How can we use the things we share in common to address some of the most challenging problems facing the world? This course examines issues concerning poverty, the environment, technology, health care, gender, education and activism to help us understand better how to initiate positive change.
Motivating Change and Holistic Responses to Poverty
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How to Change the World
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Disease and Global Health Care
Discussion about health care and poverty, considering major challenges that disease presents around the world and the global role of healthcare
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Michael S. Roth
[MUSIC]
Yes, and one of the fascinating kinds of knowledge is the
knowledge of deeply experienced practitioners who have been in
the field, and doing things often for years or even decades.
>> Yeah.
>> And this is sometimes tacit knowledge, sometimes
it's called an art, sometimes it's called professional experience.
>> Right. >> I think there's a very rich
set of issues around this, but I was convinced by my own experience, by a
very thorough analysis of malaria as a disease by the nature
of transmission, by the kinds of people that it was hitting, by the
bad experience with trying to sell nets, with the analogies to vaccine coverage.
And with the, some earlier tests that had been done of mass distribution,
especially by the American Red Cross. >> Right.
>> That do enough to move, and that by
not moving [COUGH] we would risk millions of lives lost.
The world did move.
It turned out the academic studies that came in afterwards
helped to support those conclusions, I'm very happy about that.
I think it played a very constructive role.
But I think that the base of decision-making from all points of view,
the underlying logic, science the risk balance.
The ethics and so forth, all pointed in a particular direction.
All of this comes for me back to a
basic idea, which is that, context is extraordinarily important.
>> Yeah.
>> Evaluation and decisions is not simply a statistical test.
There's a world of knowledge and expertise
often beyond the economist or the policy analyst.
Often not even tapped by the economists or policy
analysts and what I've observed in my profession's behavior.
I learned a long time ago, to ask other professions.
>> Right.
>> And understand that we have a web of knowledge, just like we have a food web,
we have a knowledge web.
And we ought to use that effectively to really think hard and clearly
about what our options are when it comes to a policy choice.
>> So do you think that one of the reasons that your work in this field has
become, in some ways it's become more controversial even
as it's become more widely recognized as being effective.
[LAUGH] It's because, in academia, and
in policy circles there's just been a, in, in more specialized focus
on data analysis as opposed to contextual and narrative considerations.
Is that, is that part of the reason, you know, there that, that I mean, you, you've
been subject of some controversy recently, and people,
you know you know, using statistics as a way,
as the sole legitimating avenue for thinking about dealing with these issues?
Yes, I think I consider it a deeper epistemological question.
>> Mm-hm.
>> Of what is knowledge and how does one come by it.
>> Mm-hm.
>> Many economists right now do these randomized trials.
They think that they're going to do a clean test,
ignoring the past they will do a set of trials, and
then they will look at a T statistic or an F test.
Right.
And that will tell them the truth.
This is in statistics a frequentist approach.
>> Yep.
>> That you start with a sample [SOUND].
You measure the you measure the the the outcomes
of a particular experiment, and that's the universe of knowledge.
My approach has been very, very different, and
it's become more different, over the last 30 years.
Which is that the more that I have seen and worked now in
more than 130 countries around the world,
that knowledge is extraordinarily important to me.
>> Yep. That knowlege of 30 years of
experience [COUGH], dealing with malariaologists or
AIDS docs or public health specialists or
demographers or hydrologist or climatologists or
agronomists, and it builds up over time.
So, I find it less persuasive to do one more trial.
>> Yeah.
>> And a lot more persuasive to have what I regard as not one data set,
but a world of data.
That I've tried very, very hard over
decades, to increasingly master as best I can.
And also to look in what are sometimes called epistemic communities.
Right.
>> Use the knowledge of communities for their advice.
If you look at this question of, to do with
malaria, that was a randomized
clinical trial without consulting the malariologists.
As a Bayesian, that's the alternative to the frequentist approach.
>> Yeah.
>> As a Bayesian who has carries a prior distribution about
the probabilities of certain kinds of outcomes based on a lifetime of refining.
My thoughts and knowledge about this and trying to incorporate new evidence.
I never come to a problem starting from scratch and looking
at one trial.
Yes I come with what might be called, preconceptions, but I would say that those
are what a Bayesian philosophers called, called, called prior distributions.
>> Mm-hm.
