Tuesday, August 27, 2013

Why I'm glad other people will do research for me

Popovers are a little tricky to make, so when I want to bake them, there's only one cookbook I go to: Cook's Illustrated New Best Recipe. Unlike most cookbooks, which maybe test a recipe once or a few times, Cook's Illustrated goes through dozens of variations and puts them through a taste-test panel. Is a popover better with pastry flour or a higher-protein flour? Skim or whole milk? Should you leave the oven at a steady temperature or bump the temperature down after an initial blast of heat? Honestly, I'm not going to take the time to figure these things out on my own.  But I'm glad someone else did.

When Jeff and I were first trying to pick a charity to donate to, I spent a couple evenings browsing the internet. I found a charity that seemed to match our values and had a good reputation. I tried to find dirt on them and couldn't find anything significant. So for the next few years, we donated there.

But this was kind of the equivalent of developing your own popover recipe. You'll probably wind up with something pretty good. But someone giving the task 40 hours a week, year in and year out, is almost certainly going to do better.

Which is why I'm glad there are professional charity evaluators out there. I'm glad the J-PAL Poverty Action Labs and Innovations for Poverty Action exist to do impact evaluations on different interventions that might help people. I'm glad the Copenhagen Convention exists to advise policy makers on how to tackle the world's most important problems.  I'm glad GiveWell exists to recommend specific charities to donors. I'm glad the Cochrane Collaboration compiles the best evidence on health in a format I can (usually) understand. I'm glad that randomized controlled trials of interventions seem to be catching on more.

Food.com offers 179 popover recipes. By looking at them, I have no idea which ones are duds and which produce perfect, airy results. Most charity evaluation sites rank thousands of charities, also pretty inscrutable to a casual viewer. I don't want 179 recipes or thousands of charity ratings. I just want the best.

There's probably a better popover recipe out there. There are almost certainly better charities out there than the ones I know about, and better ones that could be invented. But in the amount of time I'm willing to give the task, I'm not going to find them. So I'm glad there are people smarter and more dedicated than I am whose job it is to work on these hard problems.

(Want a popover?  The recipe's here.  Eat them with butter and jam.)

Photo: Jeremy Noble [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons

Saturday, August 3, 2013

Malaria, one-trick ponies, and lasting change

It's a summer afternoon, and I'm reading the latest debate about narrow vs. systemic charitable interventions.  Scratching a mosquito bite, I'm reminded of a public health intervention that took place in my own country.

When my grandparents were growing up, the American South was still plagued by malaria (or ague, as it was often called.)  And what was the effect of the disease?
“While there is good land in the Southern United States as in the North, the land in the North sells at about 12 to 20 times the price, the difference being mainly due to malaria.”  - Carter, 1922, quoted here
“The diseases due to all four species of malaria parasite share the characteristic febrile episodes with their tendency to regular periodic paroxyms with chills, rigors, and sweating. They also have many symptoms in common with other infectious illnesses, including body aches, headache and nausea, general weakness, and prostration. . . . Lethargic and with sunken and sallow features, spindly limbs, and hard swollen belly is the general description of the condition. In this state the affected individual succumbs to diseases or other hardships that would scarcely threaten a person in reasonable health.” - Carter and Mendis, Evolutionary and Historical Aspects of the Burden of Malaria

The disease had been lessening over the late 19th and early 20th centuries due to better housing (glass and screens for windows) and the use of quinine.  But in the 1940s, the government took matters into its own hands.

During World War II, troops were succumbing to malaria on bases in the Southern US.  The Office of Malaria Control in War Areas was founded in 1942 to protect the areas around military bases. After the war it became the Centers for Disease Control (the CDC) and took on the task of eliminating the disease from the entire nation.  By 1951, the disease was eradicated from the United States.

Woman in rural Georgia, 1941.  Note the wooden shutter - no glass or screen.

This is the type of intervention that I've often heard criticized for its narrow focus.  I've heard single-issue medical interventions called "one-trick ponies", "short-sighted", "kicking the can down the road."  And to be sure, the eradication of malaria in the US was a top-down intervention carried out by a government agency without much community involvement.  There was not an attempt to change the social and economic conditions that prevented people from buying their own windowscreens and DDT. It just dealt with actual disease transmission.

Instead of narrowly-focused efforts, proponents of broad social change advocate "lasting solutions," "systemic change," "a new operating system." Which is great when it happens. But if public health interventions are difficult to carry off well, systemic change is even harder.

And yet it does happen. Interestingly enough, the Civil Rights movement sprang up in the South just as malaria was ending. The newly-formed CDC, located in Atlanta to be near the most malarial areas, declared the disease eliminated from the United States in 1951. That same year Martin Luther King, Jr. graduated from seminary. American blacks still bore the burdens of political disenfranchisement, inadequate education, poor access to health services, violence, and daily acts of hate and humiliation. But they no longer ran the risk of illness or death with every mosquito bite.

Obviously there was a lot more to the Civil Rights movement than a lack of malaria. But it was one of the factors that helped. How likely is someone with “body aches, headache and nausea, general weakness, and prostration” to make it to the polls, to school, or to work? How likely are they to march on Washington?

It's easier to dream big from behind a windowscreen. Easier when you're not hungry. When you're not sick.  When you're not weakened from parasites and malnutrition.  And for those of us who would love to see systemic change, the "one-trick ponies" may be a good way forward.