Think again, again

April 25, 2011 11:11 AM

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?

Poor Economics is a book and website by Abhijit V. Banerjee and Esther Duflo. It has maps, graphs, and data drawn from the research at MIT's Poverty Action Lab. It is currently being reviewed and discussed (1, 2, 3) at the Economist. BONUS: Duflo discusses the book and Randomized Controlled Trials (Wikipedia: RCT).
posted by anotherpanacea (46 comments total)

I want to thank you for posting this. There's such a wealth of information at their site, including links links to many organizations that I've never heard of, such as "Deworm the World."
posted by zarq at 11:29 AM on April 25, 2011 [4 favorites]

Deworm the world
Deworm the children
Deworm to make a brighter day
so let's start deworming.

(I'm so so sorry. I'll show myself out.)
posted by hippybear at 11:33 AM on April 25, 2011 [15 favorites]

This looks great. The Economist review makes the book sound fascinating. I wish the Kindle edition were available already; I'd be reading it now if it were.
posted by painquale at 11:34 AM on April 25, 2011

I read a piece on Duflo in the New Yorker not long ago and it was really fascinating stuff.
posted by Miko at 11:42 AM on April 25, 2011 [1 favorite]

The rich can indulge their weakness for cigarettes and alcohol without fear of financial ruin. The poor, in contrast, have to watch every cup of sugary tea.

Isn't this the way it's supposed to be? My grandfather left Ireland because they raised the taxes on cigarettes. Nobody was wringing their hands about Tommy Kelly not having enough scratch to pay for his hourly nicotine fix.
posted by Cool Papa Bell at 11:46 AM on April 25, 2011

Why don't PARENTS vaccinate their children?
Reflexive response to mother-blaming.
posted by Lulu's Pink Converse at 11:48 AM on April 25, 2011 [12 favorites]

Isn't this the way it's supposed to be?

Cool Papa Bell, are you implying that poor people aren't "supposed to" be able to afford treats and occasional indulgences?

I suspect you're not, but the way you've framed this did make me go "...wha?"
posted by EmpressCallipygos at 11:50 AM on April 25, 2011 [1 favorite]

I'm glad their work is becoming more popularized. I am not family with Banerjee, but Duflo is a perfect example of a social scientist (or "scientist," depending on your perspective of economics) who has pushed social scientific methodology to an exceptionally rigorous level. Arguably, she has crossed the barrier of interpretation of social phenomena that many social scientists experience.
posted by terezaakarenin at 11:51 AM on April 25, 2011 [1 favorite]

Cool Papa Bell: "Isn't this the way it's supposed to be? "

Only if you accept that nanny states are appropriate.
posted by zarq at 11:53 AM on April 25, 2011

I'm still digging into the website, myself. I just found the resources for their team-taught courses using the book as a rough outline, which includes lecture notes, assignments, and videos. This is a really phenomenal resource for anyone who teaches these issues, and the videos are largely self-recommending, like Paul Kagame discussing _Dead Aid._
posted by anotherpanacea at 12:01 PM on April 25, 2011 [2 favorites]

Quite frankly, after reading The Fever, I think anyone who refers to malaria as "low-hanging fruit" has absolutely no clue about malaria.
posted by mayhap at 12:10 PM on April 25, 2011

A previous work by these two superstars of development economics, "Economic Lives of the Poor" is a really great read as well. It's also one of the most accessible journal articles on economics I've ever read.
posted by cirgue at 12:23 PM on April 25, 2011

are you implying that poor people aren't "supposed to" be able to afford treats and occasional indulgences?

I don't think it's too much of a stretch to say that treats and indulgences that carry high risks of significant long-term health costs -- tobacco among them -- should have said costs largely born by the individual indulging in them. If that prices the poor out of cigarettes, I have a hard time freaking out about it. Removing disincentives to stay away from this class of things is the last thing to do.

Only if you accept that nanny states are appropriate.

