
Is It Better to Be Poor in Bangladesh or the Mississippi Delta? - miraj
https://www.theatlantic.com/business/archive/2017/03/angus-deaton-qa/518880/?single_page=true
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mmsimanga
I was born in an African village, literally in a mud hut. I spent the first 9
years of my life in a village. The town I grew up in wasn't far from the
village so I spent holidays in the village too. I now work in IT and try keep
up with the latest frameworks. That is I am not concerned with starving to
death and I have health insurance.

If I compare my upbringing with my daughter's, there is nothing to compare. We
walked around barefoot, unsupervised, climbed trees, ate wild fruit, made
spears from wood and once you were four you had to take your two year old
sibling with you and look after them. There were no nannies. Here is the
interesting thing, none of us ever had to see an occupational therapist to
help us with our hand eye co-ordination. Falling out of a tree was enough
incentive to figure it out on your own. I digress, the point I am trying to
make is that I remember my childhood as a happy time. Full of activity and
adventure. I would have been classified as poor because I we slept on the
floor, shared blankets as kids. Kids ate from the same plate, grouped roughly
by age group. No toys except ones we made ourselves.

I am not advocating returning to the village. Running water and healthcare are
good things. I often wonder about who is better off, me in town with access to
water and health but with all manner of rates and taxes and social pressures?

Edit: typos

~~~
gmarx
Funny (ironic?) thing is that each incremental advance in civilization may be
a good thing in isolation and, given the choice between adding benefit X to
their existing situation or not, most people would choose adding benefit X
without hesitation.

And yet, somehow the sum of hundreds of such benefits (secure food,
healthcare, fire departments, internet) doesn't lead to a significant increase
in average happiness. In fact it may be that we in the west are less happy
than people living in stone age societies.

~~~
wtetzner
I wonder if it's because of the kinds of stress people in western societies
deal with. Humans have always had to deal with stress, but the modern world
seems to have more "intangible" kinds of stress. It's one thing to be stressed
about being in danger from a predator. The stress drives you to action, and
you either survive or don't. But the kinds of stress people deal with now is
somehow different. Most of the time, the things you're stressed about won't
kill you, but the stress won't go away either. Worrying about money to pay
rent, etc. The stress drives people to make enough money to make this month's
rent, but that same stress will constantly be there, because of next month's
rent.

I dunno if this makes any sense, just something that popped into my head.

~~~
LurkingPresence
I think you hit the nail right on the head. I believe there has been research
with rats on this type of thing (sorry I don't remember the name of the
study). The sort of 'ambiguous' stress of modern life is much harder on the
body/mind than say, being chased by a tiger.

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empath75
I noticed when traveling through Central America, that while extreme poverty
is everywhere, homelessness seems to be quite rare (with the caveat that I
didn't spend much time in the capital cities, so the situation there may be
different).

I think there are two reasons for it:

1) People don't seem to be as mobile, in general, and you'll find 3
generations of family living very close to each other quite often. I was
hanging out with a local in Leon, Nicaragua and met like a dozen of her family
members walking around a couple of blocks. People who are having hard times
seem to just take up with family. We found one drunk lying on the side of the
road, and she insisted we stop and find out what was wrong with him and take
him back to his family. I had barely registered that he was there.

2) There don't seem to be as many zoning or construction safety laws, so
building a shelter by yourself with almost no money seems to be quite easy. It
might be a shack on the side of the road with no water or electricity, but
it's better than sleeping on the street.

I was also struck by how jovial even people with very little seemed to be.
Like having cable tv, food, friends and family was enough for people to be
satisfied with where they are with life. They also seemed relatively
fatalistic about health and safety issues. When you don't really have any
expectation that someone is looking out for you, the idea that you could die
from an accident or sickness any day doesn't seem to be that unlikely. People
there in general just seem to take it in stride. I guess you have to if you
want to get out of bed in the morning.

I think it made me realize that loneliness might be worse than poverty, and
that the lack of social support for poor people in the us is worse than the
lack of money. We could do more for people by creating social connections than
we could be just giving them a check. I don't really know what the answer is
there. I don't think it's a problem at either the market or government can
solve.

