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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16 Facts About Migraines
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Unless you suffer from migraines yourself, you may think that having a migraine means having a really bad headache. But debilitating head pain is only one part of the medical condition called migraine disorder. Other common symptoms are nausea, dizziness, fatigue, sensitivity to light and sound, and even temporary blindness. The symptoms and causes of migraine look different in different patients, and researchers are only now beginning to understand what the condition is and how to treat it. Here are some of the most enlightening facts we know about migraine disorder.

1. IT'S THE THIRD MOST COMMON DISEASE IN THE WORLD.

Even if you don’t suffer from migraine, chances are you know someone who does: The disorder affects 14.7 percent of the population, or one in seven people, around the world. In the U.S. alone, roughly 39 million people are affected by the condition. Chronic migraine (experiencing at least 15 headache days per month over a three-month period, with over half being migraines) is more rare, impacting about 2 percent of the world population.

2. WOMEN SUFFER MORE THAN MEN.

Of the one billion people on Earth who have migraine disorder, three-fourths are women. Medical experts suspect this has to do with the cyclical nature of female hormones. According to research presented earlier in 2018, NHE1, the protein that regulates the transfer of protons and sodium ions across cell membranes, is a crucial component of migraine headaches. NHE1 production likely fluctuates a lot more in women than in men. When scientists looked at the brains of lab rats, they found that NHE1 levels were lowest when estrogen was at its peak. In general, female rats also had four times the amount of NHE1 in their brains as males. If the same holds true for people, that could explain why women are not only more likely to suffer migraines in the first place, but why they experience them more frequently and more intensely, and have more difficulty responding to treatment.

3. MIGRAINE TRIGGERS VARY WIDELY.

For doctors and sufferers, migraine triggers can be a source of confusion. They vary from patient to patient and often come from unexpected sources that have no relation to each other. Stress, too much or too little sleep, dehydration, alcohol, and caffeine are some of the most common triggers. Some people get migraines after eating specific foods, like cheese, and others are sensitive to changes in weather conditions like barometric pressure. Some people manage their migraines by pinpointing and avoiding triggers.

4. FOR SOME, AURAS ARE A WARNING THAT A MIGRAINE IS COMING.

Before the nausea, dizziness, and splitting head pain begin, auras warn some people that a migraine is on its way. Less than 25 percent [PDF] of migraine sufferers experience distorted senses, such as numbness or tingling in the hands or face, or blotches of light or darkness disrupting their vision. Auras usually occur 10 to 30 minutes before the migraine develops and last from five minutes to one hour.

5. SYMPTOMS CAN INCLUDE TEMPORARY BLINDNESS …

Unlike migraine with aura, retinal migraine is limited to one eye. Symptoms range from seeing twinkling stars to partial or complete loss of vision. The same eye is almost always affected, and the person typically regains their sight after 10 to 20 minutes.

6. … AND LOSS OF LIMB FUNCTION.

One of the rarest, and scariest, subtypes of migraine is hemiplegic migraine. People with this variant can experience weakness, numbness, tingling, or loss of motor function in parts of one half of their body, including their arm, leg, or face. Though sensations usually dissipate within 24 hours, they can last anywhere from one hour to several days. Sometimes they’re accompanied by typical migraine symptoms, such as head pain, but they can also occur on their own.

7. KIDS GET MIGRAINES TOO.

Migraine isn’t just a problem for adults—up to 10 percent of all school-aged kids are affected by the disorder, with reported cases coming from children as young as 18 months. According to the documentary Out of My Head (2018), migraine is the third most common reason for child emergency room visits. The symptoms of migraine in kids are similar to what’s seen in older patients: They may experience intense head pain, sick feelings, distorted vision, and sensitivity to sound and light. The major differences are that child migraines often develop suddenly and are shorter than they are in adults. In children, it’s not uncommon for the nausea and abdominal pain to feel worse than the actual headaches. Just as some sufferers don’t experience their first episodes until after puberty, some children with migraine grow out of it. According to one study, migraine symptoms disappeared completely in 23 percent of former child sufferers by age 25.

8. MIGRAINE MAY BE HEREDITARY.

For most people with migraine disorder, it runs in the family. Anywhere from 80 to 90 percent of migraine sufferers report having at least one family member who has it as well. If one parent has migraine, there’s a 50 percent chance their child will eventually have to live with migraine—and that risk shoots up to 75 percent when both parents have the condition.

9. MANY VETERANS RETURN HOME WITH MIGRAINES.

Genetics isn’t the only factor that contributes to someone’s chance of having migraine disorder. One study found that after a 12-month deployment in Iraq, 36 percent of veterans exhibited symptoms of migraine. The cause often stems from head or neck trauma sustained from explosions, falls, or other accidents during their service. While post-traumatic migraine goes away in most patients within a few months, in some cases it can develop into a chronic condition.

10. MIGRAINE IS LINKED TO THE "SECOND BRAIN" IN YOUR GUT.

In addition to the part of our nervous system that responds to outside stimuli, humans have an enteric nervous system: the part responsible for regulating digestion. Some medical experts believe that migraine is closely tied to this “second brain.” People with migraine are twice as likely to have IBS as people with tension headaches. Abdominal migraine, where the pain is concentrated in the stomach rather than the head, is one form the condition takes. It's most often seen in children, but it can affect adults as well.

