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Gates Foundation

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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New Technique Can Spot a Heart Attack in the Making Long Before It Happens
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Cardiology experts have developed a noninvasive way of measuring the fat around a person's blood vessels, which could help determine their risk for dangerous cardiac events. The researchers described their technique today in the journal Science Translational Medicine.

Heart attacks are incredibly common, affecting around 750,000 Americans every year. Heart disease is the number one cause of mortality in the U.S., responsible for one out of every four deaths. There are many reasons for this. Among them is the difficulty of identifying at-risk patients before it's too late.

Cardiologists' current method of choice uses a metric called coronary calcification score (CCS) to measure the hardening of a patient's arteries. CCS is a reliable way to predict future heart problems, paper co-author Charalambos Antoniades said in a statement, but it has its limitations.

"When coronary calcification is detected," he said, "it is already too late, as the calcification is not reversible."

And so, rather than measuring calcification, many researchers have begun looking for a way to measure blood vessel inflammation, which is usually a pretty good—and early—predictor of heart disease.

The inflammation itself can be hard to see without entering a patient's body. But recent studies have shown that it rarely travels alone: Blood vessels that are inflamed are also often wrapped in larger fat cells than healthy vessels. 

With this link in mind, Antoniades and his colleagues decided to try measuring the fat cells instead. They reviewed computed tomography scans from 453 patients about to undergo heart surgery, and used these data to create what they call the fat attenuation index (FAI). The higher a patient's FAI, the more inflammation they had, and the more advanced or severe their heart disease. 

The researchers then compared the FAI of 40 additional patients with the results of invasive scans of the inflammation in their hearts. Sure enough, each patient's FAI matched the swelling onscreen.

There are many benefits to using FAI, the authors say. Not only is it noninvasive and accurate, but it can be used in tandem with CCS and other methods for an even more complete picture. The next step will be validating the test's safety and accuracy in clinical trials.

FAI scans "could help direct these new types of treatments to the appropriate subgroups of patients at greatest risk," Antoniades says, "reducing costs and targeting more powerful drugs to the patients who will benefit most."

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Don't Panic About the Plague
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If reports of measles and whooping cough making a reappearance aren't alarming enough, the news that three people in New Mexico have contracted plague this year might have you on edge. But these aren't the only recent cases of plague in the state—the disease appeared in both 2016 and 2015, causing one death—or even in the U.S.

In 2015, a child contracted the plague in Yosemite National Park, and so did a tourist from Georgia; park officials closed a campground where they discovered two dead squirrels infected with the disease. That same year in Colorado, a pitbull infected four humans with pneumonic plague before being put down, and two other Colorado residents died from plague, including a 16-year-old boy.

It all seems very scary, but don't go sealing yourself in protective gear yet. There's less to fear about plague than you may think. While the public is prone to panic that a medieval illness, which wiped out a quarter of Europe in the Middle Ages during the Black Death, has suddenly arisen from obscurity, the truth is: Plague never left.

Though we haven't seen a widespread epidemic of plague since the early 20th century, thanks to advances in sanitation and medicine, and there hasn't been a human-to-human case of transmission in America since 1924, an average of seven new cases are reported every year in the U.S. From 2010 to 2015, there were 3248 cases, including 584 deaths, reported worldwide, according to the World Health Organization.

Yersinia pestis, the flea-borne bacteria that's most often responsible for plague, infects rodents; humans are “incidental hosts,” who can acquire the infection if bitten by an infected flea or rodent. Compared to the 14th century, when the Black Death spread wildly, or the late 19th century, when 10 million people died of the disease after it traveled from Hong Kong to port cities worldwide, most people today live in more sanitary conditions and have less frequent contact with the rodents most likely to carry the infected fleas. Today, 95 percent of plague cases originate in parts of sub-Saharan Africa and Madagascar.

The most common of the three strains of plague is the notorious bubonic plague, which causes painful swollen lymph nodes (also called buboes) and was responsible for Europe's Black Death—so named because internal hemorrhages caused by the infection make the skin appear black. But the pitbull that infected four Colorado residents carried the rarer respiratory strain of pneumonic plague, which is contagious when the infected person coughs up infected particulates. There is also septicemic plague, the most lethal form, which infects the blood, and most often occurs when plague virus has gone undetected and is allowed to spread.

In the U.S., you're generally only at risk of contracting plague in late spring to early fall if you've been in a rural or semi-rural area of the West, especially New Mexico, Arizona, or Colorado, and have had contact with fleas or rodents including ground squirrels, chipmunks, prairie dogs, or rats. And even then, the risk is low.

Only the pneumatic version of plague is contagious from human to human (though untreated bubonic plague can become pneumonic), but you have to be coughed upon, or receive fluid from an infected person upon an open wound or directly into your mouth or nose.

Plague symptoms mimic any flu—fever, chills, headache, difficulty breathing or coughing—but people have been known to cough up blood with the pneumonic variety. If you've been in a rural area, or camping, and come down with these symptoms two to three days later, it's best to go to a hospital.

Now for some good news: While untreated plague is quite deadly, people with plague who are treated with antibiotics within 24 hours of infection have strong recovery rates.

So while it's good to be aware and take precautions, the chances of another plague pandemic remain slim.

This story was originally published in 2015 and has been updated. 


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