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What are children dying from and what can we do about it? (ourworldindata.org)
71 points by diaphanous 48 days ago | hide | past | web | favorite | 75 comments

How many deaths from diarrheal diseases or pneumonia could be prevented with, say $4 Billion dollars?

Well, the people of Palo Alto, after a few tragic suicides-by-train, want the people of California to pay tens of billions of dollars to put Caltrain underground through their town. (The number of deaths of children in Palo Alto from the train pales in comparison to the number of deaths to children from gunshot wounds on the other side of 101 and across the bay....)


1) https://launiusr.wordpress.com/2012/02/08/why-explore-space-...

2) the diarrheal diseases generally don't need much money at all. 16oz water, fist of salt, three finger pinch of sugar. Unfortunately, the adults in charge of those children tend to remain ignorant even after the Western doctors tell them about the cure. So money won't do anything for that. You can't force a Madagascan to stop dancing with family corpses, ya know.

>So money won't do anything for that.

You can't force a Madagascan to stop dancing with corpses, but you can persuade them that it's uncouth and old-fashioned using perfectly ordinary marketing techniques. The norms of a society can be changed with remarkable speed if you write a big cheque to people who change social norms for a living.

Does this actually work cross-culturally?

My understanding of advertising is that it relies very heavily on building associations between the product being advertised and existing positive social norms. The reason truck commercials in the U.S. always feature scruffy broad-chested men driving shiny vehicles across wide-open rugged terrain is because in the U.S. we have this cultural mythology about the frontier and conquering nature and we associate manliness with this (and with facial hair, muscles, etc.). And this works because there's already a shared cultural norm that's been built up over centuries, which most of the people who develop advertisements are familiar with and can mine for ideas. When I visit my in-laws in Taiwan, the advertisements look very different (although somehow the skinny-but-buxom-blonde has made its way over there too, despite representing basically 0% of the female population).

In a past life, my primary job was getting people to click on search results faster, and my secondary job was making sure Google stayed in the press for positive reasons. A lot of this was data-driven, but when it came to adapting changes to individual countries, we'd always defer to the local teams. Google.kr looks different from Google.ru, both of which look different from Google.com, and in many cases these differences were simply because a competitor had gotten to the local country first and that's what the population had become accustomed to.

> Does this actually work cross-culturally?

With a degree of care, yes. Major marketing and advertising agencies are perfectly au fait with these challenges, because they're responsible for multinational brands. A company like Coca-Cola or Procter & Gamble is very used to selling products to consumers in radically different cultural contexts, as are the agencies they employ.

Marketing within the US is meaningfully cross-cultural - the connotations that sell a Ford F150 will fail hopelessly if you apply them to a Toyota Prius. There are very few brands and messages that will work in every cultural context, which is why marketers are acutely aware of the importance of segmentation.

Just telling people to change their behaviour is rarely successful; you need to surmount some very complex cognitive, emotional and social obstacles to change. The marketing industry has an extremely deep, sophisticated and powerful set of tools and skills in this respect. They spend all day, every day thinking about how to facilitate behavioural change. We're used to thinking of that practice as essentially amoral or evil - they persuade us to max out our credit cards, they convince us that smoking is cool, they peddle junk food - but the same skills could be used for good if only the right people decided to hire them.

That sounds a bit like marketing for marketing. I do think marketing agencies actually did loose a lot of influence in recent years. 15 years ago nearly everyone could hum the latest jingle from the newest ads and influence was indeed profound. But these times are long gone. Today there are many channels for cutural exchange that don't transport marketing messages.

15 years ago, western culture was substantially more monolithic, with much more centralized distribution channels, in comparison to the increasingly balkanized and fragmented niches that abound today.

marketing -> education

To emphasize the flaws of this argument, flip it around. You are effectively arguing that you can change the views, values, and beliefs of an entire nation by marketing. This doesn't sound so unreasonable when it's an 'us vs them' because it's easy to underestimate others. So instead let's make it a 'them vs us' argument.