Invoking the pejorative "nanny state" concept is a pretty odd rejoinder to someone who was suggesting a somewhat individualist/libertarian view of indulgences and costs. What exactly are you saying? Should a good non-nanny state subsidize the direct costs of cigs and booze for the poor? Or just the social costs down the road?
posted by weston at 12:24 PM on April 25, 2011 [2 favorites]

I don't think it's too much of a stretch to say that treats and indulgences that carry high risks of significant long-term health costs -- tobacco among them -- should have said costs largely born by the individual indulging in them. If that prices the poor out of cigarettes, I have a hard time freaking out about it. Removing disincentives to stay away from this class of things is the last thing to do.

Where exactly does one draw the line, however? There are those who say that tea is bad for you (the caffine, after all).
posted by EmpressCallipygos at 12:25 PM on April 25, 2011 [1 favorite]

Really neat post, anotherpanacea.

As a former Peace Corps volunteer, I really used to wonder: "How are these programs designed? Doesn't anyone assess if the objectives are met? How do we know if this is making an improvement (or making things worse)."

So I was thrilled to see that Duflo is conducting RCT to assess policies and whether handing out mosquito nets is preferable to selling nets, or whether making it easier to receive vaccinations or making it easier to receive vaccinations plus small incentives (e.g. lentils) will improve the vaccination rate in a given area. I honestly did not know that this approach was being applied to evaluate development ideas, and I hope that there are more researchers who conduct similar work.

I just poked around google scholar to check out Duflo's research further and found other randomized evaluation evaluation these practices, including an evaluation of microfinance practices. Some of the studies or explanations of methodologies used can be found as PDFs.

Finally, agreed that those resources are impressive. Billions of relevent video and downloadable material that can be used to supplement lectures. It is rare to see this rigorous of an approach to developing a text and creating usable material for teaching, too.

I may get this book -- it seems really relevant/interesting/well done.
posted by Wolfster at 12:29 PM on April 25, 2011 [1 favorite]

Where exactly does one draw the line, however? There are those who say that tea is bad for you (the caffine, after all).

The point of the debate over the poor spending on tea and cigarettes is not that luxuries themselves are bad, but it's that the poor aren't spending their money on more millet or chlorinated water. This is a solid observation when everyone involved can get sufficient calories in their diets, but it gets trickier when spending habits have an unambiguous effect on health due to malnutrition (which is one of Banerjee and Duflo's findings).
posted by cirgue at 12:37 PM on April 25, 2011

Yeah, I think I kind of teetered on a derail there. Sorry.

*slinks off*
posted by EmpressCallipygos at 12:57 PM on April 25, 2011

I don't think it's too much of a stretch to say that treats and indulgences that carry high risks of significant long-term health costs -- tobacco among them -- should have said costs largely born by the individual indulging in them. If that prices the poor out of cigarettes, I have a hard time freaking out about it. Removing disincentives to stay away from this class of things is the last thing to do.

That's... quite a statement to make. You're suggesting legislating morality in a way that you'd never dream of doing if it had any effect on your own life, which is hypocritical at best and really a nasty bit of work in any case. It's not great that some people are choosing to pay for cigarettes over mosquito netting, but using those cases as justification for clamping down on the spending habits of millions of people is perpetuating that oldest of chestnuts, that the poor are poor because they're just so damned stupid, and it's up to us and our noblesse oblige to take their decision-making out of their hands.

More to the point, poverty isn't a moral failing, or evidence of someone's stupidity, it's a consequence of a terrifically fucked-up system designed to inhibit class mobility. Even if it was a moral failing, that still doesn't justify removing every last trace of happiness from the lives of everyone so affected as a punitive measure. Being poor sucks. Being poor, and being treated like you're part of a criminal underclass whose quotidian happiness is solely at the discretion of elected officials who openly despise you, doesn't make it much better.

