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The Best Science Writing Online 2012
Showcasing more than fifty of the most provocative, original, and significant online essays from 2011, The Best Science Writing Online 2012 will change the way...
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One of the persistent questions about sustainable development is how to help the world’s poorest people. Their incomes are so low that they lack access to the most basic goods and services: adequate nutrition, safe drinking water and sanitation, and life-saving health interventions. One strategy, which I have long favored, is to provide targeted financial support to help the poor to meet their basic needs and thereby to escape from the poverty trap. My colleagues and I have calculated that the cost of ensuring basic life-saving health coverage for the world’s poor would be around 0.1 percent of the gross national product of the high-income countries (10 cents per $100 of income).
One example of such targeted aid is a mass free distribution of antimalaria bed nets to people living in impoverished malarious regions of Africa. Each of these long-lasting insecticide-treated nets (LLINs) costs only around $10 to produce, transport and distribute to households in rural Africa. Because the nets last for five years and two children typically sleep under each net, the cost per child per year is a mere $1.* Even at this remarkably low cost, however, some critics have opposed such an approach. They have claimed that the nets would “go missing” in large numbers because of waste by recipients and others in the supply chain who did not properly value them. These critics’ preferred solution is market sales of nets at a discount rather than a massive free distribution, on the grounds that even a small price would encourage more efficient use of the nets.
Yet there are too main arguments in favor of mass free distribution. The first is that the poorest people simply cannot afford to pay $10 per net. The second is that there are important spillover benefits (or “positive externalities”) when a person uses a bed net, because the net not only gives personal protection to the user but also helps to block transmission of the disease within the community. We should therefore encourage very high levels of bed net use, just as we do with immunizations.
This is one of those interesting cases in which both experiments and real life have now provided evidence to resolve this debate convincingly: the case for mass free distribution of bed nets has proved to be stunningly powerful. On the basis of experience and key public health concepts, official global policy has now adopted mass free distribution of anti-malaria LLINs as the global policy. As a result, after many years in which bed net coverage was extremely low, it is now soaring, and malaria cases are falling sharply in those places in Africa where mass bed net distribution is being deployed.
Here is how the events have unfolded. Evidence has long shown that Africa’s rural poor are so destitute that many are unable to pay even a tiny amount for lifesaving health interventions, even when the costs are subsidized. Not surprisingly, attempts to sell them subsidized LLINs during the years 2000 to 2005 fell badly short, even at prices as low as $2 to $3 per net. The uptake of bed nets in Africa through sales was very small, and coverage remained a tiny fraction of those in need. As of 2005, before the start of large-scale free distribution, one million children or more continued to die each year in Africa of a largely preventable and wholly treatable disease.
Beginning in 2002 and 2003, the International Red Cross and UNICEF began experimenting with a mass free distribution of LLINs in some trial sites. They found that the logistics of mass free distribution were indeed feasible, that community uptake was high, and that distributed bed nets were indeed in the households in high percentages upon spot checks of the recipient communities a few months after the mass distribution.
The evidence of success of mass distribution continued to grow. The World Health Organization adopted mass distribution as its basic standard in 2007. In a Global Malaria Action Plan, the international partnership on malaria control known as Roll Back Malaria set a goal to distribute around 300 million LLINs in Africa through free mass distribution during 2008-2010, in order to cover all sleeping sites in malaria-transmission regions. Already, as the result of mass distribution, the coverage with long-lasting insecticide treated bed nets has jumped from perhaps 10 million in 2004 to 170 million nets as of the end of 2008.
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13 Comments
Add CommentDear Dr. Sachs:
Reply | Report Abuse | Link to thisI read your article re malaria control with LLINs with interest. Without questioning the merits, you seem to say two children can use a LLIN for five years for $10 -for a cost of $0.50 per child year of use. Is that the gold standard for accuracy for environmental and social science? Did I miss something, or does $10 divided by 10 child years of use calculate to $1.00 per child year?
Edwin M. Osborne
Camarillo, CA
Dear Dr. Sachs:
Reply | Report Abuse | Link to thisYes, malaria is awful. Yes, malaria is part of what keeps many in poverty. So let's solve it! Great argument, but...
As is often the case with such great social causes, your article fails to look at the unintended consequences. Fewer people dying of malaria means more people. And the #1 cause of human-induced climate change is... humans! And people escaping poverty use more energy = more emissions per capita. So it's a double: more people and more emissions per person.
I will agree with you that helping people out of poverty is something we, as humans, owe each other. But doing so without regard to the consequences is not only foolish, but reckless as well. Can you propose a more holistic approach?
Maybe inflation entered the picture and $1.00 is only worth $0.50? One can change the article when it is posted online. How about it?
Reply | Report Abuse | Link to thisMaybe inflation entered the picture and $1.00 is only worth $0.50? One can change the article when it is posted online. How about it?
Reply | Report Abuse | Link to thisVery interesting articles.......african countries should be supported with regard to mass distribution of bed nets...Phillip M, Botswana, Africa
Reply | Report Abuse | Link to this@meadi*r and Larry144. You should both read the article more carefully. Sachs said each net protects TWO children which over 10 years equates to a total of 20 child years of protection which equals $0.50 per child.
