Archive for December, 2012

#MiddleEarthPublicHealth

The weekend is almost here, and the new year — so how to celebrate? For a start, here are the results of a mashup meme I tried to start last night on Twitter: #MiddleEarthPublicHealth:

https://storify.com/brettkeller/middleearthpublichealth

 

If the Storify version (which shows all the tweets) doesn’t work, you can search on Twitter for the #MiddleEarthPublicHealth hashtag.

28

12 2012

Do they know it's Christmas? No, because it isn't.

Remember “Do they know it’s Christmas?” That’s right, the 1984 hit song intended to raise money for famine victims in Ethiopia.  If that’s not ringing a bell (See what I did there?) then here’s the video:

You probably didn’t get very far, so here are some of the inane lyrics:

And there won’t be snow in Africa this Christmas time
The greatest gift they’ll get this year is life
Where nothing ever grows, no rain or rivers flow
Do they know it’s Christmas time at all?

In addition to reinforcing all sorts of stereotypes about Africa, this video gets one very important thing wrong: Do they know it’s Christmas time? No, they don’t, because Ethiopians are Orthodox Christians and don’t celebrate Christmas until January 7th. So next time someone says they love this song, you now have an annoying know-it-all response to shut them down — which you can consider your holiday gift from this blogger. Merry Christmas!

[On a more serious note, Ethiopia has made huge strides on food security since the fall of the Derg. If you want to read more on that, MoreAltitude (an aid blogger who recently relocated to Addis) has this take.]

21

12 2012

The greatest country in the world

I’ve been in Ethiopia for six and a half months, and in that time span I have twice found myself explaining the United States’ gun culture, lack of reasonable gun control laws, and gun-related political sensitivities to my colleagues and friends in the wake of a horrific mass shooting.

When bad things happen in the US — especially if they’re related to some of our national moral failings that grate on me the most, e.g. guns, health care, and militarism — I feel a sense of personal moral culpability, much stronger when I’m living in the US. I think having to explain how terrible and terribly preventable things could happen in my society, while living somewhere else, makes me feel this way. (This is by no means because people make me feel this way; folks often go out of their way to reassure me that they don’t see me as synonymous with such things.)

I think that this enhanced feeling of responsibility is actually a good thing. Why? If being abroad sometimes puts the absurdity of situations at home into starker relief, maybe it will reinforce a drive to change. All Americans should feel some level of culpability for mass shootings, because we have collectively allowed a political system driven by gun fanatics,  a media culture unintentionally but consistently glorifying mass murderers, and a horribly deficient mental health system to persist, when their persistence has such appalling consequences.

After the Colorado movie theater shooting I told colleagues here that nothing much would happen, and sadly I was right. This time I said that maybe — just maybe — the combination of the timing (immediately post-election) and the fact that the victims were schoolchildren will result in somewhat tighter gun laws. But, attention spans are short so action would need to be taken soon. Hopefully the fact that the WhiteHouse.gov petition on gun control already has 138,000 signatures (making it the most popular petition in the history of the website) indicates that something could well be driven through. Even if that’s the case, anything that could be passed now will be just the start and it will be long hard slog to see systematic changes.

As Andrew Gelman notes here, we are all part of the problem to some extent: “It’s a bit sobering, when lamenting problems with the media, to realize that we are the media too.” He’s talking about bloggers, but I think it extends further: every one of us that talks about gun control in the wake of a mass shooting but quickly lets it slip down our conversational and political priorities once the event fades from memory is part of the problem. I’m making a note to myself to write further about gun control and the epidemiology of violence in the future — not just today — because I think that entrenched problems require a conscious choice to break the cycle. In the meantime, Harvard School of Public Health provides some good places to start.

17

12 2012

Monday miscellany

I’m outsourcing this week’s link round-up to KirstyEvidence, a blog on research and international development I only recently discovered. Her Twelve Days of Evidence post starts with 12 non-fiction books worth buying, 11 tweeps to follow, and so forth. It’s good stuff, so click through and enjoy some light holiday reading.

(Plus, it gets me in more of a holiday mood than the Michael Bolton Christmas album playing in the Addis hotel lobby where I started writing this post. Ugh.)

 

17

12 2012

Housekeeping

I recently updated the post categories on this blog, trying to clean things up a bit. Since a lot of my posts are link roundups, shorter commentary, or photography, I added a category called “prose” that includes all the slightly longer, more substantive things I’ve written. You can browse that category here.

