Low-Hanging Fruit for Better (Global) Health? | Poor Economics
Chapter 3
Low-Hanging Fruit for Better (Global) Health?

Every year, nine million children under five die from preventable diseases such as diarrhea and malaria.  Often, the treatments for these diseases are cheap, safe, and readily available. So why don’t people pick these ‘low-hanging fruit’? 

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There are a number of inexpensive medical or public health technologies with proven effectiveness including bed-nets for malaria prevention, ORS to combat diarrhea, chlorine to sanitize water, exclusive breast-feeding, etc.
Some of these technologies are so cheap that even the very poor should be able to afford them. And the gains are huge: a $14 investment in a long-lasting insecticide-treated bed net has an average return of $88 every year over the child’s entire work life.
However, the technologies are not used much: when people must pay for bednets or chlorine, they often do not do it.
Yet, people spend a lot of money on health, but mainly on expensive cures rather than cheap prevention. In India, 66% of visits to the doctor result in a shot.
One reason is that public facilities, that deliver preventative care, are often closed.
People also may not understand how certain treatments will help. This is especially true for preventative medicine where the "treatment" has no noticeable effect.
And even if they do understand, they may procrastinate because the cost of getting the preventative care is today, but the benefits are in the future.
Small incentives, like lentils for vaccines, make it as easy as possible for people to do the “right” thing, while, perhaps, leaving them the freedom to opt out.
In rich countries, most of these decisions are made for us, and we don't have to think about it: It should not be different for the poor.

Health studies

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Low-Hanging Fruit for Better (Global) Health?

Short Title: 
Low-Hanging Fruit

Every year, nine million children under five die from preventable diseases such as diarrhea and malaria.  Often, the treatments for these diseases are cheap, safe, and readily available. So why don’t people pick these ‘low-hanging fruit’? 

Alternate Title: 
Extended Body: 

Every year, nine million children under five die from preventable diseases such as diarrhea and malaria. Often, the treatments for these diseases are cheap, safe, and readily available. So why don't people pick these 'low-hanging fruit'? Why don’t mothers vaccinate their children? Why don’t families use bednets, or buy chlorinated water? And why do they spend such large amounts of money on ineffective cure instead?

There are a number of possible explanations. These can include unreliable health service delivery, price sensitivity, a lack of information or trust, time-inconsistent behavior and the simple fact that the poor may not be able to tackle big, chronic illnesses.

None of these reasons explains everything in isolation. But understanding what stops the immediate spread of our ‘low-hanging fruit’ – bednets, de-worming medication, vaccines, chlorinated water – is an important step in improving global health, and may finally help to eliminate health-based poverty traps. 
 

Spotlight

Erica Field, Rachel Glennerster, Reshmaan Hussam / Bangladesh / 2011
 
After the discovery of arsenic in Bangladeshi ground water sources in 1994, a public health campaign at the national level encouraged users to switch to arsenic free sources such as remote tubewells or surface water. These alternative sources, while being free of arsenic, may have contained fecal-oral pathogens in the water. Using a difference-in-difference approach, the authors find that users who switched from arsenic-contaminated to arsenic-free wells exhibited a higher incidence of infant mortality due to the increased incidence of diarrheal disease.

Every year, nine million children under five die from preventable diseases such as diarrhea and malaria. Often, the treatments for these diseases are cheap, safe, and readily available. So why don't people pick these 'low-hanging fruit'? Why don’t mothers vaccinate their children? Why don’t families use bednets, or buy chlorinated water? And why do they spend such large amounts of money on ineffective cure instead?

There are a number of possible explanations. These can include unreliable health service delivery, price sensitivity, a lack of information or trust, time-inconsistent behavior and the simple fact that the poor may not be able to tackle big, chronic illnesses.

None of these reasons explains everything in isolation. But understanding what stops the immediate spread of our ‘low-hanging fruit’ – bednets, de-worming medication, vaccines, chlorinated water – is an important step in improving global health, and may finally help to eliminate health-based poverty traps. 
 

Spotlight

Erica Field, Rachel Glennerster, Reshmaan Hussam / Bangladesh / 2011
 
After the discovery of arsenic in Bangladeshi ground water sources in 1994, a public health campaign at the national level encouraged users to switch to arsenic free sources such as remote tubewells or surface water. These alternative sources, while being free of arsenic, may have contained fecal-oral pathogens in the water. Using a difference-in-difference approach, the authors find that users who switched from arsenic-contaminated to arsenic-free wells exhibited a higher incidence of infant mortality due to the increased incidence of diarrheal disease.