If what you're saying is accurate then similarly you ought be able to radically shift the views, values, and beliefs of America using marketing. Saudi Arabia has a surplus of money. They'd certainly love to spread their cultural values. Perhaps all they need to do to, for instance, get American women to start dressing 'modestly', as they define it, or American men to ostensibly abstain from alcohol and porn would be to spam Americans with advertising for such?

I'm sure you'd agree such notions are quite absurd. Marketing appeals to cultural values, it doesn't define them. I think the one thing that can make this somewhat confusing is that in certain segments of society, consumerism is itself a cultural value. And as advertising feeds heavily off of this, it can blur the relationship. But this goes back to times before modern marketing even existed. For instance the connection between royalty across the world and the color purple was driven exclusively by the fact that purple dyes, Tyrian purple in particular, were extremely rare. There was no purple marketing agency, just people defining and displaying themselves in terms of having things that others could not.

>If what you're saying is accurate then similarly you ought be able to radically shift the views, values, and beliefs of America using marketing.

If someone had the money and the motivation, I have no doubt that they could. There's reasonably compelling evidence that Russia is engaged in exactly that as we speak, albeit on a fairly modest budget. It's undoubtedly true that the USA has done so overseas; the CIA, the State Department and the DoD allocate substantial funding to "soft power" and PSYOP initiatives. The US Agency for Global Media alone has a budget of $750m, with the explicit objective of fostering support for America's definition of freedom and democracy.

An obvious example of marketing-driven cultural change is the diamond engagement ring, which became a norm almost solely through the marketing efforts of De Beers.


> There's reasonably compelling evidence that Russia is engaged in exactly that as we speak.

I mean, not through marketing. Through exposing the DNC's treatment of Bernie, yes. But...I mean... Have you seen the Facebook ads they put out? It's possible they convinced more people to vote, but they didn't change any votes. It's stuff like "Jesus loves Trump and hates Hillary" level rhetoric.

Giving rings, frequently of precious metals, as a symbol of marriage is, once again, a cultural value and one that dates back thousands of years. De Beers simply increased the popularity of one rock. They didn't even invent the tradition of diamonds which again predates their founding by hundreds of years.

As for the Russia thing, do you think if our tech companies were so directed they could not find evidence of, for instance, Saudi Arabia, Israel, or any other countless other nations also funding various organizations, purchasing ads, etc in ways that they perceive likely to benefit their interests? In my opinion the only reason the Russia thing was given the light of day is because Hillary lost and threw an extremely well connected temper tantrum in an effort to undermine the presidency. And Russia makes a pretty good bogeyman due to the mixture of their 'outsider' status and competence of their agencies and individuals. In any case it's obviously not some meaningful cultural shift. At best they played a negligible role in appealing to preexisting divides within society.

Soft power I think is a much better argument. The Cold War era in particular would be much more meaningful than e.g. Voice of America et al as funded by the USAGM. But there too I'd question the notion of marketing. This [1] is a list of socialist states, past and present. These nations invariably end up resorting to force of arms, suppression of expression, and repressive secret intelligence organizations in order to sustain their power. Unsurprisingly, they don't last long. The USSR, lasting almost 70 years, had quite a long life relative to average. When people have no freedom and your economy collapses (at least relative to free market societies), a nation is already on its way out.

People longing for free markets, free expression, and so on are not doing so because of marketing from the freer nations. The desire for freedom is inherent. It was their governments holding them back. And while we certainly played a significant role in flaunting our successes, the USSR would have inevitably gone the way of all socialist nations. As an aside, no conversation on this topic is complete without this [2]. It's a great list of some Soviet Era jokes told within the USSR. You couldn't criticism the government in public, but private politicization and criticism was ubiquitous.

[1] - https://en.wikipedia.org/wiki/List_of_socialist_states

[2] - https://www.johndclare.net/Russ12_Jokes.htm

With enough time and money, I don't see why this is out of the question. Time already changes all norms, so the money just speeds things up. I can absolutely see my society being changed, and I along with it. Smoking has had buckets of money thrown at it to hold it afloat for a long bloody time, but it has only taken 30 odd years to really cast it as being shunned by consistent government health campaigns (Australian perspective here, but we're seeing it elsewhere as well).

