Health is an area of great promise but also great frustration. There are great ideas (malaria nets, chlorine, ORS, pipe water for diarrhea) but why aren´t they use more? There are some cheap ideas people can use but because they are so cheap they believe they aren’t as useful. Poor people do care for their health. They do spend a lot of money on health and sometimes make loans. So the problem is where do they spend all that amount of money? In India 2/3´s of people who work on health systems don’t have the qualification in medicine at all. Doctors are not that informed because they don’t ask enough questions too. Doctors tended to under diagnose and overmedicate. The misuse of antibiotics and steroids increase due to ignorance.
Governments have a way of making easy things much less easy than they should be. The high absenteeism rates and low motivations among governments health providers are certainly two reasons we don’t see more preventive care being delivered. People avoid the public health system because it does not work well. This could also explain why other services that are provided through the government system, like immunizations and antenatal checks for prospective mothers, are underused.
People tend to make more use of something they have paid a lot for. In addition people judge quality by pricing: things may be judged to be valueless precisely because they are cheap (“psychological sunk cost”).
Faith or to use more secular quivalents a combination of beliefs and theories is clearly a very important part o fhow we all navigate the health system. The fact that a lot of beliefs and theories for which we have little or no direct evidence contribute to that trust. Poor people lack information. Despite continuous reassurance by high-powered medical panels that vaccines are safe, several people in the US and UK refuse to immunize their children against measles because of supposed link with autism. For example, poor in many countries seem to have the theory that it is important that medicine be delivered directly to the blood. To reject this theory you have to know something about the way the body absorbs nutrients through the digestive tract and something about why proper sterilization of needles requires high temperatures, in other words you need at least high school biology. When there is little people can do faith becomes essential. The poor are much less likely to go to the doctors for potentially life-threatening conditions like chest pains and blood in their urine than with fevers and diarrhea.
Example of immunization and rice. People have the right to choose what they want but there is a small cost of doing so, and as a result, most people end up choosing the default option. Small incentives, like giving dal for vaccines, are another way to nudge people, by giving them a reason to act today, rather than indefinitely postpone. Fines or incentives can push individuals to take some action that they themselves consider desirable but perpetually postpone taking. Our natural inclination is to postpone small costs, so that they are borne not by our today self but by our tomorrow self instead. Poor parents may even be fully convinced of the benefits of immunizations- but these benefits will accrue sometimes in the future, while the cost is incurred today. It makes sense from today´s perspective to wait for tomorrow. Unfortunately when tomorrow becomes today, the same logic applies. Incentives can push and give a reward today.
A child who grew up malaria-free earns 50 percent more per year, for his entire adult life, compared to a child who got the disease.
The poor seem to be trapped by the same kinds of problems that afflict the rest of us- lack of information, weak beliefs, and procrastination among the,. It is true that we who are not poor are somewhat better educated and informed, but the difference is small because, in the end, we actually know very little, and almost surely less than we imagine. Our real advantage comes from the many things that we take as given. We live in houses with clean water, we don’t have to remember to add Chlorine to the water supply every morning. We can (mostly) trust our doctors to do the best they can and can trust the public health system to figure out what we should and should not do. We have no choice to get our children immunized- public schools will not take them if they aren’t- and even if we somehow manage to fail to do it, our children will probably be safe because everyone else is immunized. And perhaps most important, most of us do not have to worry where our next meal will come from. In other words, we rarely need to draw upon our limited endowment of self-control and decisiveness while the poor are constantly being required to do so.
We should recognize that no one is wise, patient, or knowledgeable enough to be fully responsible for making the right decisions for his or her own health. Those who live in rich countries live a life surrounded by invisible nudges, the primary goal of health-care policy in poor countries should be to make it as easy as possible for the poor to obtain preventive care, while at the same time regulating the quality of treatment that people can get. Given the high-sensitivity to prices, is delivering preventing services for free or even rewarding households for getting them and making getting them the natural default option when possible. Free Cholorin dispensers should be put next to water sources; parents should be rewarded for immunizing their children; children should be given free deworming medicines and nutritional supplements at school; and there should be public investment in water and sanitation infrastructure at least densely populated areas. Making sure people can afford the medicines they need but also restricting access to medicines they don’t need as a way to prevent growing drug resistance.
All this sounds paternalistic and in a way, it certainly is. But then it is easy, too easy, to sermonize about the dangers of paternalism and the need to take responsibility for our lives from the comfort of our couch in our safe and sanitary home. Aren´t we, those who live in the rich world, the constant beneficiaries of paternalism now so thoroughly embedded into the system that we hardly notice it?
Recognize that information alone will not do the trick alone.
Antibiotics and immunization.
Stefy likes this.