terms of illness, was infectious disease -- third world, developing world infectious disease, caused by a poor living environment.
Yami assembled a team in Alice Springs.
He got a medical doctor.
He got an environmental health guy.
And he hand-selected a team of local Aboriginal people to work on this project.
Yami told us at that first meeting, "There's no money," -- always a good start -- " ... no money, you have six months, and I want you to start on a project --" which, in his language, he called "Uwankara Palyanku Kanyintjaku," which, translated, is "a plan to stop people getting sick" -- a profound brief.
That was our task.
First step, the medical doctor went away for about six months.
And he worked on what were to become these nine health goals -- what were we aiming at?
After six months of work, he came to my office and presented me with those nine words on a piece of paper.
[The 9 Healthy Living Practices: Washing, clothes, wastewater, nutrition, crowding, animals, dust, temperature, injury] I was very unimpressed.
Big ideas need big words, and preferably a lot of them.
This didn't fit the bill.
What I didn't see and what you can't see was that he'd assembled thousands of pages of local, national and international health research that filled out the picture as to why these were the health targets.
The pictures that came a bit later had a very simple reason.
The Aboriginal people who were our bosses and the senior people were most commonly illiterate, so the story had to be told in pictures of what these goals were.
We worked with the community, not telling them what was going to happen in a language they didn't understand.
So we had the goals and each one of these goals -- and I won't go through them all -- puts at the center the person and their health issue, and it then connects them to the bits of the physical environment that are actually needed to keep their health good.
And the highest priority, you see on the screen, is washing people once a day, particularly children.
And I hope most of you are thinking, "What?
That sounds simple."
Now, I'm going to ask you all a very personal question.
This morning before you came, who could have had a wash using a shower?
I'm not going to ask if you had a shower, because I'm too polite.
That's it.
(Laughter) All right, I think it's fair to say most people here could have had a shower this morning.
I'm going to ask you to do some more work.
I want you all to select one of the houses of the 25 houses you see on the screen.
I want you to select one of them and note the position of that house and keep that in your head.
Have you all got a house?
I'm going to ask you to live there for a few months, so make sure you've got it right.
It's in the northwest of Western Australia, very pleasant place.
OK.
Let's see if your shower in that house is working.
I hear some "Aw!" and I hear some "Ah!"
If you get a green tick, your shower's working.
You and your kids are fine.
If you get a red cross, well, I've looked carefully around the room and it's not going to make much difference to this crew.
Why?
Because you're all too old.
I know that's going to come as a shock to some of you, but you are.
And before you get offended and leave, I've got to say that being too old, in this case, means that pretty much everyone in the room, I think, is over five years of age.
We're really concerned with kids naught to five.
And why?
Washing is the antidote to the sort of bugs, the common infectious diseases of the eyes, the ears, the chest and the skin that, if they occur in the first five years of life, permanently damage those organs.
They leave a lifelong remnant.
That means that by the age of five, you can't see as well for the rest of your life.
You can't hear as well for the rest of your life.
You can't breathe as well.
You've lost a third of your lung capacity by the age of five.
And even skin infection, which we originally thought wasn't that big a problem, mild skin infections naught to five give you a greatly increased chance of renal failure, needing dialysis at age 40.
This is a big deal, so the ticks and crosses on the screen are actually critical for young kids.
Those ticks and crosses represent the 7,800 houses we've looked at nationally around Australia, the same proportion.
What you see on the screen -- 35 percent of those not-so-famous houses lived in by 50,000 indigenous people -- 35 percent had a working shower.
Ten percent of those same 7,800 houses had safe electrical systems.
And 58 percent of those houses had a working toilet.
These are by a simple, standard test.
In the case of the shower: does it have hot and cold water, two taps that work, a shower rose to get water onto your head or onto your body, and a drain that takes the water away?
Not well-designed, not beautiful, not elegant -- just that they function.
And the same tests for the electrical system and the toilets.
Housing for Health projects aren't about measuring failure -- they're actually about improving houses.
We start on day one of every project.
We've learned -- we don't make promises, we don't do reports.
We arrive in the morning with tools, tons of equipment, trades, and we train up a local team on the first day to start work.
By the evening of the first day, a few houses in that community are better than when we started in the morning.
That work continues for six to 12 months, until all the houses are improved and we've spent our budget of 7,500 dollars total per house.
That's our average budget.
At the end of six months to a year, we test every house again.
It's very easy to spend money.
It's very difficult to improve the function of all those parts of the house.
And for a whole house, the nine healthy living practices, we test, check and fix 250 items in every house.
And these are the results we can get with our 7,500 dollars.
We can get showers up to 86 percent working, we can get electrical systems up to 77 percent working and we can get 90 percent of toilets working in those 7,500 houses.
(Applause) Thank you.
(Applause) The teams do a great job, and that's their work.
I think there's an obvious question that I hope you're thinking about.
Why do we have to do this work?
Why are the houses in such poor condition?
Seventy percent of the work we do is due to lack of routine maintenance -- the sort of things that happen in all our houses.
Things wear out, should have been done by state government or local government, simply not done, the house doesn't work.
Twenty-one percent of the things we fix are due to faulty construction -- literally things that are built upside down and back to front.
They don't work, we have to fix them.
And if you've lived in Australia in the last 30 years, the final cause -- you will have heard always that indigenous people trash houses.