Nothing was ever propping smoking up. We've been smoking for literally thousands of years, long before any notion of formal marketing. Nor was it killed by some sort of marketing campaign. A large part of what happened was we had a generation grow up with ubiquitous electronic devices. You see a cascade of similar social effects such as declines in teen pregnancy, declines in violence, and a wide array of other phenomena all on the same timeframe (also alongside declines in fertility, testosterone, increases in obesity, increases in mental illness, etc).

You can even see this phenomena in practice by looking at the reverse -- quite a handy tool for measuring the soundness of an argument. In many parts of the developing world there have been similar bans on advertising and you also have plain-packaged cigarette cases with absolutely disgusting examples of what can happen if you smoke, such as people with facial disfigurations from oral cancer. Some countries have even seen extremes such as cigarettes being literally blurred out on television and push back against media that contains such to begin with. But again, negligible effects. Large part of the reason being nothing's replaced it as a past time. Bring in the zombifying pale glow of our digital screens and it'll get dropped like a bad habit.

Another counter-example to this would be things such as 'D.A.R.E.' It was a decades long well funded government program that tried to reduce drug usage through 'marketing.' It ended up having a paradoxical effect and increased various forms of drug usage.

You mean like my country, where plain packaged cigarettes came into effect? I'm not sure where you're getting negligible from. Anyone who smokes has stigma attached to them and the only ones still smoking are those who have too little willpower left over to pull themselves out of that social hole.

- Palo Alto homeowners mistakenly believed for years that the new HSR would be buried so that the noise wouldn't affect their property values. It's a kind of mass delusion thing, since you're looking at $2 billion/mile or so

- Mountain View, an adjacent city, just went througn the same calculus wrt tunneling and found it just as breathtakingly unaffordable

- Atherton was mentioned in the article or comments, which is hilarious. They have a city lawyer who's mandate is to not change a single thing.

- When I say "city", I mean approx. population 40,000. So they don't have billions to throw around, although the York family did help Santa Clara City (pop. 10,000) spend $1.2 billion for their football stadium. :)

The $4 Billion figure was the cost to Palo Alto, that they thought they could make up with increased "property values" and taxes. They expected the People of California to pay another $20 Billion or so to complete the work. All for their precious snowflakes and property values.

Nit: Santa Clara City has a population of 116,000.

The tunnel isn't to prevent suicides. It's to enable running six trains per hour. With the tracks at street grade as they are now, this causes traffic issues and increases the risk of train and car collision, which cause massive delays.

You can run trains on a viaduct above intersection, or the other way around. You don’t need to put a train in a tunnel. Railways in major European cities typically run more than 6 trains per hour, and they rarely are all underground.

That's the option that will likely be used. They haven't decided for sure that the trains will run in a tunnel, only that the residents prefer it for obvious reasons.

Nope. That and "property values" are the reason why the people of Palo Alto want it. Which is why it's relevant to the topic of "what can we spend money on to save lives." Here's a community of wealthy people most of whom will say they're for "social justice" who want to take billions of dollars of taxpayer money to _maybe_ save a few lives.


> Councilman Greg Tanaka said the tunnel option would reduce suicides and air pollution, though city Chief Transportation Official Josh Mello expressed doubts about the city’s ability to pay for it.

> Which is why it's relevant to the topic of "what can we spend money on to save lives."

The money is not being spent to save lives like you had originally claimed, so it is totally irrelevant to that topic. It is being spent to increase train frequency, which requires grade separation. The options for grade separation are building a tunnel or building overpasses. Within the context that one or the other option must be chosen, the options have pros and cons relative to each other, one minor point (brought up in passing by one city council member) of which is suicide prevention.

From the chart, it seems obvious that the old strategy of hide HIV and sexual transmission diseases under the rug, to protect the rights of the carriers, is not working at all. At least not for protecting "collateral damage" children.

Practically the Same children infected and killed by sexual transmission diseases in 2007 than in 1997. AIDS mortality has even increased. Same as 'iNTS' (what's this?)

There is a lot of room for improving in this cluster

I answer myself, iNTS is Salmonella, pretty lethal in Africa and increasing

It's quite easy to solve actually.