~~~
empath75
Just want to be clear that I don't want to paint to rosy a picture of what
poverty looks like in Central America. It's not uncommon to see a single mom
with a family of three or more kids living in a tin shack with a dirt floor.
It's fucking heartbreaking to see. And you know that you could spend a few
hundred bucks and help change their lives, but there are a billion more people
just like them in the world. We in the west have no idea how good we have it.
It's really hard to understand how the rest of the world lives unless you see
it directly.

Even just watching a documentary doesn't really capture the scale of it like
spending three months traveling from town to town and seeing nothing but
abject poverty every where you go. You really do get an understanding of why
people risk their lives to come to the US.

~~~
Brendinooo
I know there's balance to this issue - I once spent an afternoon at a
shantytown located in a garbage dump in Managua. Worldview-changing,
especially when the interpreter noted that some people felt fortunate to at
least have work to do in the dump.

But some things certainly are a matter of perspective. My grandmother was one
of 13 kids, 12 of which survived early childhood. The way she describes it,
they all lived in one three-bedroom house in a steel town: one bedroom for the
parents, one for the girls, and one for the boys.

So, 14 people in a house that, assuming it was an average-sized house from
that era that you see in these parts, was probably about 1,200-1,500 square
feet. That'd be pretty unthinkable to your average American today (outside of
NYC/SF, anyways).

"Keeping up with the Joneses", coupled with a lot of land, probably our
economic policies, and other factors, has certainly moved the needle on what
an acceptable home looks like.

~~~
CrackpotGonzo
I was born and raised in Managua. I think a visit to La Chureca (the dump
you're taking about I think) would be a life-changing experience for most. I
don't think you can truly understand poverty living in the US and not
traveling to the third world.

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charles-salvia
I think a lot of the resentment felt by the rural American poor has to do with
their perception that they are constantly ignored or overlooked, while
similarly impoverished inner-city minorities are at least given some kind of
institutional sympathy. It's hard to say how true this really is, or how much
of it is simply further fuel for pre-existing racism, but apparently this
perception is ubiquitous enough that it can be leveraged to win national
elections.

I will say the events of the last year have definitely opened my eyes to the
situation. The thing I've noticed is that it actually _is_ harder to
sympathize with the white, rural poor than it is with the inner-city
minorities, at least for me - even though I want to sympathize and I
acknowledge their suffering is probably more or less equal to the inner-city
minority poor. I suppose the reason I find it more difficult to feel
equivalent sympathy is that it's hard to get over the fact that the white
rural poor seem to constantly cling to counter-productive political/world-
views that perpetuate their poverty and act against their interests. I mean
it's just really hard to allocate significant sympathy towards a large voting-
bloc that seems to blame all their problems on terrorism and immigration. But
then again, perhaps I am generalizing - I mean I'm just a clueless liberal
living in my NYC bubble so what do I know anyway?

~~~
rtx
Would you sympathise with someone who blames his problems on slavery?

