Is It Better to Be Poor in Bangladesh or the Mississippi Delta?
March 9, 2017 9:47 AM   Subscribe

Annie Lowrey: "In your speech, you said something provocative: That you think you might be better off living below the World Bank’s extreme poverty line in a country like Bangladesh rather than here. I wouldn’t think that would be true."
Angus Deaton: "I’ve been struggling with it... if you had to choose between living in a poor village in India and living in the Mississippi Delta or in a suburb of Milwaukee in a trailer park, I’m not sure who would have the better life. That’s the point I’ve been pushing."
A conversation between Angus Deaton, Nobel laureate and emeritus Princeton economist, and Annie Lowrey for the Atlantic.

Deaton and Case, previously, on the rising death toll and falling life expectancy in rural white America, and Deaton and Kahneman, previouslier, on $75K being the magic number for income beyond which happiness doesn't increase.
posted by RedOrGreen (44 comments total) 32 users marked this as a favorite
 
It's an interesting question, especially given the right's penchant for tisk-tisking the poor because "you're better off than people in [insert poor nation]" I should think being poor in a nation where being poor is open and commonplace would be better than to live in the US, where being poor is so often excoriated and "othered" and often outright punished.
posted by Thorzdad at 10:01 AM on March 9 [17 favorites]


That was my gut feeling too, though I may be undervaluing what is left of the American social safety net. I started to think about going hungry, and while I'm sure that anyone living on less than $2 a day would be fed in Boston, for example (where I live), I'm not so sure about the Mississippi delta. And there is a certain sort of infrastructure that develops in places where people are often really really poor that may not be available in the places where that's not common. For example, I start thinking about the single use shampoo sachets that are available in India, which I've never seen here (in the US). When you're really that poor, it can difficult to make the purchase of an entire bottle of shampoo at once.
posted by peacheater at 10:10 AM on March 9 [3 favorites]


I was struck by the fact that life expectancy is higher in Bangladesh than in Appalachia. Now that's a little unfair because it's not comparing apples with apples (the poor in America vs. the poor in Bangladesh), but it's still a striking statistic that makes the question seem more reasonable.
posted by crazy with stars at 10:13 AM on March 9 [11 favorites]


The Deaton and Case study is flawed. They did not adjust for an aging demographic, substantially overstating the effect. Adjusting for baby boomer demographics shows the overall mortality rate for middle-aged non-Hispanic whites has not changed since 2005. There may be some effect of women in that bracket dying more and men dying less.
posted by helot at 10:29 AM on March 9 [4 favorites]


Sorry, but this is a ridiculous statement and demonstrates a severe lack of understanding of what it means to be poor in places that have absolutely no governmental social safety net. The idea is sensationalist, unnecessarily so.

I work in one of the poorest countries in the world and all of my friends are clinging to a very perilous existence. They have no savings, no health care, no family support, and no investments for longterm prospects. What comparisons like this fail to address is that none of my friends are poor relative to their population. The real poor? Those are the ones starving in the street; the addicted to glue-huffing, wandering around in rags and subsisting on handouts; the mentally ill, sometimes tied up with a leash to a tree.

You can fight for better conditions for Americans without resorting to offensive hyperbole.
posted by iamck at 10:38 AM on March 9 [46 favorites]


I can't remember where I read it, but the theory was that it isn't absolute income that made people miserable, it was the perception of unfairness (e.g. income inequality) that caused unhappiness. Here in hyper-segregated Milwaukee, you have a zip code with one of the lowest median incomes only a mile or two away from a zip code with 5x the income. I can't imagine what kind of psychological effect that must have to ride or drive past two million dollar houses on your way to your cockroach infested apartment with lead paint.

I don't know what it's like in Bangladesh, but I wonder if the proximity to outrageous wealth is the same.
posted by AFABulous at 10:45 AM on March 9 [10 favorites]


I work in one of the poorest countries in the world and all of my friends are clinging to a very perilous existence. They have no savings, no health care, no family support, and no investments for longterm prospects. What comparisons like this fail to address is that none of my friends are poor relative to their population. The real poor? Those are the ones starving in the street; the addicted to glue-huffing, wandering around in rags and subsisting on handouts; the mentally ill, sometimes tied up with a leash to a tree.
I don't think anyone's denying that conditions are worse as a whole in very poor countries compared to the US. The question is specifically about whether people making less than $2 a day are better off in Bangladesh or the Mississippi delta. That's a very different (and specific) question. Do you even know any Americans making less than $2 a day? But apparently there are $3 million of them.
posted by peacheater at 11:05 AM on March 9 [17 favorites]