We can have an app where if you consent to have sex with someone then your sexual health status is automatically shared with whoever you consented to before the act.

You only have sex once you get green light, otherwise you are on your own!

Does it breach their right? IDK, I'll let someone HNer educate me on that.

And if it's a solution then why isn't it being implemented, how can we leave it upto people to be truthful about their status?

People can already share their STD test results, and some clinics even make their patients' results available online so that they can be verified.

Technology isn't going to solve this sociological problem.

This is a cool infographic.

I wish you could break it down so you could see what the lowest hanging fruit for your own country is. I feel like a lot of times our priorities get distorted by the media and tools like this could help us focus on what will truly help the most people.

This. It also showed that mortality rate has been roughly halved since the 90s, but I wonder if that halving has been evenly split around the world, or if it is disproportionate to certain localities. [I'd assume the latter]

This visualization from the same source answers your question:


In summary, it's highly disproportionate, with rapidly industrializing nations in Asia representing a huge portion of the decline in child mortality.

It's an interesting layout but has an annoying feature I've noticed in similar infographics. The division looks like it should be proportional to occurrences, but it is not.

EDIT: appears i was bitten by how I was viewing it originally - downloaded the graphic and it appears to be roughly proportional with areas (i.e. I didn't find more than 10% error)

mea culpa!

It would help if the 1990 and 2017 boxes were same-width bars because people are good at estimating relative lengths, but not relative areas. But it would also be uglier and asymmetric, so maybe not worth the trade-off.

The chart says “each box area represents the number of deaths...”

What makes you think it’s not proportional?

Did some quick checks; it does appear that it's area-proportional.

Leishmaniasis is a cool case: the drop in death is partially attributable to the orphaned drug process approving a drug that had been abandoned as unprofitable. When capitalism can't save lives, governments can.

The orphan drugs are unprofitable precisely because the government regulation require expensive certification before you can produce drugs. Thus, in this case, you’re praising government for solving (at least partly) a problem that the government created in the first place.

That's like saying "government is solving a problem it created" when government builds a water treatment plant so that a small community who can't afford one, can reach water quality levels mandated by the government. Yes, but...

This would be an apt analogy if the small community was legally forbidden from using water the quality of which doesn't meet government standards. Yes, drinking low quality water is probably harmful, but not having anything to drink at all is significantly more harmful.

nitpick here.

the visual says diarrheal diseases (10%) + pneumonia(15%) = 25% total.

why is that bottom left blue box larger than 1/4 of the full box?

the top left red box totals >29% , and why is that box smaller than the bottom left blue box (25%) ?

> Infectious diseases have always been one of the major causes of child deaths, but the success of vaccination campaigns and antibiotic availability has done a great deal to reduce mortality from infectious diseases. Measles vaccination is a perfect example: the number of measles cases has shrunk by 86% since 1990. The WHO has estimated that between 2000 and 2017 measles vaccination has prevented 21.1 million deaths across Africa.

> Today we also have vaccines available for tuberculosis, meningitis, hepatitis, and whooping cough. The best way to protect children against malaria today is to provide insecticide treated bednets, but a new malaria vaccine implementation program is also underway.

Quoted for emphasis. Note the striking lack of deaths on the chart from autism (which vaccines don't cause).

Nutritional deficiencies are interesting because to kill a child it takes a lot.

So it's just the tip of the iceberg.

Problem is all the children who survive have retarded IQ's (lack of iodine can be -10 IQ points) they grow up and stay poor and have more children who will die due to their sustained poverty.

I really have no idea why we pump money into schools when we can target 0-2 year olds and educate them for life. You can't fix lost IQ points later on no matter what you do.

People are stuck in poverty because capitalism forcibly inflicts poverty on them, not because of "IQ". Poverty is a enforced policy choice, not a personal failing.


I would think that doesn't belong in a gathering of childhood fatality statistics, pretty much by definition.

I might be a pro lifer, but I have to support this distinction.

Now the dark hilarity of describing the fatality rate of abortions as 0.6 per 100k abortions, on the other hand...