15

12 2012

Friday photos: Simien Mountains panoramas

Sunset panorama made from seven photos stitched together — taken from a ridge above Geech Camp in the Simien Mountains (click for higher resolution version):

And a daytime panorama from somewhere below Sankaber Camp:

14

12 2012

Defaults

Alanna Shaikh took a few thing I said on Twitter and expanded them into this blog post. Basically I was noting — and she in turn highlighted — that on matters of paternalism vs. choice, economists’ default is consumer choice, whereas the public health default is paternalism.

This can and does result in lousy policies from both ends — for example, see my long critique of Bill Easterly’s rejection of effective but mildly paternalistic programs due to (in my view) relying too heavily on the economists’ default position.

I was reminder of all this by a recent post on the (awesomely named) Worthwhile Canadian Initiative. The blogger, Frances Wooley, quotes a from a microeconomics textbook: “As a budding economist, you want to avoid lines of reasoning that suggest people habitually do things that make them worse off…” Can you imagine a public health textbook including that sentence? Hah! Wooley, responded, “The problem with this argument is that it flies in the face of the abundant empirical evidence that people habitually overeat, overspend, and do other things that make them worse off.”

The historical excesses and abuses of public health are also rooted in this paternalistic streak, just as many of the absurdities of economics are rooted in its own defaults. I think most folks even in these two professions fall somewhere in between these extremes, but that a lot of disagreements (and lack of respect) between the fields stems from this fundamental difference in starting points.

(See also some related thoughts from Terence at Waylaid Dialectic that I saw after writing the initial version of this post.)

 

13

12 2012

Alwyn Young just broke your regression

Alwyn Young — the same guy whose paper carefully accounting for growth in East Asian was popularized by Krugman and sparked an enormous debate — has been circulating a paper on African growth rates. Here’s the 2009 version (PDF) and October 2012 version. The abstract of the latter paper:

Measures of real consumption based upon the ownership of durable goods, the quality of housing, the health and mortality of children, the education of youth and the allocation of female time in the household indicate that sub-Saharan living standards have, for the past two decades, been growing about 3.4 to 3.7 percent per annum, i.e. three and a half to four times the rate indicated in international data sets. (emphasis added)

The Demographic and Health Surveys are large-scale nationally-representative surveys of health, family planning, and related modules that tend to ask the same questions across different countries and over large periods of time. They have major limitations, but in the absence of high-quality data from governments they’re often the best source for national health data. The DHS doesn’t collect much economic data, but they do ask about ownership of certain durable goods (like TVs, toilets, etc), and the answers to these questions are used to construct a wealth index that is very useful for studies of health equity — something I’m taking advantage of in my current work. (As an aside, this excellent report from Measure DHS (PDF) describes the history of the wealth index.)

What Young has done is to take this durable asset data from many DHS surveys and try to estimate a measure of GDP growth from actually-measured data, rather than the (arguably) sketchier methods typically used to get national GDP numbers in many African countries. Not all countries are represented at any given point in time in the body of DHS data, which is why he ends up with a very-unbalanced panel data set for “Africa,” rather than being able to measure growth rates in individual countries. All the data and code for the paper are available here.

Young’s methods themselves are certain to spark ongoing debate (see commentary and links from Tyler Cowen and Chris Blattman), so this is far from settled — and may well never be. The takeaway is probably not that Young’s numbers are right so much as that there’s a lot of data out there that we shouldn’t trust very much, and that transparency about the sources and methodology behind data, official or not, is very helpful. I just wanted to raise one question: if Young’s data is right, just how many published papers are wrong?

There is a huge literature on cross-country growth ‘s empirics. A Google Scholar search for “cross-country growth Africa” turns up 62,400 results. While not all of these papers are using African countries’ GDPs as an outcome, a lot of them are. This literature has many failings which have been duly pointed out by Bill Easterly and many others, to the extent that an up-and-coming economist is likely to steer away from this sort of work for fear of being mocked. Relatedly, in Acemoglu and Robinson’s recent and entertaining take-down of Jeff Sachs, one of their insults criticisms is that Sachs only knows something because he’s been running “kitchen sink growth regressions.”

Young’s paper just adds more fuel to that fire. If African GDP growth has been 3 1/2 to 4 times greater than the official data says, then every single paper that uses the old GDP numbers is now even more suspect.