11. DESPITE THE HIGH COST OF MIGRAINE DISORDER, RESEARCH IS UNDERFUNDED.

In 2017, the National Institutes of Health invested $22 million in migraine research. Asthma research received $286 million, breast cancer $689 million, and diabetes $1.1 billion.

12. THE DISORDER COSTS US UP TO $13 BILLION ANNUALLY.

Though migraine isn't life-threatening like these other conditions, it is widespread enough to have a negative impact on society as a whole. Workers with migraine often end up taking a lot of time off from their jobs, which can cost their employers. According to Out of My Head, it’s estimated that 113 million work days are missed annually due to migraine, adding up a to $13 billion loss.

13. MIGRAINE MAY HAVE INSPIRED PARTS OF ALICE IN WONDERLAND …

In the famous children’s book, Alice drinks a liquid that makes her grow many times her size and eats a cookie that shrinks her to tiny proportions. Migraine sufferers may recognize themselves in these passages. Possible symptoms of the disorder include micropsia and macropsia, or perceiving objects to be much smaller or larger than they really are. Some theorize that Alice in Wonderland author Lewis Carroll suffered migraines and wrote his experiences into his story. The book’s connection to migraine is so famous that today the related symptoms are commonly known as Alice in Wonderland Syndrome.

14. … AND PLAGUED A FOUNDING FATHER.

Another famous person from history who likely suffered from migraines was Thomas Jefferson. His symptoms could last for weeks and often appeared during stressful times in his life. There was even an episode that coincided with one of the most important nights of his political career. One night in June 1790, he invited Federalist Alexander Hamilton and Republican James Madison to his home for a dinner party in the hopes of getting his peers to agree on a location for the new U.S. capital. Despite dealing with lingering head pain from a migraine, he successfully brokered the compromise that landed the capital at its current spot on the Potomac River between Maryland and Virginia. In return, Madison agreed that he would not block Hamilton's plan for the federal government to take on state war debt, thus helping establish the young nation's credit.

15. MIGRAINE IS LINKED TO DEPRESSION.

In the U.S., up to 40 percent of people with migraine also have depression. Risk of anxiety, bipolar disorder, and panic disorder are also higher in migraine sufferers. Researchers are still figuring out the connections between mental illness and migraine. While the anticipation of painful symptoms can cause depression and anxiety in some people, experts believe that mental illness is often more than just an effect of living with migraine. The production of the brain chemical serotonin is involved in both migraine and depression. That’s why tricyclic antidepressants designed to increase serotonin levels are sometimes prescribed to treat migraine.

16. A NEW SHOT CAN TREAT MIGRAINE.

Many migraine therapies from the past few decades have been the result of trial and error. Medications designed to treat other conditions, such as antidepressants, epilepsy medicine, and botox, have all been prescribed to migraine sufferers, with mixed results. Earlier in 2018, the first-ever shot made to treat migraines specifically secured FDA approval. The shot, which blocks a peptide linked to migraine, is taken once a month and can improve symptoms or completely eliminate them in some cases. Before the new injection came along, the only other migraine-specific medications patients had to choose from were triptans, which stimulate the neurotransmitter serotonin. They can't prevent migraine, but they can help dampen symptoms by reducing inflammation and constricting blood flow. According to Out of My Head, triptans were first approved more than two decades ago—so new medication options are long overdue.

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Canine Flu is On the Rise: Here's What You Should Know
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It's been eight years since the World Health Organization announced the end of the swine flu pandemic, and now the condition is back in the news for infecting a different type of host. As Live Science reports, the H1N1 virus is mixing with canine flu to create new strains that could potentially spread to people.

Dog flu has been around for a couple of decades, but the two main canine strains, H3N8 and H3N2, have never been contracted by humans. According to a new study published in mBio, some dogs in the Guangxi region of China were found carrying H1N1, the flu strain at the root of the swine flu outbreak. Researchers also discovered three entirely new flu strains that were a combination of H1N1 and regular dog flu viruses.

The unrecognized flu strains are the most troubling discovery. As the flu travels between species, it mingles with viruses that are already there, creating a level of genetic diversity that leaves our immune systems, which are best equipped to fight strains they've already been exposed to, vulnerable. The swine flu epidemic of 2009 started in a similar way, when H1N1 jumped from birds to pigs, and eventually to people.

But the new report isn't a reason to banish your pet to the doghouse next time she seems under the weather. The virus samples were collected from dogs in China between 2013 and 2015, and in the years since, zero humans have caught influenza from dogs (though dog flu has started spreading to cats). If the virus continues mutating to the point where it can infect humans, both the CDC and U.S. Department of Agriculture will take action. But for now, the CDC states that canine flu viruses "pose a low threat to people."

Canine flu may not be dangerous to humans yet, but it can still be stressful for dog owners if their pet comes down with a case. Ask your vet about getting your dog vaccinated, and if you see your dog coughing, sneezing, and acting less energetic than usual, make an appointment to get him checked out as soon as possible. If he does have the flu, he can be treated with plenty of rest and hydration.

[h/t Live Science]

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