The Checklist Manifesto: How to Get Things Right

by Atul Gawande

Sewage ran in the streets. Chronic poverty and food shortages left 30 to 40 percent of the children malnourished. Virtually all drinking water sources were contaminated. One child in ten died before age five—usually from diarrhea or acute respiratory infections. The roots of these problems were deep and multifactorial. Besides inadequate water and sewage systems, illiteracy played a part, hampering the spread of basic health knowledge. Corruption, political instability, and bureaucracy discouraged investment in local industry that might provide jobs and money for families to improve their conditions. Low global agriculture prices made rural farming life impossible, causing hundreds of thousands to flock to the cities in search of work, which only increased the crowding. Under these circumstances, it seemed unlikely that any meaningful improvement in the health of children could be made without a top-to-bottom reinvention of government and society.