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Myth-Busting Poverty and Health

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Gates Foundation

When bad things happen, they often happen fast. When good things happen, they often happen slowly—sometimes so slowly that we only notice them after the fact.[1] This is certainly the case with how we think about the state of our world; we see some catastrophe on the news and think that the net effect is that the world is trending downward. We tend not to do the homework required to reflect on the slow, positive changes that come after years of hard work. In today's Gates Annual Letter, Bill and Melinda Gates make a convincing argument that, in many ways, the world is better than it has ever been. I agree. Life ain't perfect, but suffering and death are decreasing.

When I write about the slow, good news, the comments sections are fascinating. While many comments are positive, there are some persistent negative assertions that come up over and over—what's fascinating is that they're factually incorrect, but them apparently feel correct to the people who are writing them. Let's call these "myths about helping people," and let's take a rational look at why a big one simply isn't supported by the facts.

Myth: Foreign Aid is a Big Waste

First let's define "foreign aid": "a voluntary transfer of resources from one country to another." This generally means a relatively richer country giving money or goods to a relatively poorer country.

So the myth here is a many-headed hydra; at its core is a hunch that it's a waste of resources to give money to another country. Let's walk through this one and look at some data:

1. Cutting foreign aid would not save donor countries much money

One argument against foreign aid is simply that is costs too much. But foreign aid actually amounts to a tiny fraction of government spending. When we look at the economic assistance donor countries provide, it's in the low single digits of the overall budget. Norway is the most generous country in the world in this regard, and it spends a whopping 3% of its annual budget on foreign aid. The United States spends less than 1% on economic foreign aid—that's roughly $30 billion. About $11 billion of that is spent on health care (medication, disease prevention, bed nets, etc.). This last figure pencils out to about $30 per person, per year, in the U.S. on average.

So the fact is, at least in the United States, that we're talking about less than 1% of the budget. We can save less than 1% of our budget, or we can save lives around the world.

2. Foreign aid actually helps people

Another argument against foreign aid is that it's wasted—it doesn't help people, and instead ends up in the pockets of corrupt governments. While, yes, there is corruption in the world, here are three examples of organizations that receive money from U.S. tax dollars, and what that money has done to help staggering numbers of people:

GAVI - Has vaccinated 440 million children against various diseases since 2000. By 2015 this number is projected to increase by another 234 million. This means kids are protected from diseases like polio, measles, rotavirus, yellow fever, and the list goes on. Why this matters: By 2015, GAVI will have vaccinated 50 million children against rotavirus. Rotavirus causes an estimated 450,000 deaths each year.

The Global Fund - Has treated 11.2 million cases of TB; provided antiretroviral drugs to 6.1 million people; and has distributed 360 million insecticide-treated nets (these are used to prevent malaria) since 2002. Why this matters: In 2000, only 3% of households in sub-Saharan Africa owned at least one insecticide-treated mosquito net. Now, 54% of households own at least one net. If malaria deaths continue to drop at the current rate, by 2015 malaria mortality will have dropped by 56% compared to 2000.

Polio Global Eradication Initiative - Has vaccinated 2.5 billion children against polio since 1998. Why this matters: In 1981, there were 350,000 new cases of polio. In 2013 there were just 385.

While some foreign aid money has been siphoned off by corrupt governments, that is not an argument against foreign aid in general—it's an argument about how we should spend the money so that it actually helps people. (See above for examples.)

3. Foreign aid reduces infant mortality...and that's a big deal

Another old saw is that foreign aid may help in the wake of disasters, but it doesn't substantially affect the biggest problems affecting humanity. Here's data to disprove that one.

If you compare today to the year 2000, there are now 7,256 fewer children dying every single day. If that doesn't seem like a big deal, read it again, or think of it this way—there are 2.56 million fewer infant deaths each year compared to the year 2000. If you're a parent, consider the 7,256 families that today did not have to contend with the death of their child.

And this progress isn't just recent—it has been sustained in a slow march over decades. According to the World Bank, "In 1990, more than 12 million children in developing countries died before the age of 5 from diseases such as diarrhea, malnutrition, pneumonia, AIDS, malaria, and tuberculosis. By 2012, that number had dropped to 6.6 million."

Reducing infant mortality isn't just about reducing heartbreak for parents; children who do not die grow up to be adults. These adults are the next generation of workers. Having a healthy, working adult population is a key way that countries develop on their own. (Note: there is also an intriguing correlation between reducing infant mortality and reducing fertility rates—it appears that when infant mortality goes down, people tend to have fewer children. If you're concerned that overpopulation will result if we save kids' lives, please consult Myth #3 in the Annual Letter.)

4. Foreign aid is an investment

It's easy to look at foreign aid as money that's spent each year with no financial return, a kind of static handout. But if you actually look at what this money buys (aside from preventing death), the return is tremendous. Take polio eradication—there are only three countries left in the world (Afghanistan, Nigeria, and Pakistan) where polio is endemic. Once polio is fully eradicated, we'll save $2 billion each year spent on polio. This is simple: eradicating disease will save money in the long term, both for donor countries and for countries where the disease had a financial impact.