I was talking with my daughter about this just yesterday, because she was working on a civics paper on poverty and inequality. She has been to India, living with a middle class Indian family, so she has a good idea of what it is all about.
This is not in the US, but even here, there are people who fall out of the welfare system. If you live on two dollars a day here, you are definitely worse off than living on two dollars in Bangladesh, because if you are living on two dollars a day here, you don't have access to welfare - maybe you are an illegal immigrant, or a veteran who has left the system because of PTSD, or an EU immigrant who hasn't managed to get a job, and thus doesn't have access to services. Or you are homeless because you have untreated mental health issues - maybe because your parents were homeless too.
One of my friends found a whole family of Romanians living in a garbage container in her yard. People like that avoid street healthcare workers because they represent authorities, so while they probably could get basic care, they don't.
If they were back in Romania, they would have a network, food prices would be way lower, they would be able to get (bad) jobs, their children would be able to go to school. But how can they get back - they have nothing.
In the US, I've been places in the south that looked exactly like the favelas of Brazil, with the same level of services.
Here where I live, there is a large community of African immigrants, and thus also a community of illegal immigrants, living on the street. Each and every one I've talked with has regretted coming here. They can't go back, because they don't have the money, and they can't live here. Where they came from, they were poor but they had families and a roof over their head, here they are poor and lonely and also cold.
The family my daughter visited in India? They lived here before but migrated back home, after seeing how what seemed to be an astronomical wage here melted into thin air when rent was paid and food bought. And they were middle class, not poor.
posted by mumimor at 11:06 AM on March 9 [37 favorites]


The real poor? Those are the ones starving in the street; the addicted to glue-huffing, wandering around in rags and subsisting on handouts; the mentally ill, sometimes tied up with a leash to a tree.

I started my career ( a gazillion years ago in the early '90s) in mental health working with children and adults with Autism and other developmental disabilities. I know and have seen with my own eyes people in America who have indeed been 'tied up to a tree" and/or locked up in a room in a trailer with no heat/water from age 9-14... I know stories that will make your hair curl. Fast forward to now and the lovely opiate epidemic, and I now get to see children who've spent the first three years of their lives laying in a crib in their own excrement and severely malnourished, while their parents are high. There is tons of terrible here..... and damn little help. Something like 80% of the kids in child protective services are in there due to the drug epidemic here. And poverty and hopelessness are primary causes....
posted by Gyre,Gimble,Wabe, Esq. at 11:07 AM on March 9 [26 favorites]


Or what mumimor said.....
posted by Gyre,Gimble,Wabe, Esq. at 11:09 AM on March 9


I'm not sure how I feel about framing it as is it worse to be in dire poverty in [developed country] versus [developing country]. Trying to figure out comparatively which is worse is missing the point, which is that there are some living conditions that should be beyond the realms of what we should accept as living conditions for anybody, anywhere.

To be fair to Deaton I think the point he is trying to make is that there is a relatively high level of terrible depravation in the US and that is certainly a point worth making.

What would be interesting to know is what countries have the lowest levels of this kind of depravation and why. Almost certainly a bunch of them are in northern Europe and almost certainly rampant addiction in a community can make any situation a lot worse.

[Until I clicked into the article I thought it was talking about Angus Deayton and I was wondering how the hell I missed his reinvention as a Nobel Laureate. Discovering the truth was a little disappointing.]
posted by roolya_boolya at 11:43 AM on March 9 [5 favorites]


Well it all depends which groups you are comparing in each country (since there are definitely select people in Bangladesh who are better off than select people in the US).

If you just look at income, it's not a good comparison at all. Even adjusted for purchasing power, $2 in Bangladesh might get you a semi-dry roof and enough food to live, and there's just no way it could in the US. The social safety net in the US might help a little bit for a couple of years, but most benefits have a time cutoff.

If you look at poor regions of each country it's not really a good comparison either. In the US, good jobs are just not available in places like the Mississippi Delta, so the young, healthy, and smart tend to move out and leave the most vulnerable people behind. In Bangladesh it's a different situation since it's harder to move to a rich place.

Percentiles don't work of course, since the 10th percentile of the US is far richer than the 10th percentile of Bangladesh.

