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Gates Foundation
Gates Foundation

Myth-Busting Poverty and Health

Gates Foundation
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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Emery Smith
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Stones, Bones, and Wrecks
The 'Alien' Mummy Is of Course Human—And Yet, Still Unusual
Emery Smith
Emery Smith

Ata has never been an alien, but she's always been an enigma. Discovered in 2003 in a leather pouch near an abandoned mining town in Chile's Atacama Desert, the tiny, 6-inch mummy's unusual features—including a narrow, sloped head, angled eyes, missing ribs, and oddly dense bones—had both the “It's aliens!” crowd and paleopathologists intrigued. Now, a team of researchers from Stanford University School of Medicine and UC-San Francisco has completed a deep genomic analysis that reveals why Ata looks as she does.

As they lay out in a paper published this week in Genome Research, the researchers found a host of genetic mutations that doomed the fetus—some of which have never been seen before.

Stanford professor of microbiology and immunology Garry Nolan first analyzed Ata back in 2012; the mummy had been purchased by a Spanish businessman and studied by a doctor named Steven Greer, who made her a star of his UFO/ET conspiracy movie Sirius. Nolan was also given a sample of her bone marrow; his DNA analysis confirmed she was, of course, human. But Nolan's study, published in the journal Science, also found something very odd: Though she was just 6 inches long when she died—a typical size for a midterm fetus—her bones appeared to be 6 to 8 years old. This did not lead Nolan to hypothesize an alien origin for Ata, but to infer that she may have had a rare bone disorder.

The current analysis confirmed that interpretation. The researchers found 40 mutations in several genes that govern bone development; these mutations have been linked to "diseases of small stature, rib anomalies, cranial malformations, premature joint fusion, and osteochondrodysplasia (also known as skeletal dysplasia)," they write. The latter is commonly known as dwarfism. Some of these mutations are linked to conditions including Ehlers-Danlos syndrome, which affects connective tissue, and Kabuki syndrome, which causes a range of physical deformities and cognitive issues. Other mutations known to cause disease had never before been associated with bone growth or developmental disorders until being discovered in Ata.

scientist measures the the 6-inch-long mummy called Ata, which is not an alien
Emery Smith

"Given the size of the specimen and the severity of the mutations … it seems likely the specimen was a pre-term birth," they write. "While we can only speculate as to the cause for multiple mutations in Ata's genome, the specimen was found in La Noria, one of the Atacama Desert's many abandoned nitrate mining towns, which suggests a possible role for prenatal nitrate exposure leading to DNA damage."

Though the researchers haven't identified the exact age of Ata's remains, they're estimated to be less than 500 years old (and potentially as young as 40 years old). Genomic analysis also confirms that Ata is very much not only an Earthling, but a local; her DNA is a nearest match to three individuals from the Chilote people of Chile.

In a press statement, study co-lead Atul Butte, director of the Institute for Computational Health Sciences at UC-San Francisco, stressed the potential applications of the study to genetic disorders. "For me, what really came of this study was the idea that we shouldn't stop investigating when we find one gene that might explain a symptom. It could be multiple things going wrong, and it's worth getting a full explanation, especially as we head closer and closer to gene therapy," Butte said. "We could presumably one day fix some of these disorders."

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iStock
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Health
Just Two Cans of Soda a Day May Double Your Risk of Death From Heart Disease
iStock
iStock

If you've been stocking your refrigerator full of carbonated corn syrup in anticipation of warmer weather, the American Heart Association has some bad news. The advocacy group on Wednesday released results of research that demonstrate a link between consumption of sugary drinks—including soda, fruit juices, and other sweetened beverages—and an increased risk of dying from heart disease.

Study participants who reported consuming 24 ounces or more of sugary drinks per day had twice the risk of death from coronary artery disease of those who averaged less than 1 ounce daily. There was also an increased risk of death overall, including from other cardiovascular conditions.

The study, led by Emory University professor Jean Welsh, examined data taken from a longitudinal study of 17,930 adults over the age of 45 with no previous history of heart disease, stroke, or diabetes. Researchers followed participants for six years, and examined death records to determine causes. They observed a greater risk of death associated with sugary drinks even when they controlled for other factors, including race, income, education, smoking habits, and physical activity. The study does not show cause and effect, the researchers said, but does illuminate a trend.

The study also noted that while it showed an increased risk of death from heart disease, consumption of sugary foods was not shown to carry similar risk. One possible explanation is that the body metabolizes the sugars differently: Solid foods carry other nutrients, like fat and protein, that slow metabolism, while sugary drinks provide an undiluted influx of carbohydrates that the body must process.

The news will likely prove troublesome for the beverage industry, which has long contended with concerns that sugary drinks contribute to type 2 diabetes and tooth decay. Some cities, including Seattle, have introduced controversial "soda tax" plans that raise the sales tax on the drinks in an effort to discourage consumption.

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