Another reason foreign aid is an investment is that countries receiving foreign aid develop their way out of needing it, and can themselves become providers of aid. This is already happening. Here's a list of countries that formerly received huge amounts of foreign aid, but today receive very little: Botswana, Morocco, Brazil, Mexico, Chile, Costa Rica, Peru, Thailand, Mauritius, Singapore, and Malaysia. (You can explore the data on a country-by-country basis over time.) Even more interesting, there's a set of countries that are now net donors (meaning that they give more than they receive); these include South Korea and China. India may soon join this list, as it now receives just 0.09% of its GDP in foreign aid (down from 1% in 1991); India currently gives money to Bangladesh and others.

The bottom line

While there are certainly inefficiencies in the way foreign aid money is spent, it's clear that this aid saves millions of lives. For many countries, foreign aid is currently the only way to reduce infant mortality. To quote Bill Gates:

"A baby born in 1960 had an 18 percent chance of dying before her fifth birthday. For a child born today, the odds are less than 5 percent. In 2035, they will be 1.6 percent. I can’t think of any other 75-year improvement in human welfare that would even come close."

Share Your Thoughts, and Bust Your Own Myths

Above, I dealt with just one of three big myths tackled in today's letter. I urge you to read the rest, and if you feel moved to do so, share the myths that irk you the most. (On Twitter, a handy hashtag is #stopthemyth.) As I've done above, it helps to show your work, so we're dealing with data.

1 = A note on this notion that bad things happen fast and good things happen slowly. I'm not the first person to make this observation; Gordon Livingston wrote a similar sentiment about family life: "Only bad things happen quickly, ... Virtually all the happiness-producing processes in our lives take time, usually a long time: learning new things, changing old behaviors, building satisfying relationships, raising children. This is why patience and determination are among life’s primary virtues."

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CDC Traces Infectious Disease Outbreak in Seven States to Pet-Store Puppies
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Campylobacter bacteria have infected 39 people in seven states, and puppies sold at one chain of pet stores in Ohio are likely to blame. As NPR reports, a federal investigation is currently underway as to the exact cause of the outbreak of the intestinal infection.

The symptoms of Campylobacter include fever, diarrhea, and abdominal pain, and in rare cases it can lead to death in victims with weakened immune systems. About 1.3 million people fall ill to it each year, but the bacteria can also infect animals like dogs.

Of those hit by the latest outbreak, 12 are employees of the national chain Petland in four states, according to the CDC. The other 27 have either bought a puppy from a Petland store recently or live with or visited someone who has. Eighteen cases have been reported in Ohio, and the rest have appeared in Florida, Kansas, Missouri, Pennsylvania, Tennessee, and Wisconsin. While no deaths have been reported, nine victims have been hospitalized.

Puppies, like humans babies, are more likely to get sick than full-grown dogs, which may explain how the Petland animals caught the illness in the first place. But even apparently healthy adult dogs may be harboring the bacteria and spreading it through their feces. To avoid catching it from your canine companion at home, the CDC recommends washing your hands whenever you make physical contact. This also applies when handling their food and especially when picking up and throwing away their poop (with disposable gloves of course).

For the small percentage of people who do contract the infection each year, the best course of action is to wait it out if you're healthy otherwise: Symptoms take about a week to clear up.

[h/t NPR]

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10 Intriguing Facts About Joseph Lister
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Surgical patients once routinely died from their operations, as physicians believed that bad air—not bacteria—was responsible for their post-operative infections. This changed in the 19th century with a British physician named Joseph Lister (1827-1912), who dedicated his life to learning what caused infections and how to prevent them.

Get to know the quiet, studious doctor who is often called “the father of modern surgery"—and who has both a mountain and a popular mouthwash brand named after him.

1. JOSEPH LISTER'S FATHER HELPED USHER IN THE MODERN MICROSCOPE—AND HIS SON'S FUTURE CAREER.

As a child, Lister’s scientific curiosity was encouraged by his father, Joseph Jackson Lister, who was an English wine merchant and amateur scientist. The elder Lister's tinkering with early microscopes paved the way for today’s modern achromatic (non-color distorting) microscope—an accomplishment that would admit him to the Royal Society, the world’s oldest national scientific society.

In addition to dissecting small creatures, articulating their skeletons, and sketching the remains, the younger Lister—who knew from an early age that he wanted to be a surgeon—spent much of his childhood using his father's microscopes to examine specimens. He would rely on microscopes throughout his scientific career, using them to research the action of muscles in the skin and the eye, how blood coagulated, and how blood vessels reacted during an infection’s early stages.

2. LISTER WAS ENGLISH, BUT HE SPENT MOST OF HIS CAREER IN SCOTLAND.

Lister was born in the village of Upton, in Essex, England, and studied at University College, London. After graduating and working as a house surgeon at University College Hospital—where he became a Fellow of the Royal College of Surgeons—the young doctor moved to Edinburgh, Scotland, to work as renowned surgeon James Syme's assistant at the Royal Infirmary [PDF].

The move was supposed to be temporary, but Lister ended up finding both professional and personal success in Scotland: He married Syme’s daughter, Agnes, and was eventually appointed Regius Professor of Surgery at the University of Glasgow.