So I'm not sure how you can make a reasonable comparison. Given any fixed amount of money, I'd rather live in Bangladesh, since the money would go a lot farther there. But if I were a smart able-bodied person who just didn't have a lot of money, I'd rather be in the US, since I'd have a far higher chance of making enough to live on in the US.
posted by miyabo at 11:49 AM on March 9 [6 favorites]


I'm not sure how I feel about framing it as is it worse to be in dire poverty in [developed country] versus [developing country]. Trying to figure out comparatively which is worse is missing the point, which is that there are some living conditions that should be beyond the realms of what we should accept as living conditions for anybody, anywhere.

Well in a way, it says in the beginning of the article:
Is the world getting better or worse?

Better, he believes, truly better. But not everywhere or for everyone. This week, in a speech at a conference held by the National Association for Business Economics, Deaton, the Nobel laureate and emeritus Princeton economist, pointed out that inequality among countries is decreasing, while inequality within countries is increasing. China and India are making dramatic economic improvements, while parts of sub-Saharan Africa are seeing much more modest gains. In developed countries, the rich have gotten much richer while the middle class has shriveled.


It has been more and more explicitly stated during this last year that white resentment is about how there is a huge global redistribution going on, from white men in North America and Northern Europe to brown and black people including women everywhere (including North America and Northern Europe). And it's true. And it's not only creating anger on the right, a lot of my old socialist friends are equally worried and confused. At the same time, inequality everywhere is just exploding and that is increasing the real and perceived plight of the middle class, as is the conservative/third way mantra of governmental economic restraint which obscenely protects the rich from taxes. The redistribution is not from "America" to "China", but only from the middle class in the US to the new middle class in China. The rich and the elites are unaffected both places.

On top of all that, poverty is relative, not just because of perception (living next to much richer people and feeling poor because of it), but also in very real terms. As miyabo says, 2 dollars in Bangladesh will buy you a lot more than 2 dollars in the Mississippi Delta. Here, 2 dollars won't even buy you a cot in a shelter for one night or a bowl of lentil stew.
posted by mumimor at 12:05 PM on March 9 [18 favorites]


What most impressed me about Deaton's answer was his willingness to say, "I don't know."

But if you had to choose between living in a poor village in India and living in the Mississippi Delta or in a suburb of Milwaukee in a trailer park, I’m not sure who would have the better life. That’s the point I’ve been pushing.
posted by layceepee at 12:08 PM on March 9 [12 favorites]


Again, I have no direct experience in Bangladesh/India etc, only Milwaukee, but my impression is that there is a stronger extended family network in developing countries. That is largely absent in poverty-stricken areas here, in large part because of the devastatingly high incarceration rate among Black men.
posted by AFABulous at 12:16 PM on March 9 [6 favorites]


There are poverty-stricken places in the US where people get by on an extended family network (which comes with its own set of problems); it really probably depends on too many factors (race, ethnicity, class, region) to be a meaningful or answerable question, but it is important to raise awareness of the realities of poverty in regions like the US South, because conditions are often comparable to undeveloped countries. Early in this interview, Lowrey suggests people in the US would be better off than cohorts in undeveloped countries thanks to decent infrastructure and access to healthcare/social services, and that betrays an ignorance of what US poverty actually looks like. Because often these are regions where the infrastructure's collapsed, social services have been gutted or are too punitive to really be a net "good," and healthcare is just nonexistent.
posted by byanyothername at 12:26 PM on March 9 [9 favorites]


It's anecdotal, but I've heard the same claims from Indian natives who grew up in areas with high poverty rates. They claimed the level of common compassion and social connection/support was generally higher. Even many people barely subsisting still have connections to much larger social networks that help ameliorate the downsides of the poverty, is the claim I've heard. But on the other hand, it's hard to know or get a good sense for what role legacy social class prejudices might play in how even native Indians might see and interpret the reality.
posted by saulgoodman at 12:43 PM on March 9 [2 favorites]


Things have really gone to shit when you start arguing about who does poverty the best.
posted by srboisvert at 2:04 PM on March 9 [6 favorites]


tough. is there overt racism in Bangladesh?