I can't watch the TED talks at work, but just from the analysis by the Economist, this looks to be a fascinating book.
posted by Mayor West at 1:05 PM on April 25, 2011 [12 favorites]

Regarding indulgences, a lot of this really does have to do with various accounts of the poverty trap, such that incremental savings won't fix it. (I learned a lot from Charles Karelis on the role of "relievers" in the persistence of poverty. He argues that it's rational for the poor to blow their cash on experiences that partly relieve the suffering of poverty if there's an S-curve. And at least in the US, we know there is!)
posted by anotherpanacea at 1:09 PM on April 25, 2011 [3 favorites]

previously :P

also btw tyler cowen (self-)recommends More Than Good Intentions: How a New Economics is Helping to Solve Global Poverty by Dean Karlan

cheers!
posted by kliuless at 1:11 PM on April 25, 2011

perpetuating that oldest of chestnuts, that the poor are poor because they're just so damned stupid

What if "the poor" (or most people) are spending money on little treats because they don't have time to read the latest NYT article on sugar which explains that sucrose may be metabolized in the liver while glucose isn't and because they don't have time to develop a fun hobby like indoor rock climbing (which has some health risks also)? What if they don't have time to do the mental calculations to weigh near-term alleviation of dreariness versus long-term obesity and diabetes? Shouldn't there be some way to, perhaps not make decisions for people, but make trade-offs more immediate and obvious?

Unfortunately, the main way we handle immediate incentives and disincentives is through monetary cost. Maybe we need to look for another way.
posted by amtho at 1:16 PM on April 25, 2011 [1 favorite]

I don't think it's too much of a stretch to say that treats and indulgences that carry high risks of significant long-term health costs -- tobacco among them -- should have said costs largely born by the individual indulging in them. If that prices the poor out of cigarettes, I have a hard time freaking out about it.
posted by weston at 8:24 PM on April 25

Right, so in spite of the fact that the poor have shittier lives already - by virtue of being poor - they'd damn well better lay off the pleasant vices that might give them some relief from time to time because, hey, they're too poor for that sort of pleasure. Leave that to the decadent rich who can afford both the vice and the medical bills it creates. The poor better knuckle down, work all hours god sends, for a pittance, and then go home and not drink, not smoke, not do anything but consider how much their lives suck, and how fucking furious it makes them feel to read opinions like yours.

You'd better hope TV keeps 'em numb enough. Otherwise, come the revolution, watch your back.
posted by Decani at 1:50 PM on April 25, 2011 [3 favorites]

My grandfather left Ireland because they raised the taxes on cigarettes.

Belatedly, what?

My grandfather left Ireland because he was starving to death.
posted by Astro Zombie at 2:08 PM on April 25, 2011 [3 favorites]

weston: "Invoking the pejorative "nanny state" concept is a pretty odd rejoinder to someone who was suggesting a somewhat individualist/libertarian view of indulgences and costs. What exactly are you saying?

I'm saying that raising taxes on luxury items to price poor people out of their vices is the act of a nanny state. That's neither a libertarian nor individualist act.
posted by zarq at 2:11 PM on April 25, 2011 [2 favorites]

I found this interesting:

More generally—and perhaps more worryingly—poor people seem to worry a lot about health but also to be reluctant to spend small amounts on easy preventive steps, or even take things provided free. Worse, they then spend vast sums of money on “healthcare” provided by unqualified quacks, which is usually ineffective and sometimes downright harmful. (The book provides some rather disturbing data on what passes for medical advice in the slums of Indian cities).
posted by storybored at 2:24 PM on April 25, 2011 [2 favorites]

Very interesting. Some other food for tought

Of the 1%, by the 1%, for the 1% (via Boing). Noble laureate economist Joseph E. Stiglitz says

The upper 1 percent of Americans are now taking in nearly a quarter of the nation’s income every year. In terms of wealth rather than income, the top 1 percent control 40 percent. Their lot in life has improved considerably. Twenty-five years ago, the corresponding figures were 12 percent and 33 percent.