3. HE THOUGHT ABOUT BECOMING A PRIEST INSTEAD OF A DOCTOR.

Like many young professionals, Lister sometimes had doubts about his career path. The physician received a devout Quaker upbringing, and at one point he considered becoming a priest instead of a surgeon. However, Lister’s father encouraged him to stay in medicine and serve God by helping the sick. Lister would ultimately leave the Quaker faith to marry Agnes Syme, who belonged to the Scottish Episcopal Church.

4. HE STRUGGLED WITH DEPRESSION.

While away at school, Lister came down with a mild case of smallpox. He recovered, but the health scare—along with the death of his older brother, who succumbed to a brain tumor—pushed him into a deep depression. The student left school in London and traveled around Britain and Europe for a year or so before returning to the university and pursuing his medical studies with renewed vigor.

5. LISTER IS THE REASON WE STERILIZE WOUNDS.

When Lister was a surgeon, bloodstained bed linens and lab coats weren’t washed, and surgical instruments were rarely cleaned. And even though Italian physician Fracastoro of Verona had theorized in 1546 that small germs could cause contagious diseases, nobody thought they had anything to do with wound infections. Instead, many surgeons believed that miasmas—or bad air—emanating from the wound itself were responsible.

Lister, however, trusted his own observations. As a young doctor-in-training, he noted that some wounds healed when they were cleaned and damaged tissue was removed. However, the problem of infection continued to plague Lister through his career until he encountered the work of French scientist Louis Pasteur, who discovered that microbes could cause infection.

Intrigued, Lister began using a formula of diluted carbolic acid—a coal-tar derivative used to kill parasites found in sewage—to sterilize medical instruments and wash his hands. He also applied this mixture to bandages, and sprayed carbolic acid in operating rooms where surgeries resulted in high mortality. He reported the results at a meeting of the British Medical Association in 1867: "my wards […] have completely changed their character, so that during the last nine months not a single instance of [blood poisoning], hospital gangrene, or erysipelas has occurred in them.”

While some physicians balked at his techniques, claiming they wasted time and money, Lister’s approach caught on. Soon, physicians in Germany, the U.S., France, and Britain were following his lead. As for Pasteur and Lister, the two scientists corresponded, and would finally meet in person for the first time in 1878. And at Pasteur's 70th birthday celebration in 1892, Lister gave a praise-filled speech about the life-saving benefits of Pasteur's research.

6. LISTER WAS KIND TO PATIENTS.

Lister referred to some patients as "this poor man" or "this good woman" (he refused to call them "cases"), and he always tried to keep them calm and comfortable pre-and post-operation. Once, the surgeon even sewed a doll's missing leg back into place for a young charge.

7. HE TREATED QUEEN VICTORIA ...

Lister's most famous patient was Queen Victoria: In 1871, the surgeon was called to the monarch's estate in the Scottish Highlands after the queen sprouted an orange-sized abscess in her armpit. Armed with carbolic acid, Lister lanced the mass, drained its pus, and dressed and treated the wound to prevent infection—but at one point, he accidentally sprayed his disinfectant in the displeased queen's face.

Lister would later joke to his medical students, "Gentlemen, I am the only man who has ever stuck a knife into the queen!"

8. ... WHO LATER MADE HIM A BARON.

As Lister's fame grew, Queen Victoria made him a baronet in 1883. Later, she elevated the physician to baron status. Lister would remain beloved among members of the royal family, including Edward VII, who was diagnosed with appendicitis two days before his royal coronation in 1902. His doctors consulted Lister before performing a successful surgery, and the king made sure to thank him once he was crowned. "I know that if it had not been for you and your work, I wouldn’t be sitting here today," the monarch told Lister.

9. LISTERINE MOUTHWASH IS—SURPRISE!—NAMED AFTER LISTER.

Even if you didn’t learn about Lister in science class, you’ve probably used his namesake formula: Listerine. The popular mouthwash brand—which is promoted with the slogan "Kills germs that cause bad breath"—was originally invented in 1879 by American physician Joseph Lawrence. Lawrence had created the green liquid as an alcohol-based surgical antiseptic, and he fittingly named the product after his pioneering predecessor. However, Listerine would ultimately be marketed for oral hygiene purposes, after first being peddled as a cigarette additive, a cure for the common cold, a dandruff treatment, and more.

10. LISTER ALSO HAS A MOUNTAIN NAMED AFTER HIM.

Lister has public monuments and hospitals dedicated to him around the world, but if you travel to Antarctica, you may also encounter a massive mountain named in his honor: At around 13,200 feet, Mount Lister is the highest point in the Royal Society Range, a mountain range in Victoria Land, Antarctica, that was first explored by the British during the Discovery Expedition from 1901 to 1904. This expedition was organized by the Royal Society and the Royal Geographical Society—and since Lister was the Royal Society’s president from 1895 to 1900, the range’s most majestic peak was named after him.

Additional Source: The Butchering Art: Joseph Lister's Quest to Transform the Grisly World of Victorian Medicine by Lindsey Fitzharris

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