Reply | Report Abuse | Link to thisMITDGreenb, do you really mean to say that we should let people die to avoid increased energy emissions?
Reply | Report Abuse | Link to thisFor one, that is heinously immoral.
And two, it's illogical. If you're actually concerned with decreasing energy emissions, then focus on the developed world, which is responsible for the majority of the problem. If you're concerned about over population, then focus on birth control: as it stands, most African countries (including Kenya, MIT's trial site) have little access to it. http://www.acpd.ca/acpd.cfm/en/section/acpdmedia/articleID/262
What a wonderful story about an inexpensive way to help a large number of people! I read a blog post recently about a number of low-cost tests for HIV and other conditions (http://iconsinmedicine.wordpress.com/). The organization that runs this blog and the associated program also sound really interesting (http://www.iconsinmed.org). They link up physicians with one another to provide teleconsultations. Really interesting!
Reply | Report Abuse | Link to thisPeople like MITDGreenb make me sick. to say that if a problem that is caused by the solution is to get rid of humans is despicable. If you are in favour of such a solution, why don't you start by eliminating yourself and your family.
Reply | Report Abuse | Link to thisI am in complete agreement with wealhtheow. Killing children after the fact is reprehensible. If that really is your concern, education and birth control would definitely be the moral thing to do.
Reply | Report Abuse | Link to thisWell, it would seem that MITDGreenb values total human carbon footprint more than human life....First off, wow! I didn't realize someone could be that cold-blooded. Second off, it is an illogical conclusion: citizens of the developing world have a very low carbon footprint per capita relative to the developed world. The world can tolerate many more such people from the developing world than it can people from the developed world.
Reply | Report Abuse | Link to thisBy your logic, the best solution to the climate problem would be for the citizens of the developing world to kill off several tens of millions of citizens of the developed world...they do outnumber us afterall.
This discussion is an excellent case study how a discussion goes wrong by logical fallacies (google logical fallacies for theoretical background).
Reply | Report Abuse | Link to thisThere are two points that @MITDGreenb in his/her statement made clear.
1. As it often occurs, the solution to one problem causes new problems.
2. Human overpopulation is a serious problem on this planet dispelled by many.
Now the counter argument of @trebmald is a typical straw man knock down. Killing children after the fact is reprehensible. But, @MITDGreenb didnt demand to kill children. It is @trebmalds invented straw man thats easier to burn down.
@trebmald also uses the tu quoque fallacy by declaring why don't you start by eliminating yourself and your family. In consequence, as you dont commit suicide your argument is invalid. The easiest way to solve an argument, really.
Next, in addition to a straw man, @wealhtheow employs a red herring redirecting the discussion towards problems with birth control.
An even more sophisticated red herring is applied by @Bill77. By Fist off.. he/she starts an emotional appeal. Then Second off.. a red herring but also a wrong conclusion as some of the carbon dioxide emission caused by production in developed countries is consumed as products in developing countries. We are one world after all. His final logic is an appeal to consequences, so please withdraw your argument, else we have to eliminate the developed world.
Finally, thats my point. The word suffers from too many too stupid people, and as education in developing countries is much worse than in developed countries, it must be expected that the additional life saved in developing countries will decrease the statistical average of human intelligence. In other words, it will not bestow new geniuses to solve the worlds problems but rather pirates to make everything worse. Well, this argument might be challenged, and I feel my doubts raising too.
Hmm, MPatch, you in your infinite logical wisdom apparently have granted yourself the right to judge some people to be "stupid" based upon a few sentences. Tossing around the names of logical fallacies (straw man, red herring, emotional appeal, etc) does not suddenly make your own claims true...would that not be a "non sequitur" (they are wrong, so I must be right)?
Reply | Report Abuse | Link to thisI stated:
"citizens of the developing world have a very low carbon footprint per capita relative to the developed world". My conclusion is not wrong simply because the developing world uses *some* high-carbon footprint products produced by the developed world. If you truly think this argument makes my claim false, it is YOU who is in danger of being considered "stupid". It is more than likely greatly offset by goods produced in the developing world (using cheap labor) for sale to the developed world.
The 2006 carbon dioxide emissions per capita listed in the Wikipedia, shows that much of Africa has a per capita emission of less than 1.0 metric tons. Libya and South Africa being notable standouts...but South Africa isn't really the developing world we're talking about either...former UK colony (I believe the Dutch colonized northern South Africa IIRC).
However, there are certainly people who drive cars in Africa, so my claim is just completely false then?
Saving lives will not bestow the world with new geniuses? So, genius is a product of education (knowledge), and not a high potential for intellectual creativity?
Do you understand that even with schooling, it is hard for the children of Africa to learn if they (many of them) are in a constant state of suffering and/or dying from Malaria? or at least watching their friends and siblings dying of it and other parasite related diseases?
You contend that saving the lives of people in the developing world is a waste because they are "stupid anyway" (to paraphrase your claim). Could you tell me what exactly the tens of millions of American Idol / reality TV watching citizens of the developed are doing to contribute to the betterment of the human race with their "vastly superior" intelligence? What do they contribute to justify the vast expenditure of resources spent to make them fat and entertained?