And if the Teaparty is against the elites (it is so easy to be against...) sure as hell they are not talking about them...but don't let remotely mowed grassroot movements fool you...capitalism is working in China...or not


China Housing Bubble? Most Chinese can't afford newly built houses (and we are talking about massive condos, not private villas) - uhhhhmm...horray for turbocapitalism? Not! Unless, of course, you believe that 40 million (out of 1,2 billion) chineses were lifted from poverty...yeah...from absolute to relative: all it takes is maybe an handful of dollars, but it looks very nice in selectively quoted statistics!

Worry not, for the Finance is getting back to track...to more and more for fewer, that is..

The Real Housewives of Wall Street (previously on Mefi) ...having troubles refinancing your loan ?

.... "Taibbi really goes to town on the $220 million loan made to the wives of two Morgan Stanley execs, who had no visible investment experience. These millionaires were given another $220 million of tax-payer money, at rock-bottom interest rates, without any requirement to pay it back. "
posted by elpapacito at 2:26 PM on April 25, 2011 [1 favorite]

Of the 1%, by the 1%, for the 1%

Discussed on MetaFilter here.
posted by hippybear at 2:28 PM on April 25, 2011

Thanks hippybear
posted by elpapacito at 2:31 PM on April 25, 2011

I don't think it's too much of a stretch to say that treats and indulgences that carry high risks of significant long-term health costs -- tobacco among them -- should have said costs largely born by the individual indulging in them.

Fine. Are you going to cut them a break in Social Security withholding as well? Because last I checked they'd come out ahead.
posted by ChurchHatesTucker at 2:42 PM on April 25, 2011 [1 favorite]

My grandfather left Ireland because they raised the taxes on cigarettes.

Belatedly, what?

It's a story famous in my family. One day in the late 50s, he came home and announced that a recent Irish tax increase on cigarettes had finally pushed him over the edge, and he was going to take steps to move the family, first to Canada (Uranium City, represent!), and then to Southern California in hopes of a better economic life.

Dude carefully rationed his meager little indulgences, and a seemingly arbitrary increase in the tax meant he could have only fewer cigarettes per day. And his reaction was essentially, "Fuck this, we're going to America."

It was the proverbial straw that broke the camel's back.

My point is this: It's entirely appropriate to ensure that the poor have access to the best education, opportunity and health care available so they can lift themselves out of their current situation, but it's equally as appropriate to demand compliance to certain proven values as part of any state-funded help we give them. This is why you can't buy beer with food stamps, for example, and why federal welfare programs like TANF have benefit maximums (e.g. 5 year time limits).

Moreover, it's appropriate to demand the poor attempt to help themselves.

So, little nudges in the right direction? How about more nudges, actually?

"You have to watch every cup of sugary tea? Bummer for you. But you know, you're poor. We're all very sorry about it. Now, why don't you put down the teapot and grab this rope we're all trying to fucking throw you, mmm-kay?"
posted by Cool Papa Bell at 3:13 PM on April 25, 2011 [3 favorites]

It's not great that some people are choosing to pay for cigarettes over mosquito netting

Not ... great ...? That's all you can say?

Shouldn't it be ... criminal?

Again, I'll take it down to something closer to home ... you can't buy alcohol and cigarettes with U.S. food stamps. It's literally criminal to attempt to do so (e.g. via arbitrage-style trading). Should we change this practice? Why? Because we think they're not stupid. Sure, that's a nice kumbaya feeling, but it doesn't happen in practice. At least not historically.

And, if not ... why doesn't the idea scale to work on the mosquito-netting level?
posted by Cool Papa Bell at 3:25 PM on April 25, 2011 [1 favorite]

I'm saying that raising taxes on luxury items to price poor people out of their vices is the act of a nanny state.

If that's what trips the bar for nanny-statism for you and doesn't also trip social cost worries, then I can only assume at a minimum that you also oppose any kind of social health care system and probably don't tend towards analyses that consider lost human capital, but maybe you'd like to challenge my assumptions.

That's neither a libertarian nor individualist act.

Whether or not you agree with them, there are indeed little-l libertarian interventionists (some would say "paternalists") who believe that tinkering with incentives doesn't undermine individual freedom.
posted by weston at 3:32 PM on April 25, 2011 [1 favorite]

If that's what trips the bar for nanny-statism for you and doesn't also trip social cost worries,

What the hell are you talking about?

