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Sexy Diseases Get All the Money August 19, 2006

Posted by David Bookstaber in Government Spending, Social Politics.

Here is a distressing situation:

Haiti has the highest child mortality rate in the Western Hemisphere.  One in eight children dies by age five, and a third are chronically malnourished.  [T]he major causes of infant mortality in Haiti [are] diarrhea, fever, acute respiratory infections, malaria, measles, and malnutrition….  [O]nly 34% fully immunized, Haiti’s children continue to be plagued by limited protection against the most common childhood diseases

This is a crisis that cries out for foreign charity: basic medical services could save the lives of most children dying in Haiti.  And since charity these days seems to be run through the government, we should not be surprised to see gobs of foreign government aid pouring in.  But where is it going?

McClatchy today runs a report on some of this foreign aid, which has included more than $100MM specifically to treat AIDS.  This turns out to be a story of utterly perverse priorities:

Haiti long has had the highest AIDS rate outside Africa.

[A] story making the rounds in Haiti describes patients who become distraught when they learn they do not have AIDS – because they know that AIDS patients receive free medicine, treatment and sometimes food often unavailable to those with other illnesses.

What’s the difference between AIDS and, say, malnourishment or measles?  All are killing people in Haiti.  But there are a number of reasons that we should be much more eager to treat the latter than the former:

  • There are cheap and fully effective vaccines for measles.  There is no vaccine for AIDS.
  • Vaccinated people do not communicate diseases against which they are vaccinated.  Malnourishment is not communicable or contagious.  AIDS is.  By spending money to keep people with AIDS alive, we are also spending money to keep another HIV carrier in the population.
  • There are known behaviors that communicate the Human Immunodeficiency Virus.  Though not all people infected with the virus are necessarily guilty of those risky behaviors, the fact that a person carries HIV suggests that they are at higher risk for communicating the virus.
  • AIDS is at best a disease that can be controlled with expensive drugs, and at worst will still lead to an early death.  Malnourishment and measles are very cheap to prevent and treat, and once treated will not adversely impact a person’s life expectancy or quality of life.

So where would a rational charity concentrate its work?


1. NBG - August 27, 2006

There are perverse priorities elsewhere as well. Consider the uproar in India over pesticide contamination in Coke and Pepsi. Over a billion Indian drink contaminated water, but that grabs neither the headlines nor Indian politicians.

For more on that, see http://vagyakartha.blogspot.com, “Public Apathy and Perverse Priorities”

2. federalist - December 17, 2006

NYTimes today shines light on an example of a very cheap way to improve health: Iodize salt.

putting iodine in salt, public health experts say, may be the simplest and most cost-effective health measure in the world. Each ton of salt needs about two ounces of potassium iodate, which costs about $1.15.

Worldwide, about two billion people — a third of the globe — get too little iodine, including hundreds of millions in India and China. Studies show that iodine deficiency is the leading preventable cause of mental retardation. Even moderate deficiency, especially in pregnant women and infants, lowers intelligence by 10 to 15 I.Q. points, shaving incalculable potential off a nation’s development.

The most visible and severe effects — disabling goiters, cretinism and dwarfism — affect a tiny minority, usually in mountain villages. But 16 percent of the world’s people have at least mild goiter, a swollen thyroid gland in the neck.

The cheap part, experts say, is spraying on the iodine. The expense is always for the inevitable public relations battle.

In some nations, iodization becomes tarred as a government plot to poison an essential of life — salt experts compare it to the furious opposition by 1950s conservatives to fluoridation of American water.

In others, civil libertarians demand a right to choose plain salt, with the result that the iodized kind rarely reaches the poor. Small salt makers who fear extra expense often lobby against it. So do makers of iodine pills who fear losing their market.

Rumors inevitably swirl: iodine has been blamed for AIDS, diabetes, seizures, impotence and peevishness. Iodized salt, according to different national rumor mills, will make pickled vegetables explode, ruin caviar or soften hard cheese.

Breaking down that resistance takes both money and leadership.

“For 5 cents per person per year, you can make the whole population smarter than before,” said Dr. Gerald N. Burrow, a former dean of Yale’s medical school and vice chairman of the iodine council.

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