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A glass mainly full, or slightly empty?

Blog Post2 min read

Academics like us are sometimes rewarded for making a big deal out of little disagreements. If I like your article, and agree with your conclusions, and agree with the main line of your argument, but disagree with a step in it -- hey! Maybe that's a place where I can write another paper!

So, I'm a little amused at my own reaction when I read that Jim Yong Kim -- one of the founders of Partners in Health and pioneers of treating multidrug-resistant tuberculosis -- is Obama's candidate for World Bank president, and Diane's similar reaction when I told her the news.

My thought was: "Oh, no! This guy thinks that we should be focusing on treatment!" In other words, I wasn't glad that he isn't a war-politician; I wasn't glad that he thinks that poverty is importantly about health; I wasn't even glad the he thinks poverty is importantly about infectious disease. I jumped at where we disagree.

To clarify, Dr. Kim is a physician, and has long argued for -- and put into practice -- the idea that poor people should be treated for infectious diseases, just like rich people in rich countries would be. All else equal, I think so, too.

But in a world of costs, opportunity costs, and second-bests, all else isn't equal. First, we may be able to accomplish more by preventing diseases (sanitation, anybody?). Second, quite a lot of damage is done early in life, or even in utero, damage that often is in principle preventable.

Finally, there is much evidence of attempts at medical treatment, at least here in India, that have done more harm than good. Diane's advisor Jeff Hammer has coauthored some telling papers in this literature, and any day now she will be blogging about tragedies in a district hospital that she has gotten to know.

From my reading of the Partners in Health literature, they might respond that we should try to get more resources, so that treatment and prevention do not have to be alternatives. We should fix district hospitals. Both are good outcomes; both are difficult to do.

Honestly, I know very little about what a World Bank president does all day, or what levers he can pull. As an economist might ask, what is the causal effect of a World Bank president, relative to the counterfactual person in the job? I don't know. Nor, frankly, do I know Dr. Kim's views on latrines. Nor does he need my vote.

So, I might as well drink the glass mainly full. Poverty is importantly about infectious disease. Good luck to Dr. Kim.


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