>> But they haven't come out of nowhere.
>> Right.
>> whim, they've come out of a lot of experience.
This raises some quite deep questions actually.
>> Yeah. >> About how a field
should behave.
People may say, well but Jeff you know, how do we trust your judgement.
That's a, that's, that's a good question. >> It's a good question.
>> it, it, it has been right on, on many
many issues, like the need to freely distribute bed nets.
Many years before an RCT was actually done.
And I could at some length recreate the, over a number
of hours, all the reasons why it came to a particular conclusion.
All of the prior experience, all of the analogies.
All of the logic, all of the risk assessment.
[COUGH].
I can assure you it was not a, a lightly taken decision.
On the contrary, I work day and night for several years on this issue.
And not aiming at a published paper,
but aiming actually to get malaria under control.
Vectors,
yeah.
>> This isn't to denigrate the research, but it is
to say that my goal was to stop the disease hit.
Then after the disease has come down sharply,
Some people say, oh, well you were lucky.
No, that wasn't lucky.
>> [LAUGH]
>> That, that was based on very considered views.
>> It's based on judgement and as you, I think
really you started off, is that these judgments are not made
in vacuums, they're made in history, and they're made with a long context.
I mean, your long context of work in the field, but also of
the historical sociological, economic context of
the places in which you're working in.
And their local knowledges and local epistemologies, and I think
the issues you've raised for our students are really important.
I mean, that there are, the way you put it,
multiple ways of knowing and multiple paths to the truth.
It's not just about one statistical path.
One of the things that's been consistent in your work over
a long period of time, is the recognition of a moral claim.
And I, I, and I wonder if you would spend a
minute talking to our students about the, the, the moral claim you
think that that these global health challenges, and, and extreme poverty
have on, on people who are, are not suffering from those things
when, when, let's say they're taking a class like this.
>> First, I, I believe that the field that I'm in, and I love it by the way.
I've been doing this for 41 years now economics,
since I began as a student in 1972, is
only useful as a practical field. >> Right.
>> If it were for the beauty I would rather watch art.
>> Yes.
>> Listen to music watch a good movie, read a novel.
If it were for high intellectual achievement per se, I would
rather master mathematics and it's a dazzling
intricacies and all that it accomplishes.
I find my field only useful if it can actually do things.
>> Right.
>> Now, also though, I don't feel that we live in this world as hired guns.
>> Mm-hm.
>> To do something that someone says, well, use your tools to do this.
I believe that we need to live in a moral framework.
>> Mm-hm. >> I,
in this regard, I find myself mainly an
Aristotelian in the sense that Aristotle essentially defined
ethics as the kind of behavior consistent with
living in the city state, in the polis.
>> Mm-hm.
>> And we live in a world where we have to
behave in certain ways so that we don't blow each other apart.
>> Right. >> So that we act decently and so on.
In this
regard, I have found very many moral teachings to be extraordinarily important
for guiding me, usually from a pretty eclectic point of view, I have to say.
>> Uh-huh.
>> I'm a fan of the Buddhist idea that all that
glitters is is not what you want to throw your life after.
I am a, a big fan of Aristotle's notion that we are social
animals and have to behave ourselves in living in society.
I am a huge fan of Jesus' teaching that he who feeds the least among me, feeds me.
This is a, a basic idea of the Roman
Catholic teachings called the preferential option for the poor.
Mm-hm. >> Which I deeply believe in.
But I
also know that Jeremy Bantham in the 19th century had
a very different take and came to the same conclusion.
There's a declining marginal utility of income.
So transferring money from a very rich person to
a very poor person raises the sum of utilities.
I can go with that also. I think all of these are important.
We cannot live and should not live without a moral framework.
We cheat ourselves in our society these days,
by not having a place where morals are discussed.
And morals as Pope Francis is reminding us every day.
Morals are not simply strictures or one's views about abortion or.
>> Yep.
>> About the do nots and thou shall nots.
Morals are about how we treat each other decently.
and,
what Pope Francis just said in is evangile godium is a papal exortation.
That the highest of value, is mercy. And that is being decent to others.
I believe that.
And I also believe that the idea which is another teaching of, of the church.
I'm not a member of the Roman Catholic
Church, but I believe the social teachings are extremely
important, are that that there is what the the,
the Roman Catholics call the universal destination of goods.