~~~
charles-salvia
I would say it's counter-productive - but at least a direct causal line can be
drawn between slavery and the current lower average socio-economic status of
black people in the US. Whereas, there is absolutely _no_ causal line between
the current plight of poor white people and Mexican immigrants/Islamic
terrorism.

~~~
intopieces
Not trying to derail the topic, but is Islamic terrorism a claimed cause for
the plight of poor white people? If anything, Islamic terrorism is a boon to
poor white people. US Military will provide a decent cash influx at sign-up,
fund education, and provide a steady paycheck for a few years.

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nafizh
I am a Bangladeshi who is now a grad student in US. Perhaps I can give a
generalized peek view of the health system of Bangladesh. I feel much more
safe being in Bangladesh if I were to have some urgent/serious health
problems. There are public hospitals where doctors are always available. You
go and buy a ticket which is very cheap(in the order of 1-2 dollars in BD
currency) and you get to see a doctor. Sure, there are lots of people, you
might have to wait for 2 hours, but it beats the insurance system here in US
any day. In fact, the concept of having a health insurance is so alien in BD
that I feel there will be riots if someone wanted to introduce that. Also, the
quality of the doctors in the public hospital is almost on par with the
private hospitals. Because for any up and coming doctor, if they want to gain
recognition, they first have to get a job at a public hospital. Then they may
also practice at a private hospital at their extra hours. If you do not want
to wait and you have the money(which is in the order of 10 dollars in BD
currecy) you can visit the same doctor at a private hospital. Medicines are
really cheap mostly too. This is one of the reasons many Bangladeshi green
card holders or US citizens would go to BD for health care if they have some
serious issues. I feel there is a huge cultural difference regarding the
solution of healthcare between US and BD. The public in BD expects the
government to take care of its people through public hospitals. That is why
when I came to US and got acquainted with the system of healthcare here it was
a huge shock to me.

~~~
mmsimanga
Very interesting perspective. Thanks for sharing. In South Africa you get both
private and public. Some public hospitals are very good. Particularly those
attached to medical schools. However you have to be referred and your case
prioritized if you have something wrong.

Private medical aids are big business. It gets more expensive by the year and
the benefits seem to be less and less. Its a grudge purchase. How much money
is in medical aid in SA, take a look at this story. The CEO of the biggest
medical aid made enough to [buy a top notch
property]([https://therealdeal.com/2014/01/06/south-african-
insurance-m...](https://therealdeal.com/2014/01/06/south-african-insurance-
mogul-adrian-gore-buys-737-park-condo-for-11m/)) in New York. Bear in mind
exchange rate is 1US$ = 13ZAR

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pizzetta
The author of the question does not have a straightforward answer but puts
this forward as a thought provoker.

For example while Appalachians have higher income on average (PPP) than a
typical Bangladeshi, Appalachian life expectancy is lower. So maybe the
marginal increase in income is more impactful in a place like Bangladesh
-where people are less able to commit self-harm (even unintended like poor
diets). Maybe people in Bangladesh, not having much in the way of comfort do
more with marginal incomes. Maybe we can learn from these social forces to
take advantage of our higher income and provide better living for people who
while not at extreme poverty levels do worse then people living in extreme
poverty.

~~~
thrownblown
Does Bangladesh have a systemic prescription opiate problem?

How about an illegal heroin problem?

~~~
chimeracoder
> Does Bangladesh have a systemic prescription opiate problem?

If you want to talk about the impact of opiates on Bangladeshi poverty today,
you should go back much further in history.

Bengal opium, being much higher quality than the product found in China and
Afghanistan, was the major impetus behind the British annexing the territory
back in 1757. They used this monopoly to extract exorbitant taxes from Bengal,
causing widespread man-made famines which killed tens of millions of people.
They then used this tax money and the opium to flood the Chinese market with
cheap, high-quality opium, against the Chinese rulers' will, in an attempt to
undermine the Chinese government as well by creating a widespread opiate
epidemic. China did not come under _explicit_ colonial rule the way Bengal
did, but it came very close.

Over this time period, Bengal went from being the richest region in the
second-richest empire/region in the world (next to China) to one of the
poorest, which it still is today, despite its rapid growth in recent years.

This strategy isn't over, by the way. The opiate market was (and still is) a
part of the US military strategy in Afghanistan - balancing the desire to
"crack down" on heroin production and smuggling against the desire to provide
Afghani civilians with an agricultural economy that doesn't rely on Taliban
support.

Bangladesh doesn't have a _synthetic_ opiate problem, simply because people
there are generally too poor to purchase synthetic opiates in the first place.
Raw opium is still used in these areas due to its widespread availability, but
it's much less addictive than the synthetic opiates, because pharmaceutical
synthetics are obviously designed to be highly concentrated and potent.