I made a statement. It doesn't require a microscopic analysis, and you're going pretty fucking far afield in your assumptions.
posted by zarq at 3:43 PM on April 25, 2011

...it's equally as appropriate to demand compliance to certain proven values as part of any state-funded help we give them.

I don't think it's too much of a stretch to say that treats and indulgences that carry high risks of significant long-term health costs -- tobacco among them -- should have said costs largely born by the individual indulging in them. If that prices the poor out of cigarettes, I have a hard time freaking out about it. Removing disincentives to stay away from this class of things is the last thing to do.

I don't know guys. Holding people accountable for cash hand-outs is one thing, telling people how to live is another. It's a slippery slope that starts at don't buy beer with food stamps (reasonable) and ends with foster kids only being allowed to buy used clothing (unreasonable). If someone told me that they could help me pay off my mortgage but that I could only eat beans, greens, and brown rice for the next ten years, I would tell them to fuck off. It's a lot like Christian charities requiring you to love the jesus but, instead of clutching bibles, the poor will be forced to eat a lot of fiber.

The poor aren't a nameless group to do social experiments on. They are you and me and they have the right to a little vice here and there.
posted by Foam Pants at 4:24 PM on April 25, 2011 [2 favorites]

[the poor] are you and me and they have the right to a little vice here and there.

I have to disagree; I would say that no-one--rich, poor, middle-class or whathaveyou--has the right "to a little vice here and there." I think a little vice here and there is a privilege. Unfortunately, or not, a little vice is a privilege that becomes considerably easier to exercise with every extra bit of wealth you gain.

Nonetheless, I also believe that every person--rich, poor, middle-class--has the right to determine when and where to exercise the privilege of partaking in a little vice now and again. If that means skipping lunch all week so they can buy a beer, let them. However, I also recognize that it gets really murky when it's not an adult skipping lunch all week to buy beer, but rather a parent not feeding his kids lunch all week so he can buy beer. There's a simple solution to the former problem and only complicated approaches to the latter.

I'm looking forward to reading this book. Anyone know whether it looks into the costs of luxuries vs. necessities and the social implications of forbidding people to choose one over the other?
posted by crush-onastick at 4:46 PM on April 25, 2011 [2 favorites]

I'm very much looking forward to reading this, and have been ever since reading the New Yorker piece Miko mentioned above.

I'm ok with sin-taxes, but they are small potatoes compared to actual policy decisions like whether or not the rich pay taxes, whether or not vaccines and early childhood medical care are free, and whether or not the country engages in a destructive civil war. So sure, tax cigs, but don't pretend that it is the way to have the biggest impact.
posted by Forktine at 5:23 PM on April 25, 2011 [1 favorite]

What a fantastic resource! I think about these things all the time, and am always up for a new place to gather info. Thanks. =)
posted by traversionischaracter at 5:51 PM on April 25, 2011

I'm not saying that buying beer instead of food for your kids is a good decision, far from it, I just think that requiring the poor to eradicate their sinful bad habits to receive the state's grace treats a swath of citizens like children and creates resentment. There is a grey area that we enter into that is health/morality according to who, ya know? If you take these dollars for food for your kids, you can't get terrible for you but tasty Cheez Whiz (good) and you can't buy unbleached white flour (WTF?). Only whole wheat, even though you can't really bake a cake with that but you are poor and shouldn't be eating any cakes because they are bad for you. I know that is extreme but it is an arena we are talking about entering.
posted by Foam Pants at 6:15 PM on April 25, 2011

My point is this: It's entirely appropriate to ensure that the poor have access to the best education, opportunity and health care available so they can lift themselves out of their current situation, but it's equally as appropriate to demand compliance to certain proven values as part of any state-funded help we give them. This is why you can't buy beer with food stamps, for example, and why federal welfare programs like TANF have benefit maximums (e.g. 5 year time limits).