Look closer... How else would you explain the decrease in congenital birth defects? Eugenism?

If you are suggesting that decrease is proportional to an increase in abortions, I believe you would be very wrong


coupled with some estimates on population indicates the total number of abortions has gone down by about 10%.

If birth defects are passed on from parent genes, I don't think abortion can explain a constant rate of decrease. It can explain it in the 'kill all the defective' sense (Iceland), but not 'cleaning the gene pool' sense.

"Folic acid"

Zero sum, huh?

It’s hard to get pregnant at 3.

I have a pet theory that saving children from natural deaths is harmful to future generations. Surely by intervening so much, we're giving unhealthy people as much evolutionary advantage as healthy people. If the whole world reaches western standards of infant mortality and stays there long enough, will children eventually become dependent on even more interventions and be even more vulnerable to death without them? It might take a lot of generations, but aren't we supposed to value future humans higher than present ones because there will be more of them?

I would have died in childhood without modern medicine, and have a lifelong illness as a consequence of surviving. I may pass that on to my own children. That's a problem that never happened in all human history before about a 100 years ago when useful medicine started to exist, so maybe its effects will be disastrous for the human race. On the other hand, perhaps it's OK if we evolve more dependency on technology. We already need clothes, cooking, and shelter which helps us have advantages and flexibility that animals don't have.

> I may pass that on to my own children

A more palatable approach would be to treat you but not allow you to have children with the same condition. In the past this has been done in fairly barbaric ways but embryo selection offers a far more reasonable solution with minimal limitations on individual rights.

As for whether we should treat children and condemn them to a life of suffering, we already do this calculus with the elderly. Whether or not to perform a procedure depends on the chances of success and the number of quality years they can expect to have afterwards, procedures that will extend life by a year and result in a bedridden patient are routinely skipped, it's only applying the same to children that makes us squeamish.

My friends an ambulance driver and recently had to transport a blind, deaf and mentally retarded baby with a chronic heart condition. The question all the doctors and nurses in the hospital had to ask that night is whether they should treat the child if their heart fails. For me at least the answer is an obvious no in that case.

That's a slippery slope. Who gets to decide who lives and who dies? Who should we abort or sterilize? We all suffer to some degree, then we all die. It's the human condition.

> Who gets to decide who lives and who dies?

Doctors do all the time, they even have their own word for it: triage. When resources are insufficient to cover the needs of everybody, difficult decisions need to be made. Or as the case may be, easy decisions...

Is a decission reserved to parents, in this case. Triage is a term that aim to save the maximum number of people in disasters with many victims. Not to decide if somebody dies or lives.

People is classified in colors black, red, etc after its state. If you are in an accident and you cry and shout repeatedly you are classified in a lower priority than the quiet person that do not moves.

Between population growth not slowing anywhere near fast enough and rapid environment loss due to climate change, there is a good chance we'll see the mother of all triages. Not something to look forward to.

Yup, "lets kill the poor and all our problems will be solved" is a trendy old idea, trendy and deeply wrong also.

I thought this discussion was about prioritizing care to children that have a chance at a normal life (e.g. are not "a blind, deaf and mentally retarded baby with a chronic heart condition"), not killing the poor. My bad.

Yes, but it's an unavoidable slippery slope forced on us by nature, that we can affect with technology and that won't be going away until we can eliminate death and suffering. It's not a new slippery slope, doctors/parents/bureaucrats have to make decisions like this every day already and have for most of human history.

It's where we draw the lines on this slippery slope that constantly evolve.

Ultimately the parents should get to decide, but we should make all means necessary available to them to give them the option so select, or engineer, a healthy embryo.

At one point you could ask what the difference is between not treating a condition and euthanasia.

Well not just children. E.g. the proportion of women needing c-sections is increasing.

I don't think dependence on technology would improve human life in the long run, since the genetic maladaptation load would eventually overwhelm the ability of technology to keep up and we'd be back to where we started. But the key is that we're getting the ability to engage in genetic engineering, so realistically we should be applying technology to treat diseases to the best of our ability while we stall for time to get genetic engineering online so we can permanently stave off inherited diseases.