Monday miscellany

  • First, a request: I remember recently reading the first report of sexual transmission of malaria, a case where someone acquired malaria from a well-traveled partner despite never traveling to malarial areas themselves. I thought maybe it was in MMWR but have scanned that and other publications and done a few searches and cannot locate this article. It’s possible this was an elaborate dream — epidemiologists think and write about weird things, so why not dream them too? But if anyone else remembers reading this or can find the article, please let me know! [Update: see comments]
  • A new paper:  “The Mean Lifetime of Famous People from Hammurabi to Einstein.” (h/t to Economic Logic)
  •  I just revisited a blog post by World Bank health economist Adam Wagstaff: “How can health systems “systematic reviews” actually become systematic?” The post and the comments are a great conversation and reveal some of the differences that are revealed when working across disciplines. Also, I think you should be reading Wagstaff’s posts (at the WB Let’s Talk Development blog) because he’s one of the fathers of health inequity research and I ended up citing him a bunch in my (in progress) Masters thesis, especially this World Bank report (PDF) on analyzing health equity using household survey data. Also, the companion page for that report has Stata .do files for each chapter, amongst other resources.
  • Also from Wagstaff: “Shocking facts about primary health care in India, and their implications.” See also Amanda Glassman’s take on the same paper.
  • Tyler Cowen reviews Ben Goldacre’s new book Bad Pharma (which I blogged before). And then Goldacre showed up to argue in the comments about whether his policy suggestions would increase the cost of drug R&D.
  • One of my photos of Somaliland is featured in this article on investment in the country.
  • The NYT Opinionator blog highlights GiveWell‘s work in “Putting Charities to the Test.”
  • Finally, the blog WanderLust has an interesting summary of 9 events that shaped the humanitarian industry.

10

12 2012

On deworming

GiveWell’s Alexander Berger just posted a more in-depth blog review of the (hugely impactful) Miguel and Kremer deworming study. Here’s some background: the Cochrane reviewGivewell’s first response to it, and IPA’s very critical response.

I’ve been meaning to blog on this since the new Cochrane review came out, but haven’t had time to do the subject justice by really digging into all the papers. So I hope you’ll forgive me for just sharing the comment I left at the latest GiveWell post, as it’s basically what I was going to blog anyway:

Thanks for this interesting review — I especially appreciate that the authors [Miguel and Kremer] shared the material necessary for you [GiveWell] to examine their results in more depth, and that you talk through your thought process.

However, one thing you highlighted in your post on the new Cochrane review that isn’t mentioned here, and which I thought was much more important than the doubts about this Miguel and Kremer study, was that there have been so many other studies that did not find large effect on health outcomes! I’ve been meaning to write a long blog post about this when I really have time to dig into the references, but since I’m mid-thesis I’ll disclaim that this quick comment is based on recollection of the Cochrane review and your and IPA’s previous blog posts, so forgive me if I misremember something.

The Miguel and Kremer study gets a lot of attention in part because it had big effects, and in part because it measured outcomes that many (most?) other deworming studies hadn’t measured — but it’s not as if we believe these outcomes to be completely unrelated. This is a case where what we believe the underlying causal mechanism for the social effects to be is hugely important. For the epidemiologists reading, imagine this as a DAG (a directed acyclic graph) where the mechanism is “deworming -> better health -> better school attendance and cognitive function -> long-term social/economic outcomes.” That’s at least how I assume the mechanism is hypothesized.

So while the other studies don’t measure the social outcomes, it’s harder for me to imagine how deworming could have a very large effect on school and social/economic outcomes without first having an effect on (some) health outcomes — since the social outcomes are ‘downstream’ from the health ones. Maybe different people are assuming that something else is going on — that the health and social outcomes are somehow independent, or that you just can’t measure the health outcomes as easily as the social ones, which seems backwards to me. (To me this was the missing gap in the IPA blog response to GiveWell’s criticism as well.)

So continuing to give so much attention to this study, even if it’s critical, misses what I took to be the biggest takeaway from that review — there have been a bunch of studies that showed only small effects or none at all. They were looking at health outcomes, yes, but those aren’t unrelated to the long-term development, social, and economic effects. You [GiveWell] try to get at the external validity of this study by looking for different size effects in areas with different prevalence, which is good but limited. Ultimately, if you consider all of the studies that looked at various outcomes, I think the most plausible explanation for how you could get huge (social) effects in the Miguel Kremer study while seeing little to no (health) effects in the others is not that the other studies just didn’t measure the social effects, but that the Miguel Kremer study’s external validity is questionable because of its unique study population.

(Emphasis added throughout)