...I...don't believe the article is suggesting that luxury items be subsidized, however, so I'm not sure where this argument is coming from. I think they were stating that "the rich can gargle with bourbon while the poor have to weigh out their tea leaf by individual leaf" as a sort of "here's what each side's daily life is like" kind of picture.
posted by EmpressCallipygos at 6:29 PM on April 25, 2011 [1 favorite]

I've got an idea! What if we just legislate that poor people have to buy their cigarettes from the second-hand store?
posted by en forme de poire at 7:12 PM on April 25, 2011 [1 favorite]

Another good book on this topic is Half the Sky which is more about the role of women, but has good tidbits about spending habits.
posted by R343L at 7:26 PM on April 25, 2011

The poor aren't a nameless group to do social experiments on.

Um, but isn't this what the FPP is doing - running random controlled experiments?

And what if those experiments end up vastly improving the lives of the poor. Consider this example given in the third Economist article about improving childhood vaccination rates. Current rates are abysmal even though vaccines are readily and free available. So the intervention:

...Their idea: a small bag of lentils given as a sort of “reward”. This was opposed by public health officials, who thought “bribing” people to do what they should do anyway was a bad way to go. Yet it had a dramatic effect—and actually reduced the cost per immunisation to the NGO, because the nurses who had to be paid for the whole day anyway were now busier. Yes, convincing people of the benefits is probably useful in the long run, but this does the trick much better and more quickly—and, possibly, experience with immunisation is a pretty valuable kind of "convincing". And yes, it's paternalistic. But a whole host of things are essentially done for us—often by a paternalistic state, which purifies our drinking water and provides sewage systems and so on.
posted by storybored at 9:12 PM on April 25, 2011

but it's equally as appropriate to demand compliance to certain proven values as part of any state-funded help we give them.

I used to think this too. We shouldn't be paying for people's vices when they aren't contributing back to society.

But then I started to realize that "compliance" is just used as a tool to keep the poor poor. Look at the current proposals for drug testing welfare recipients. Do you really think the conservatives pushing those plans really care about poor people? Or is it more about puritanical drug-laws and ensuring the poor remain poor. In the process creating a convenient "welfare queen" bogeyman that ensures their base will continue voting for them.

When pushing for laws and incentives that restrict individual liberties, we should look at what unintended consequences those policies may produce. If you really want to help poor people quit their vices, give them subsidized treatment options.
posted by formless at 10:10 PM on April 25, 2011

Nicholas Kristof discovered that women were far less likely to spend money on beer and cigarettes than were men among the very poor.
posted by Ideefixe at 10:13 PM on April 25, 2011

My job is making charts and graphs for books on international development. I see this data every day, for almost nine years now, and it never fails to sadden and distress me. I don't have a lot to add to what's above, but I wanted to say thanks for maybe opening some new eyes to it. There's so much good being done, and so far yet to go, and the success stories are the minority. Making books by economists for economists makes me feel like I'm working in a bubble sometimes, and I am always heartened to see these discussions on the "outside" of the development community.
posted by kostia at 10:22 PM on April 25, 2011 [1 favorite]

they'd damn well better lay off the pleasant vices that might give them some relief from time to time because, hey, they're too poor for that sort of pleasure.

I didn't categorically outlaw any kind of pleasure. I'm specifically taking aim at vices that carry significant risks of heavy health costs (along with the opportunity costs) and if your idea of standing up for the poor is prioritizing their right to have a cigarette, well then, I'm sure the poor will be find their condition greatly improved with buddies like you and Altria on their side.

I made a statement. It doesn't require a microscopic analysis

You're annoyed that somebody wants to analyze and respond to your statement on Metafilter? Really?

Sure, everybody likes to toss of a statement they haven't actually thought through now and again, but if you don't want people to engage you on the implications of what you're saying, maybe posting a statement on a site well-known for beanplating even actually trivial issues might not be your best strategy.

and you're going pretty fucking far afield in your assumptions.

Do share.
posted by weston at 12:37 PM on April 26, 2011