400,000 Lives

That’s a big number. In 2006 about one million people died from malaria. Nowadays about 600,000 die each year. Four hundred thousand people didn’t die of malaria last year because of the progress we’ve made against the disease. How does that compare to the current Ebola crisis? And what gets more press?

Read more about progress against malaria in this NYTimes Health article highlighting Rear Adm. Timothy Ziemer’s accomplishments as the head of the President’s Malaria Initiative for the last eight years.


Smart Phone Diagnostics

Our phones are with us all the time and can therefore provide better data than a patient self-reporting to a doctor. A smart phone tracking one’s health 24/7 will give ALL the data, not just what the patient is willing, let alone remembers, to share.

“What the Health app is supposed to do, and eventually will, is aggregate all of your personal health information using different apps and fitness devices into one place. The result makes it easy for you to paint your entire health picture, without having to bounce among numerous apps and collect the data yourself.”   http://www.cnet.com/how-to/getting-to-know-ios-8s-health-app/


Better Democracy, Better Health

As reported in vox.com, a study of Brazilian election trends due to the introduction of electronic voting demonstrated that as marginalized citizens gained access to the ballot box, health outcomes improved.

Princeton University professor Thomas Fujiwara’s study “found correlations between the introduction of electronic voting and increases in public health funding, increases in the number mothers getting prenatal health care, and declines in the number of low-weight babies born.These correlations were statistically robust, and survived tests for confounding explanations.”

Those on both sides of the voter ID debate in the US would do well to read Fujiwara’s study!


Lessons of Old Cemeteries

“Anyone who has spent an afternoon in a Victorian cemetery knows that gratitude, not fear, should be the defining feeling of our age, and yet it is fear that defines us. We worry, we cringe. It seems the less we have to fear, the more we fear.” 

These lines from Daniel Gardner’s superb book The Science of Fear sum up what we should be thinking about our present times. But we don’t. Why? Because the horrid conditions we don’t experience from the past–even the relatively prosperous Victorian era–aren’t salient. We don’t smell human waste or inhale the fumes from burning trash. We don’t wend our way through malarial puddles and animal excrement as we walk our streets. We don’t experience polio, typhus or cholera epidemics that kill thousands of people around us.

If you visit a Victorian cemetery, as Gardner does in his book, you’ll see many headstones for little children and young people struck down by diseases that have been eradicated from the US. One should feel gratitude to live in this incredible age, right?

The irony of the current Ebola scare is how puny it is compared to the yellow fever, cholera and small pox epidemics that littered our history. The Spanish Flu epidemic of 1918 killed more than half a million people in the US. As of today there has been one Ebola death in the United States.

Perspective, people! Let’s get all of our kids vaccinated! Let’s knock down those malaria numbers a few hundred thousand a year. And yes, let’s combat Ebola, but it’s not the cataclysmic threat too many fear it is.

Remittances: Bringing It Home

“Sending money home” was something my wife’s grandfather did for his parents during the Depression. Living in rural Appalachia, Ellis Jackson got a job at the Civilian Conservation Corps (CCC) and sent whatever money he made back home. This seems like a kindhearted, if quaint, relic from the past, right?


The positive impact of remittances is another driver of the decline of poverty across the globe. “In 2013, international migrants sent $413 billion home to families and friends — three times more than the total of global foreign aid (about $135 billion). This money, known as remittances, makes a significant difference in the lives of those receiving it and plays a major role in the economies of many countries. Economist Dilip Ratha describes the promise of these “dollars wrapped with love” and analyzes how they are stifled by practical and regulatory obstacles.” from TED

A study of the effect of remittances by the Refugee Migration Movement Research Unit (RMMRU) found that “remittances from international migration contribute to raising the standard of living of not only the recipients but also the non-migrant households living in migration intensive localities through expanding local demand which in turn create employment and increase wages.”


The Burning Cuyahoga and the Environmental Kuznets Curve

Ah, the aroma of burning river, a whiff of our idyllic past.

Between 1868 and 1969, the Cuyahoga River burned at least 13 times (Wikipedia), the worst of which occurred in 1952, although the 1969 fire (much smaller than 1952) inspired a Time article that catalyzed the environmental movement. The cause of these fires were heavy oil slicks and other flammable materials, including trash, floating on the river’s surface. For those who think that terrible pollution is a 20th and 21st Century problem, it is interesting to note that the first recorded fire on the river was witnessed three years after the end of the American Civil War.

Today the Cuyahoga River is doing much, much better. “River reaches that were once devoid of fish now support 44 species. The…survey in 2008 revealed the two most common species in the river were hogsuckers and spotfin shiners, both moderately sensitive to water quality. Habitat issues within the 5.6 miles (9.0 km) navigation channel still preclude a robust fishery in that reach. Recreation water quality standards (using bacteria as indicators) are generally met during dry weather conditions, but are often exceeded during significant rains due to nonpoint sources and combined sewer overflows.” (Wikipedia)

While not perfect, this improvement reflects general improvements in most environmental indicators of pollution in developed countries like the United States, Japan, Australia and Western Europe. In the early days of industrialization, these countries poured the excrement of their factories in the most convenient river, lake or ocean. But as citizens got richer and wealth spread–basic needs met by a growing economy–rampant pollution became unacceptable. Citizens wouldn’t stand for it.

So rivers burn and people become outraged…and a Republican president creates the Environmental Protection Agency. Today there is much less pollution in the developed world then there was 50 years ago (C02 and other greenhouse gasses being important exceptions). Today pollution problems are much worse in rising countries like China and India. And it should be no surprise that China, especially, is making environmental cleanup a major priority. Forty years ago China was still gripped in its self-destructive Cultural Revolution. Who cares about air pollution when hundreds of thousands of people are dying? Now the notorious Beijing air is a top priority as most Chinese no longer just eke out a living.

This pattern–develop, pollute, enrich, reform–is described by the Environmental Kuznets Curve (EKC). While controversial, it has been studied quite a bit and makes intuitive sense. At the start of development, countries focus on production at any costs. Tire factory in a poor country? Just blast the noxious smoke into the air to float away. But as the tire workers became richer and their children went to school, survival was not longer the number-one priority. The persistent hacking of family members led to complaints to a local bureaucrat, and thus, usually in fits and failures and eventual successes, an environmental movement emerges.

Yes, this is too neat, and Bhopals and Chernobyls loom large in the story of pollution in developing countries. Nonetheless, the clean-up of the Cuyahoga and thousands of rivers like it in developed countries speak to some important truths. People complaining to officials works. And one source of the complaints is relative affluence.

How the EKC works–When per capita Gross Domestic Product reaches somewhere in the neighborhood of $4000, pollution decreases as the pressures from the “rising” locals force better environmental protections, especially for improved air quality (dioxides and particulate matter). However, the EKC is a moderately crude model. Rising wages is not the only, or even primary, driver of environmental change; access to property rights, rule of law, fair elections–civil society–are crucial. Chernobyl happened in a totalitarian state. Nuclear energy has caused very few deaths in rich countries yet strong environmental groups and constituencies keep nuclear energy relatively small. That’s power.

As Yandle et al. point out in an paper about the EKC: When ordinary people have political power, civil rights as well as economic rights, air and water quality improves in richer and poorer countries.

So the affluence brought by development is a powerful driver of eventual environmental improvement, but political power and civil rights are virtually necessary for these improvements, too.