And what they mean by that is that, you
can have private property, but if you come to a
situation where private property leads the rich person to
say I don't have to help the starving poor person.
That private property claim is overwhelmed
by a moral claim.
It's called the universal destination of goods.
>> Universal destination of goods.
>> And, and what it means is that already Pope
Leo in the 19th century said private property is fine.
But it can't override basic human need, private property is not invaluable.
It's human dignity that needs to be treated as the higher good.
And so if a rich person says this is my
food, I don't have to share it with that starving person, it's my right.
This is a libertarian point of view for example.
>> Right.
>> That liberty is the number one value.
I believe that this is a wrong consideration.
That property rights are bound in a moral framework.
Whether it's Aristotelian or Catholic, or I should say Methodist.
Because this is also, John Wesley and the Methodists played
an incredible role in history in fighting slavery first.
In saying that this a kind of property rights that is inconsistent.
With the human good, and it was the
Methodists that played the dominant role in infusing
morality into what was one of the great
moral victories of modern history, the end of slavery.
So I believe
this is something for all of us, I am a big fan of the field of ethics.
I could read it endlessly.
>> I can see that.
>> I find myself pretty eclectic, but I also find that the, great
sages, whether it's Buddha, or whether it's Jesus, or whether it's
the Jewish injunction called tzedek tirdof, which in
Hebrew means, justice, justice shall you pursue.
All of these to my mind speak the same basic point.
Which is that we are human beings in a society of others.
And it is our moral responsibility to take cognizance and respect of humanity.
And Kant of course introduced his categorical imperative and and Bentem
introduced his Utilitarianism and Rawls introduced his Maximin and
principle, students should learn, enjoy, think hard, reflect, apply.
But one thing I would say about ethics is if you apply a doctrine, and it turns
out to lead to bizarre conclusions, maybe your doctrine is too simple.
>> Yeah.
>> This is my view of the problem with libertarianism.
>> Yeah.
>> Which is that, yes, you can take a strong doctrine and then end up
with a view that says that the rich can lead the, the poor to die.
And that is taken by some as a philosophical epiphany.
I just regard it as, as a measure of the paucity of the fundamental basis of
the Libertarian Philosophy.
>> See, you're, you're, a pluralist in your approaches to to all of these things
and, and, you make sure that you don't follow a series
of steps that leads you into a dogmatic response to anything, because dogma
is never going to be as complex as the situation you're trying to solve.
So it sounds like in all of these things, you use
many resources to try to combat a very real problem and.
>> I, I, I have found if I may say
and maybe it's the nature of how I have viewed this.
I've been asked in many times and sometimes I put myself forward to say here
is a problem that needs to be solved. Now, when you do that you're working
with people in different cultures, different
races, different religions, different world outlook.
If you are too dogmatic, you can say
goodbye to the chances to actually solve that problem.
And therefore it probably comes from my starting point, which is that
I have found the most thrilling thing in my professional life to be out
in this complex exciting sometimes profoundly frustrating even scary world,
trying to meliorate grave conditions or
trying to solve problems where technology or better organization give us a solution.
You have to be pretty pragmatic in that.
Because otherwise, you'll hit a wall very quickly.
>> Yeah. >> You ask to go home and
you won't have made much progress.
And for me, the bottom line is, is actually, I have to say,
in a strange kind of way, it's not a good try, although that counts.
It's actually making progress. >> So, so, as, as our students are
thinking about some of these big issues climate change, extreme
poverty, global health challenges and they want to try do to something.
Not that's going to solve the problems in
one fell swoop obviously but to do something positive.
Any before we say good bye, any suggestions about, they'll be tens of
thousands of students in this class most of whom are living outside the U.S.
Are there some things that you would suggest as they finish the class as
they, that they do to continue trying to change the world for the better?
>> Absolutely. The first thing is if you've come
into this field, whether it's economics or politics
or management or some related field, global health.
Because you're interested in solving
problems, never lose that basic motivation.
Even if a professor tells you the most important thing is
a specific technique, and so forth, I'm not against learning the techniques.
But the motivation, in my view, is the fundamental source of being,
having the perseverance and ability to get up off the ground.
>> Mm-hm.
>> To keep going to listen carefully to others.
Take your bruises because there's nothing in the
world that's organized to make your problems simple.