...guy from Alabama
posted by jonesfowler at 2:05 PM on March 9 [2 favorites]


This was a fascinating read, thank you. I had read the LA Times expose on OxyContin a while back, which was eye opening, and this just added more fuel to the fire.
posted by Joh at 2:21 PM on March 9 [1 favorite]


They couldn't have gotten an actual Bangladeshi in the conversation?
posted by divabat at 3:17 PM on March 9 [10 favorites]


Well, they didn't get a Bangladeshi because, I presume, they weren't thinking of its as a specific country with a particular culture and unique social and legal infrastructure but as "random poor country with lots of poor people."

But while we're talking about Bangladesh as a specific example, I'm not sure what your point is, jonesfowler, but yes, there is overt racism in Bangladesh, as well as anti-immigrant sentiments (but mostly against African immigrants -- white immigrants are just fine (and called expats rather than immigrants)). Racism there doesn't have the same history or origins as racism in Western Europe or the parts of the Americas that were part of the slave trade, so it doesn't manifest in exactly the same way, but it's still there and still overt.

Also, to those speculating, an expectation of stronger social or family networks cuts both ways. It might help many people in poverty, but when the whole society is organized in way that expects that familial infrastructure to exist for all people, it makes those without it suffer even more. I worked for a short period in Bangladesh with an anti-trafficking organization, and it was a real struggle to come up with solutions that were actually viable for girls who had been repatriated after being rescued from international sex trafficking. They were back in Bangladesh, but many were shunned by their families and social networks, and unlikely to ever marry into another family. The local NGO community set up camps for the girls to live and study and work, but they were basically resigned to the idea that, even after reaching adulthood, the girls would never be able to leave the camps because without a familial network they wouldn't survive.

Look, this whole exercise is silly if you take it as a literal measurement of "who has it worse." The point is that extreme poverty exists in both the United States and the developing world, and the general wealth of a nation doesn't necessarily translate into a better life for its poorest citizens. Those of us in rich countries like the U.S. should ask ourselves why that is true, and do better -- not argue about which version of poverty is "worse."
posted by alligatorpear at 3:37 PM on March 9 [32 favorites]


I think Jonesfowler would be referring to the fact that some of the poor in the US may also be African-American, various immigrants, etc. My understanding is that anyone non-WASP in the US is going to be dealing with a level of discrimination, and in Bangladesh, although poor, if it's Bangladeshi poor one would assume they're not dealing with that aspect or cause of discrimination. I'm not saying that's necessarily the case, but the logic holds up for me.
posted by Peter B-S at 3:43 PM on March 9


we probably should let divabat weigh in, if she wants to, because she's actually from Bangladesh.
posted by AFABulous at 3:46 PM on March 9 [5 favorites]


The real poor? Those are the ones starving in the street;

From someone who read the interview, these are exactly the people he is talking about.
posted by MisantropicPainforest at 5:59 PM on March 9


I'm not exactly from Bangladesh per se - my parents and most of my family are, but they migrated overseas before I was born. So I'm not entirely qualified to speak about the subject.

As far as discrimination goes: I know there's tensions between Bangladeshis and Biharis (a minority group from Pakistan) that goes back to the days of the Liberation War if not before, but I'm not sure how that translates to class differences. There is a massive class difference - either you're upper class or you're dirt poor, and even with dirt poor you're either someone's maid or you're on the streets. What the rest of the world would call "middle class" even on the lower end would be close to upper class here because just by virtue of having a stable place to live you're "high class".

It's not as racially diverse as, say, America is - there are migrants of various places, but it's not quite as overt as it would be in the US. But there's still racism and other forms of xenophobia - now you get to add things like religion and indigenity into the mix. Fun.
posted by divabat at 6:03 PM on March 9 [6 favorites]


A little Street View experiment:

Would you rather live here or here?

Here or here?

Here or here?

It's possible to find some neighborhoods in the US which appear to be almost as poor as randomly chosen places in Bangladesh. But it's really hard to find such places, and they're pretty small. This is obviously totally unscientific but it's kind of interesting.
posted by miyabo at 9:02 PM on March 9


I've often said this. It's got very little to do with external appearances, and everything to do with the design of the entire system.

It is easier to be poor in Dhaka rather than Chicago.

You can rent a hovel in a slum, which will still be near enough to walk to work in the best neighbourhoods. You can buy cabbage either by the weight or by whatever cash amount you have to spare i.e. give me 50 cents of cabbage is impossible in the US system

You aren't paying for utilities, pragmatically speaking, in your slum, because there's a shared water tap from the city and/or stolen electricity wires.