Isn't C-section for some people like a luxury to keep the body nice or something like that? Genuine question because I heard (yes, hearsay) that C-sections are for people in the USA like fashion? The again, I can't imagine any doctor, in my country at least, doing a C-section unless it is absolutely necessary.

> Isn't C-section for some people like a luxury to keep the body nice or something like that?

No, C-sections are (in normal conditions) more damaging to the body.

> Genuine question because I heard (yes, hearsay) that C-sections are for people in the USA like fashion?

I think the main non-medical reason for C-section preference is control of birth timing, but while it's definitely a thing, I don't know how common it is. Elective C-sections are more common in the US than most other countries, but usually that is based on medical indications prior to labor. I think I've heard that US practice tends to be more likely, all things considered, to view C-section as medically appropriate.

> The again, I can't imagine any doctor, in my country at least, doing a C-section unless it is absolutely necessary.

If it is only probably necessary, it may make sense to do an elective C-section rather than wait for the crisis where the mother and child are both in distress to switch to an emergency C-section.

This is a lie you have been told to prevent women getting medically necessary surgery. Probably told by the same people who tell lies about the abortion process.

There are lots of situations in which normal birth is unsafe for the baby - breech birth, cord strangulation, etc. There are also lots of situations where it is unsafe for the mother. It leaves a visible scar and requires a long recovery period.

Yes and no. C-sections are often medically necessary to ensure the health of the mother and baby. At the same time, elective C-sections are quite common as well, either for pain/recovery reasons or to lockdown the timing of the delivery.

OP's position is a bit extreme, but I wanted to share this as it's somehow related: forced sterilization under Japanese Eugenic Protection Law.

About 16,500 people, mostly women with disabilities, were targeted between 1948 and 1996 under a Japanese law that aimed to stop the birth of children described as “inferior”.


Didn't UK and US have similar policies?

Humans are merely robots executing optimization process that benefits their genes chances of reproduction (and not for any explicit benefit to individuals themselves), but there is no reason we should go along with it. We have the tools to eventually break free.

If we ever lose access to technology, we'll die back to stone age anyway and only strongest and most ruthless will survive. What's a few more deaths because of genetic maladaptations as long as there is enough genetic diversity so some can survive and reproduce?

Genetic diversity is a main factor for survival of any species, as long as your children are functional to reproduce is fine.

Is unhealthy to have blue eyes, 100% round erythrocites and white skin in Africa. You have a much higher risk of develop skin cancer or Malaria. Is also unhealthy to have black eyes, curly hair and black skin in Norway. You lose more heat and have problems with vitamin D absortion... but both traits suppose an advantage in different areas.

Most mutations are entirely harmful. Those are included in the ones that we're promoting by saving young children. We've evolved to this point without saving children from them. So have all species. Surely the continual re-guiding of the evolutionary path is important to prevent a species from degenerating into something that's worse in every way? If we were to remove all selection pressures, the species would surely lose all kinds of qualities we like - not just less able to stay alive but less intelligent, more often deformed in painful ways, less tolerant to various foods, shorter life, less fertile, etc. I think some ever-present evolutionary pressure is needed to fight off entropy.

You're talking about specialization, which is quite different from random damage. Accordingly, we should keep the races distinct if we want to preserve those qualities, in the same way ecologists try to prevent closely related species from interbreeding and diluting their advantages. Though perhaps it doesn't matter anymore with housing, clothing, medicine, sun screen, etc. that allow blacks to safely live in Norway/etc.

I wondered when we'd get someone saying "but do we even want to prevent the avoidable suffering and death of children?"

If you're offended by questions, that suggests you have faith but not confidence. Sometimes the answer isn't so great like "shouldn't we use the most powerful antibiotics available in every case to maximize each patient's chances?" or any other utility maximization, really. It can all have negative consequences.

I don’t think this is something to worry about provided general healthiness is still being positively selected for, and we have every reason to believe that it is.

What makes you think that our ability to save (disease venerable children) is itself not an evolutionary advantage?

And then we can follow from there, if we stop saving them we do not develop our evolutionary advantage further.

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