Nabila Tabassum Chowdhury > Recent Status Updates

"It not only ensures that we take care of ourselves better than we would if we had to be on top of every decision, but also, by freeing us from having to think about these issues, it gives us the mental space we need to focus on the rest of our lives."

"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 own 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 a paternalism now so thoroughly embedded into the system that we hardly notice it?"

"Because regulating who sets up a practice and decides to call himself a doctor seems to be beyond the control of most governments in developing countries, the only way to reduce the spread of antibiotic resistance and the overuse of high-potency drugs may be to put maximal effort into controlling the sale of these drugs."

"As far as treatment is concerned, the challenge is twofold: making sure that people can afford the medicines they need (Ibu Emptat, for one, clearly could not afford the asthma medicine that her son needed), but also restricting access to medicines they don’t need as a way to prevent growing drug resistance."

"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. "

"Nudges may be especially helpful when,for whatever reason,households are somewhat dubious about the benefits of what is being proposed to them.This makes preventive care a doubly appropriate candidate for such policies:The benefits r in the future & in any case,it is hard to understand exactly what they are.The good news is that nudges may also help with the convincing,which may jump-start a positive feedback loop."

"There is a second reason this is wrong. Both the right wing and the left wing seem to assume that action follows intention: that if people were convinced of the value of immunization, children would be immunized. This is not always true, and the implications are far-reaching."

"We think that both of these views are somewhat wrongheaded ways to think about this and other similar problems, for two reasons. First, what the 2-pounds-of-dal experiments demonstrate is that in Udaipur at least, the poor might appear to believe in all kinds of things, but there is not much conviction behind many of those beliefs."

"For the right, this is because it will be wasted; for the conventional left, which includes much of the public health community and the good doctor from Seva Mandir, this is because it degrades both what is given and the person who gets it. Instead, we should focus on trying to convince the poor of the benefits of immunization."

"In the end, the mistrust of incentives for immunization comes down to an article of faith for both those on the right and the left of the mainstream political spectrum: Don’t try to bribe people to do things that you think they ought to do."

"They may also not understand why all the different shots in the basic immunization regime are needed—after two or three shots, parents might feel that they have done what they should. It is all too easy to get misleading beliefs about what might work in health."

"Moreover, immunization just prevents some diseases—there are many others—and uneducated parents do not necessarily understand what their child is supposed to be protected against. So when the child gets sick despite being immunized, the parents feel cheated and probably resolve not to go through with it again."

"When a child is immunized against measles, that child does not get measles. But not all children who are not immunized actually contract measles (especially if others around them who are the potential source of infection are immunized), so it is very difficult to draw a clear link between immunization and the lack of disease."

"It is probably even harder to learn from experience about immunization, because it does not fix an existing problem, but rather protects against potential future problems."

"Furthermore, they found no difference in usage rates among those who had paid for them and those who had not. The same kinds of results, which rule out the possibility that subsidies are to blame for low usage, have now been found in other settings. But if subsidies are not the cause, what is?"

"TAMTAM sent field officers to the homes of people who had purchased nets at the various subsidized prices. They found that between 60 percent and 70 percent of women who had acquired a net were indeed using it. In another experiment, over time usage went up to about 90 percent."

"Why do poor people demand so much (bad) health care, but show such indifference toward these preventive services, and more generally toward all the wonderful, cheap gains that the medical profession has invented for them?"

"We must therefore accept the possibility that if people do not go to the public health centers, it is also in part because they are not particularly interested in receiving the services they offer, including immunizations."

"A part of the answer is that a lot of the cheap gains are in prevention, and prevention has traditionally been the area where the government is the main player."

"When faced with a serious health issue, poor households cut spending, sell assets, or borrow, like Ibu Emptat, often at very high rates: In Udaipur, every third household we interviewed was currently repaying a loan taken out to pay for health care. A substantial proportion of those loans are from moneylenders, at rates that can be very high: The standard interest rate is 3 percent per month (42 percent per year)."

"The poor also spend large amounts of money on single health events: Among the poor families in Udaipur, 8 percent of the households recorded total expenditures on health of more than 5,000 rupees ($228 USD PPP) in the previous month, ten times the monthly budget per capita for the average family, and some households (the top 1 percent spenders) spent up to twenty-six times the average monthly budget per capita."

"In most countries, more than one-fourth of the households had made at least one visit to a health practitioner in the previous month."

"When asked whether there was a period of a month in the recent past when they felt “worried, tense, or anxious,” roughly one-fourth of the poor in both rural Udaipur and urban South Africa said yes. "

"Since they do not seem to be willing to sacrifice much money or time to get clean water, bed nets, or for that matter, deworming pills or fortified flour, despite their potentially large health benefits, does that mean the poor do not care about health? The evidence suggests the opposite."

"What the lack of demand underscores is perhaps the fundamental difficulty of the problem of health: The ladders to get out of the poverty trap exist but are not always in the right place, and people do not seem to know how to step onto them or even want to do so. "

"As he sees it, there are health-based poverty traps, but there are also ladders we can give to the poor to help them escape from these traps. If the poor cannot afford these ladders, the rest of the world should help them out."

It is not that people don’t care about their health. They do, and they devote considerable resources to it. They just seem to spend money elsewhere: on antibiotics that are not always necessary, on surgery that comes too late to help. Why does it have to be this way?

"But there are all too many instances where food policy remains hung up on the idea that all the poor need is cheap grain."

"We do see some instances of this across the world, pushed by organizations such as the Micronutrient Initiative and HarvestPlus: A variety of orange sweet potatoes (richer in beta carotene than the native yam) suitable for Africa was recently introduced in Uganda and Mozambique.35 A new salt, fortified both with iron and iodine, is now approved for use in several countries, including India."

"Developing ways to pack foods that people like to eat with additional nutrients, and coming up with new strains of nutritious and tasty crops that can be grown in a wider range of environments, need to become priorities for food technology, on an equal footing with raising productivity. "