As for the raw numbers, 0.3% of Bangladeshis consume opiates at least once per
year, compared to 0.57% in the US, 0.8% in Italy, 2.65% in Afghanistan (the
highest) and 0.004% in Singapore (the lowest).

~~~
thrownblown
>Bangladesh doesn't have a synthetic opiate problem

I feel that's the key here. That oxycontin was over prescribed for about a
decade. We are talking people getting in a car wreck and waking up in a
hospital addicted to opiates.

I'm assuming we are in agreement that the pharmaceutical opiates are way more
addictive than their illegal analogs. Snorting a pill is way less work than
shooting up or "chasing the dragon" but once you're addicted and your brain
tells you need dope to live, you'll do whatever you need to do to live.

>As for the raw numbers, 0.3% of Bangladeshis consume opiates at least once
per year, compared to 0.57% in the US.

I wonder what the opiate use rate is amongst the Appalachian population. A few
days ago there was a map posted of heroin overdoses in the US and West
Virginia was the hottest hot spot. Anecdotes of OD's and pill heads in WVA
abound. When I showed the map to one of my friends, he told me has had 12(!)
people that he went to high school with die of pills and/or heroin.

I can't help but feel that the pharmaceutical companies and their executives
are complicit in the current US opiate epedemic.

Thanks Obama(care)!

~~~
chimeracoder
> I'm assuming we are in agreement that the pharmaceutical opiates are way
> more addictive than their illegal analogs.

Actually, that's... a complicated question.

Pharmaceutical opiates are definitely more addictive than raw opium (that's
like asking if eating white sugar is sweeter than cane sugar). But once you're
comparing heroin available on the street to prescribed opiates, there are
enough variables (variable quality of product, means of ingestion, the
different situations under which a person chooses one over the other, etc.)
that there isn't a straightforward answer.

~~~
thrownblown
>there isn't a straightforward answer.

We have to acknowledge the biological component of addiction, that some people
are predisposed to certain addictions. There is a physical, chemical component
that comes into play.

I, for example, smoked my first cigarette at 12 y/o. I continued to smoke
cigarettes socially for the better part of the next decade, often buying my
own packs of smokes. I never understood the "need" to smoke that many of my
fellows expressed. I enjoyed the nicotine high, but never once felt it
necessary to smoke tobacco to live a "normal" life. I stopped smoking one day
after college and never felt the urge to smoke again. Even after long-term
repeated exposure to nicotine I never developed a physical dependancy.

The "William Shatner seat" article posted yesterday sent me down a rabbit hole
of Shatner talk shows (in "Aftermath" he interviews Bernie Goetz and it is
amazing) ending on his "Raw Nerve" interview with Rush Limbaugh where Rush
goes into great detail regarding his own painkiller habit. Contrasting how he
speaks about opiates about how his body told him he needed pills like he needs
food or water to my own personal experiences with opiates and nicotine only
reinforces this belief that some people just have the right brain chemistry to
get addicted.

My next thought is that the chemistry of the brain changes over time, under
stress or when exposed to other chemicals. Ergo, at some point, people may be
more prone to particular addictions than at other times.

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xyzzy4
The poor in Bangladesh are at least allowed to have shelter in slums. Anywhere
in the US it would be highly illegal and violate many regulations.

~~~
thrownblown
I don't understand the downvotes.

Rent is just theft based on the monopolization of land. Forcing the poor to
pay to live in government approved ghettos is more extortion of their limited
resources by those who monopolize the commons.

------
sremani
The answer is simple, don't take what I say seriously, take what I do
seriously.

7 out 10 times you are better of in Mississippi delta.

The other 3 times are both cultural and relative wealth.

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divbit
How is the healthcare system in India? Google gives me conflicting answers.

~~~
simonh
What's that got to do with Bangladesh?

~~~
virtuabhi
Because in the article Deaton uses India also ("...But if you had to choose
between living in a poor village in India and living in the Mississippi
Delta...").

~~~
simonh
Thanks, missed that.