You do pay off the thugs, but you're paying off thugs everywhere.

You don't need a credit card or credit rating to get a phone. You aren't worried about a monthly bill because prepaid pay as you go affordable plans let you top up airtime for the mobile as and when you're able.

Oh sure you may or may not have access to the discounted govt health service for the poor which exists in the developing world or an NGO clinic with volunteer healthworkers, but what is the healthcare that you do have without insurance or ACA in the USA anyway?

And so on, and so forth
posted by infini at 1:07 AM on March 10 [5 favorites]


I found the article was much more wide-ranging and interesting than just this pull-quote suggests, and it certainly was an interesting thing to read. The whole opiate addiction epidemic thing is a true tragedy of our times. The old hippie wisdom is that drug epidemics in communities burn themselves out after a few years because they either kill the addicts or people see what is going on and get clean or avoid altogether. We've never had a situation like this pill-to-needle situation we have going on right now. It's almost like having your wisdom teeth out or a lower back injury should be labeled gateway drugs. (And then there's the whole Fentanyl-adulteration situation, which is just horrifying.)
posted by hippybear at 3:32 AM on March 10 [5 favorites]


Yes, saw this this morning and was horrified.

The lawsuit was filed in federal court Thursday against drug wholesalers AmerisourceBergen Drug Co., Cardinal Health Inc., McKesson Corp., and H.D. Smith Wholesale Drug Co. Also named in the suit are CVS, Rite Aid, Wal-Mart, Kroger and Walgreens.

According to a complaint filed by Paul Farrell Jr., the lawsuit alleges the companies are to known to have sold more than 40 million doses of opioid pain medicine in Cabell County between 2007 and 2012, while the county's population was 96,319, according to the 2010 U.S. Census.

The lawsuit is seeking compensation and punitive damages from the companies for the creation of a public nuisance.

posted by infini at 3:44 AM on March 10 [7 favorites]


A little Street View experiment

I'm not sure what the point of that was, but it seems like you like the American examples better.
When I look at the American examples, I see no shops, few people, and nothing to do. When I look at the examples of Bangledesh you picked, I see shops, people, things to do.

I'm a photojournalist and I've been places in the US where you have to drive 30 or 40 miles to buy a fresh vegetable or find an open storefront that isn't a bar or a post office. That's an extreme example, but I've been to plenty of small towns around the country recently where the downtown is mostly empty and the only storefronts open are liquor stores, vape shops, check cashing, and a post office.

I've been all over China and even in the remotest, poorest regions (farmers with dirt floors in the poorest country in Jiangsu(that might be a bad example because the province is so wealthy; they had some paved roads, at least); areas of southern Yunnan cut off by highways; dusty farm villages far away from the train system in Xinjiang or Inner Mongolia) and they all had pretty decent access to fresh, good food (even in the remote mining camp I visited near the Xinjiang/Qinghai border in winter); decent transit options (pay a few cents to get a seat in a van/pickup traveling on a set route between villages); some had weekly market days that traveled from village to village which had food, clothing, entertainment, dentistry. China's not Bangladesh, but the rural poor in China haven't seen the rapid growth that the eastern urban centers have.

I don't know what the word for this is, but for lack of a better term, I'd say that the Chinese examples I've seen have a sort of "social infrastructure" that's lacking in the US. It wasn't always that way in the US...a lot of that social infrastructure in the US has disappeared in the last few decades. I'm speaking mostly from my own experience and knowing what my family had available to them when they homesteaded in a very remote part of Montana basically fresh off the boat from Czechoslovakia (or whatever it was called then) more than 100 years ago. I see the results of a lot of the same erosion of social infrastructure in rural New England close to where I live now, though there are a lot more grocery stores compared to rural Montana.
posted by msbrauer at 6:24 AM on March 10 [12 favorites]


It wasn't always that way in the US...a lot of that social infrastructure in the US has disappeared in the last few decades.

It hasn't disappeared, it's been deliberately and systematically looted, gutted, and hollowed out for the past 35 years. There's a difference.
posted by blucevalo at 7:07 AM on March 10 [6 favorites]


When I look at the American examples, I see no shops, few people, and nothing to do. When I look at the examples of Bangledesh you picked, I see shops, people, things to do.