It's one of the almost rock-solid pieces of evidence which I've never seen evidence for, that's always reeled out as "That's the problem with indigenous housing."
Well, nine percent of what we spend is damage, misuse or abuse of any sort.
We argue strongly that the people living in the house are simply not the problem.
And we'll go a lot further than that; the people living in the house are actually a major part of the solution.
Seventy-five percent of our national team in Australia -- over 75 at the minute -- are actually local, indigenous people from the communities we work in.
They do all aspects of the work.
(Applause) In 2010, for example, there were 831, all over Australia, and the Torres Strait Islands, all states, working to improve the houses where they and their families live, and that's an important thing.
Our work's always had a focus on health.
That's the key.
The developing world bug, trachoma, causes blindness.
It's a developing-world illness, and yet, the picture you see behind is in an Aboriginal community in the late 1990s, where 95 percent of school-aged kids had active trachoma in their eyes, doing damage.
OK, what do we do?
Well, first thing we do, we get showers working.
Why?
Because that flushes the bug out.
We put washing facilities in the school as well, so kids can wash their faces many times during the day.
We wash the bug out.
Second, the eye doctors tell us that dust scours the eye and lets the bug in quick.
So what do we do?
We call up the doctor of dust, and there is such a person.
He was loaned to us by a mining company.
He controls dust on mining company sites.
And he came out and, within a day, it worked out that most dust in this community was within a meter of the ground, the wind-driven dust -- so he suggested making mounds to catch the dust before it went into the house area and affected the eyes of kids.
So we used dirt to stop dust.
We did it.
He provided us dust monitors.
We tested and we reduced the dust.
Then we wanted to get rid of the bug generally.
So how do we do that?
Well, we call up the doctor of flies -- and, yes, there is a doctor of flies.
As our Aboriginal mate said, "You white fellows ought to get out more."
(Laughter) And the doctor of flies very quickly determined that there was one fly that carried the bug.
He could give school kids in this community the beautiful fly trap you see above in the slide.
They could trap the flies, send them to him in Perth.
When the bug was in the gut, he'd send back by return post some dung beetles.
The dung beetles ate the camel dung, the flies died through lack of food, and trachoma dropped.
And over the year, trachoma dropped radically in this place, and stayed low.
We changed the environment, not just treated the eyes.
And finally, you get a good eye.
All these small health gains and small pieces of the puzzle make a big difference.
The New South Wales Department of Health, that radical organization, did an independent trial over three years to look at 10 years of the work we've been doing in these sorts of projects in New South Wales.
And they found a 40 percent reduction in hospital admissions for the illnesses that you could attribute to the poor environment -- a 40 percent reduction.
(Applause) Just to show that the principles we've used in Australia can be used in other places, I'm just going to go to one other place, and that's Nepal.
And what a beautiful place to go.
We were asked by a small village of 600 people to go in and make toilets where none existed.
Health was poor.
We went in with no grand plan, no grand promises of a great program, just the offer to build two toilets for two families.
It was during the design of the first toilet that I went for lunch, invited by the family into their main room of the house.
It was choking with smoke.
People were cooking on their only fuel source, green timber.
The smoke coming off that timber is choking, and in an enclosed house, you simply can't breathe.
Later we found the leading cause of illness and death in this particular region is through respiratory failure.
So all of a sudden, we had two problems.
We were there originally to look at toilets and get human waste off the ground, that's fine.
But all of a sudden now there was a second problem: How do we actually get the smoke down?
So two problems, and design should be about more than one thing.
Solution: Take human waste, take animal waste, put it into a chamber, out of that, extract biogas, methane gas.
The gas gives three to four hours cooking a day -- clean, smokeless and free for the family.
(Applause) I put it to you: is this eliminating poverty?
And the answer from the Nepali team who's working at the minute would say, don't be ridiculous -- we have three million more toilets to build before we can even make a stab at that claim.
And I don't pretend anything else.
But as we all sit here today, there are now over 100 toilets built in this village and a couple nearby.
Well over 1,000 people use those toilets.
Yami Lama, he's a young boy.
He's got significantly less gut infection because he's now got toilets, and there isn't human waste on the ground.
Kanji Maya, she's a mother, and a proud one.
She's probably right now cooking lunch for her family on biogas, smokeless fuel.
Her lungs have got better, and they'll get better as time increases, because she's not cooking in the same smoke.
Surya takes the waste out of the biogas chamber when it's shed the gas, he puts it on his crops.
He's trebled his crop income, more food for the family and more money for the family.
And finally Bishnu, the leader of the team, has now understood that not only have we built toilets, we've also built a team, and that team is now working in two villages where they're training up the next two villages to keep the work expanding.
And that, to me, is the key.
(Applause) People are not the problem.
We've never found that.
The problem: poor living environment, poor housing and the bugs that do people harm.
None of those are limited by geography, by skin color or by religion.
None of them.
The common link between all the work we've had to do is one thing, and that's poverty.
Nelson Mandela said, in the mid-2000s, not too far from here, he said that like slavery and apartheid, "Poverty is not natural.
It is man-made and can be overcome and eradicated by the actions of human beings."
I want to end by saying it's been the actions of thousands of ordinary human beings doing -- I think -- extraordinary work, that have actually improved health, and, maybe only in a small way, reduced poverty.
Thank you very much for your time.
(Applause)