So this is the first thing I would say to the students.
Second I am a great fan of a concept.
Which I hope we hear more and more of in future years, sustainable development.
That means a holistic view
of society, whether it's our city, our community.
>> Mm-hm.
>> Our country or the world, that takes
into account economic, social and environmental considerations holistically.
What good is it solving an economic problem if it destroys the environment.
What good is it, if the economic problem helps people at the top but creates even
more damage for people at the bottom.
So I want holism in, in the approach as a kind of moral.
>> Mm-hm, yes. >> Starting point also.
And that also puts in mind a third precept
that I've learned is in some ways the hard way.
Which is keep learning.
You're in a course right now you're studying, but the issue of sustainable
development in a good society is, requires life long learning.
I was already a tenured professor at Harvard University in
1985 when I began to do something practical in Bolivia.
And my mouth, jaw just fell open. >> [LAUGH]
>> Oh my god nobody taught me about this.
About the politics.
The, the, the many complexities certainly the management and so forth.
And I've had
to learn now over the next 28 years about many of those things.
So this is a life long learning.
There will be huge opportunities for one very real reason.
We have huge problems. Human induced climate change, extreme
poverty big environmental crises pollution big social crises of inequality in
our societies, indigenous populations, deeply deprived of even
their basic rights and access to Public services.
So with eyes open, heart filled, mind filled with lots of good ideas
and lots of tools, there's no shortage of great things to do over the next 30 years.
The world is very likely to have sustainable development
goals or SDGs. >> Mm-hm.
>> As guide posts after 2015, and this will also be another tool.
For all of us to say, here's a direction we can move.
Let's take it on, take on the challenge, get the job done.
>> Jeffrey Sachs, thank you so much for talking with me and for with our students.
It's been inspiring, and thank you for all the great work you're doing.
And lots of luck and look forward to more conversations.
>> Wonderful, I, I do as well, and
thank you so much for teaching this great course.
It's, it's going to be a huge con, it is a huge contribution.
>> Thank you.
So I've talked to you about becoming aware, provoking care, bringing resource
together, marshaling resources, and and, and, and then we have some real design
challenges. And we'll you, that is we, we need to
create design patterns of intervention that we test
so as to find the ones that work best.
Here technology can play a very important role.
And those of you who are perusing all the talks
at the Social Good Summit that are linked, many which
are linked to this class, you'll see that there's a
great faith in, in technology from mobile devices to new
modes of vaccine delivery to soccer balls that work as batteries.
Technology can, can play, can play a
really important role, role in this regard.
Technology is crucial for adding to our resources of clean water,
better education, and easier delivery, easier delivery, of preventative care.
I,
I want to emphasize this. I hope I'm not being too repetitive.
But these things are already in our grasp.
That's one of the things I found, striking in preparing this
class, as, as you know, I'm no expert in global health.
You know, I'm my own field is just to remind you, is I'm
a, a 19th and 20th century historian of ideas of philosophy and, literature.
And as I've been reading for this course, and talking to experts
from the World Bank to our departments here at Wesleyan, about these issues.
The thing that I find so remarkable, sometimes I find it depressing, sometimes
I find it exciting, is that we already know how to make these changes.
These things are already in our grasp.
That, that can be depressing because because gosh we know
how to do it and we're not doing it, how sad.
But what's great, we don't want to be sad about this.
We actually
want to be energized because we know how to make the change.
We need the political will and social consensus to make the change happen.
Amartya Sen, whose work really inspired a lot of the people
in this class talks about this in, in the following way.
He, he says, with adequate social opportunities,
individuals can effectively shape their own destiny and help each other.
Individuals don't have to be seen as passive recipients of the benefits or of
the cunning development programs, or we might add, of, you know, foreign aid.
There is indeed a strong rationale for recognizing, Amartya said.
Says for recognizing
the positive role of free, and sustainable
agency among people who are the most vulnerable.
Sustainable agency, the kinds of things we're talking
about this week in our unit on health,
and disease is reducing vulnerability to disease as
a mode of enhancing agency, of expanding capabilities.
We know how to do it.
Our job is to put together the social will
to bring our knowledge, our care, and our resources.
To bear on some of the world's most dramatic
problems, but problems that together we can begin to address.
Thank you.
[BLANK_AUDIO]
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