Also you're highly unlikely to see deep poverty on Street View here. I job shadowed a social worker in Appalachia, and we had to park at the bottom of a holler, and walk up a rutted, muddy "road" to see the client in question, who lived in trailer. There were holes in the ceiling and floor. The holler housed about 12 families with children in a jumble of ancient trailers and ramshackle houses. Like msbrauer says, no stores within walking distance, but a Walmart about 30 miles away.
posted by Gyre,Gimble,Wabe, Esq. at 8:18 AM on March 10 [3 favorites]


I mentioned this in a megathread, but one of the themes of the interview -- perhaps something that's more noticeable to Deaton as an immigrant -- is how America finds ways to give people the things they want (and things that are considered good for the state as a whole) even if those things kill them.

You get your homestead, because America makes citizens by giving them property, but it's a lottery whether you can improve it enough to survive, and once you own land, you grow roots. Think of the political rhetoric around "family farms" when a lot of the remaining ones are simply uneconomical. Or the way people who've had their small, remote communities bought out for things like reservoirs still pine for their old homes and feel like they've left behind their family's graves. There's a parallel with opiates: people want something to take away the pain, and the market (and Medicaid) provides.

I've been to remote bits of Nepal; I grew up around some of the poorest parts of the UK; I've been through some of the most left-behind bits of Appalachia, and I get it. It isn't just the lack of social infrastructure: it's how it relates to where the social infrastructure actually exists. I'd compare it to favelas and Indian shanties in its juxtaposition of poverty and wealth, but it's not quite that either, because it's a way of life propped up by a combination of private property ownership and public assistance.

Deaton presents some real challenges here, whatever your political perspective. (He's citing Bangladesh, I presume, because of its population density, not just because "brown poor people".)
posted by holgate at 9:31 AM on March 10 [3 favorites]


Street View

Bear in mind, poor neighborhoods often don't end up on Street View, or are misrepresented on Street View so as to have the false appearance of a presence on Street View. I don't know if this has gotten better as time has gone on, but it was still a problem a few years ago. Many poor people live in places where Google isn't going to go, or if they do, they'll stitch together a few of the nicer looking areas. If you want truly visually decrepit, the US South has plenty of that, but as infini and others have said, that is only a small part of the poverty picture.

Anyway, I don't think the question is a question at all; it's just pointing out that serious poverty comparable to what we imagine occurs "over there" is a reality in the US, compounded with the lack of access to food, resources, healthcare etc. that is part of US poverty. It is sort of doubly offensive that people in the US are in the habit of imagining net poor countries as quagmires of unending misery where joy, humanity and culture are impossible things crushed under the weight of poverty and corruption...while net wealthy countries simply can't by their very nature engineer such poverty at home. The world is much more complicated than that.
posted by byanyothername at 11:41 AM on March 10 [4 favorites]


Well, I know that one side effect of the poverty in the Mississippi Delta is incredible rates of sexual abuse. I don't know if that is also the case in Bangladesh but I would certainly prefer poverty without rape and molestation, given the choice.
posted by crunchy potato at 1:42 PM on March 10 [2 favorites]


I don't know about Bangladesh personally, but you've got a point. Both India and many African countries have problems with high rates of violence against women and children, particularly sexual. How much of it is technically driven by poverty vs how much by historically patriarchal culture, I haven't checked but my primary research among low income people (Philippines, East & South Africa, North&West India) has shown me evidence that the economic value of women is recognized. What might instead be driving the higher rates of sexualized violence could be the overall lower value given to the quality of life and wellbeing of the "poor". These are just speculations and this is a topic to keep an eye out for. There's a huge difference in rural and urban cultures - I *will* wear region appropriate clothing, for instance, to send the right signals, when I'm out with my notepad and camera in random rural third world, since I don't have teh automatic protection of being caucasian.

My gut says the response to poverty in a historically poor and developing country is very different from being poor in an advanced nation. You're not angry in quite the same way are you?
posted by infini at 10:06 PM on March 10 [4 favorites]


Oh sure you may or may not have access to the discounted govt health service for the poor which exists in the developing world or an NGO clinic with volunteer healthworkers, but what is the healthcare that you do have without insurance or ACA in the USA anyway?

Sorry, no. Have you been to a hospital in the "developing world"? I could fatigue you with stories that could make your toes curl. In Niger, I've had people die in front of me. At the very worst, US Emergency services do not turn people away, everyone gets treatment.

There really is no comparison here, and I hate to call out first world privilege, but a lot of what is being said in this thread is pretty tone deaf.
posted by iamck at 2:04 PM on March 11 [2 favorites]


At the very worst, US Emergency services do not turn people away, everyone gets treatment.

hahahahahaha oh come on

also Niger is not Bangladesh let's not assume all "poor countries" are the same
posted by divabat at 2:43 PM on March 11 [2 favorites]


Have you been to a hospital in the "developing world"?

I was born in one.

divabat has a point - poor != poor - infrastructure, systems, attitudes to the poor and low caste, resources, and whether the colonizers (French in Niger) have as yet let go are all factors.

WASHINGTON, July 1, 2015 – The World Bank’s latest estimates of Gross National Income per capita (GNI) continue to show improved economic performance in many low-income countries, with Bangladesh, Kenya, Myanmar, and Tajikistan now becoming lower-middle income countries


Also, some countries are just trendier for NGOs than others.
posted by infini at 9:11 PM on March 11


There really is no comparison here, and I hate to call out first world privilege, but a lot of what is being said in this thread is pretty tone deaf.

Its pretty clear Deaton is using specific countries to provide concrete examples for his broader question: is it better to be very poor in a rich country or very poor in a poor country?

Also, hospitals/health care in general are but one factor used to answer this question. If we grant that health care is worse in poor countries that is just one factor among many, and doesn't completely determine the answer.
posted by MisantropicPainforest at 4:58 AM on March 12


Also, hospitals/health care in general are but one factor used to answer this question. If we grant that health care is worse in poor countries that is just one factor among many, and doesn't completely determine the answer.

Good point! This is a recent report on a Lancet Study on Life Expectancy projections in the rich world club of the OECD

By contrast, projected life expectancy is lower in countries with higher levels of young adult mortality and major chronic disease risk factors, and possibly less effective health systems. These countries also tend to have higher social inequalities, which might lower national life expectancy by affecting the entire population or through the poor health of the worst-off social groups and communities, which in turn affects the national average. Notable among poor-performing countries is the USA, whose life expectancy at birth is already lower than most other high-income countries, and is projected to fall further behind such that its 2030 life expectancy at birth might be similar to the Czech Republic for men, and Croatia and Mexico for women. The USA has the highest child and maternal mortality, homicide rate, and body-mass index of any high-income country, and was the first of high-income countries to experience a halt or possibly reversal of increase in height in adulthood, which is associated with higher longevity. The USA is also the only country in the OECD without universal health coverage, and has the largest share of unmet health-care needs due to financial costs. Not only does the USA have high and rising health inequalities, but also life expectancy has stagnated or even declined in some population subgroups. Therefore, the poor recent and projected US performance is at least partly due to high and inequitable mortality from chronic diseases and violence, and insufficient and inequitable health care.
posted by infini at 12:09 PM on March 12 [4 favorites]


The incidence of poverty in the US is interesting reading, particularly comparatively when you have your head mostly in the so called developing world.

The United States is one of the richest countries in the world, but it would look dramatically different if its 50 states were organized according to income instead of geography.

If that were the case, residents of the poorest state in the union would have a median household income that’s just above the federal poverty line for a family of four. They would also expect to live shorter lives than people in more than half of the world's countries.

It's not a pretty picture, according to the researchers who carried out this thought experiment.


"In essence, there are several developing countries hidden within the borders of the United States — regions defined, in this case, by poverty," they wrote in a study published Thursday in the American Journal of Public Health. "The 'state' of poverty in this country is dramatic and deeply disturbing."

posted by infini at 12:12 PM on March 12 [2 favorites]


Travel up the spine of Appalachia and you see a developing country, one that's been a developing country for perhaps 200 years.

One of the long-standing thorny problems in American politics is the question of whether it's right to give people money to move out of places that might be better reclaimed by nature, because it's cheaper and produces better outcomes than trying to support them in place. It was tried as part of the New Deal in the Dust Bowl and worked very badly; it happens in very subtle ways through things like higher education funding. But there are equally mechanisms to keep people in those places, whether farm subsidies or welfare schemes or just the pull of having title to property and having no mortgage payment in a relatively cheap part of the country.

If every American got $10,000 on their 18th birthday, no questions asked, but with the strong suggestion that it could be used to go somewhere else, I wonder how it would be spent.
posted by holgate at 11:20 PM on March 16 [1 favorite]


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