Why I had to lie about the Danes, and how it can be smart to build half a house

Dinner Is Served

An orange sun was setting behind the acacia trees on the savanna of the Bandundu region south of the Congo River, half a day’s walk from the end of the paved road. This is where you find the people who live in extreme poverty: they are stuck behind that mountain, beyond where the road ends. My colleague Thorkild and I had spent the day interviewing the people in this remote village about their nutrition, and now they wanted to throw us a party. No one had ever walked so far to ask them about their problems.

As Swedish villagers would have done 100 years ago, they were demonstrating their gratitude and respect by serving their guests the biggest piece of meat they could find. The entire village was gathered in a circle around Thorkild and me as we were presented with our plates. On top of two large green leaves lay two whole, skinned, grilled rats.

I thought I might throw up. Then I noticed that Thorkild had already started eating: we were both very hungry after a whole day’s work with no food. I looked around at the villagers who were smiling at me expectantly. I had to eat it, and I did. It was actually not that bad: it tasted a bit like chicken. To be polite, I tried to look happy as I swallowed it down.

Then it was time for dessert: another plate, full of big, white larvas from the palm nut tree. And I do mean big—each one was longer and thicker than my thumb, and had been lightly fried in its own fat. But I wondered, had they been too lightly fried? Because they seemed to be moving. The villagers were proud to offer us such a delicious treat.

Remember, I am a sword swallower. I should be able to push anything down my throat. And I am not usually a fussy eater: I had even once eaten porridge made from mosquitos. But no. This, I couldn’t do. The heads of the larvas looked like little brown nuts and their thick bodies like transparent wrinkled marshmallows, through which I could see their intestines. The villagers gestured that I should bite them in two and suck out the insides. If I tried I would puke the rat back up. I did not want to offend.

Suddenly, an idea. I smiled softly and said regretfully, “You know what, I am sorry, but I can’t eat larvas.”

Thorkild turned to me, surprised. He already had a couple of larvas hanging out of the corners of his mouth. He really loved those larvas. He had previously worked as a missionary in Congo, where they had been the highlight of every week for one whole year.

“You see, we don’t eat larvas,” I said, trying to look convincing. The villagers looked at Thorkild.

“But he eats them?” they asked. Thorkild stared at me.

“Ah,” I said. “You see, he comes from a different tribe. I come from Sweden, he comes from Denmark. In Denmark, they love eating larvas. But in Sweden it’s against our culture.” The village teacher went and got out the world map and I pointed out the water separating our two countries. “On this side of the water they eat larvas,” I said, “and on this side we don’t.” It’s actually one of the most blatant lies I have ever told, but it worked. The villagers were happy to share my dessert between them. Everyone, everywhere knows that people from different tribes have different customs.

The Generalization Instinct

Everyone automatically categorizes and generalizes all the time. Unconsciously. It is not a question of being prejudiced or enlightened. Categories are absolutely necessary for us to function. They give structure to our thoughts. Imagine if we saw every item and every scenario as truly unique—we would not even have a language to describe the world around us.

The necessary and useful instinct to generalize, like all the other instincts in this book, can also distort our worldview. It can make us mistakenly group together things, or people, or countries that are actually very different. It can make us assume everything or everyone in one category is similar. And, maybe most unfortunate of all, it can make us jump to conclusions about a whole category based on a few, or even just one, unusual example.

Once again, the media is the instinct’s friend. Misleading generalizations and stereotypes act as a kind of shorthand for the media, providing quick and easy ways to communicate. Here are just a few examples from today’s newspaper: rural life, middle class, super mom, gang member.

When many people become aware of a problematic generalization it is called a stereotype. Most commonly, people talk about race and gender stereotyping. These cause many very important problems, but they are not the only problems caused by wrong generalizations. Wrong generalizations are mind-blockers for all kinds of understanding.

The gap instinct divides the world into “us” and “them,” and the generalization instinct makes “us” think of “them” as all the same.

Are you working for a commercial company on Level 4? There’s a great risk you’re missing the majority of your potential consumers and producers because of your generalizations. Are you working in finance in a big bank? There’s a great risk you are investing your clients’ money in the wrong places, because you’re bundling together people who are vastly different.


How many of the world’s 1-year-old children today have been vaccinated against some disease?

A: 20 percent

B: 50 percent

C: 80 percent

To compare ignorance between different kinds of experts, the regular polling companies couldn’t help me. They don’t have access to the staff of big corporations and government organizations. That’s one reason I started polling my audience at the start of my lectures. I have tested a total of 12,596 people at 108 lectures over the last five years. This question gets the worst results. Look at the table on the next page, where I have ranked 12 groups of experts according to how many picked the most incorrect answer.

The worst results come from an annual gathering of global finance managers at the headquarters of one of the world’s ten largest banks. I have visited three of them. I can’t tell you which one this was, because I signed a piece of paper. A roaring 85 percent of the 71 well-dressed bankers in the room believed that a minority of the world’s children had been vaccinated. An extremely wrong answer.

Vaccines must be kept cold all the way from the factory to the arm of the child. They are shipped in refrigerated containers to harbors around the world, where they get loaded into refrigerated trucks. These trucks take them to local health clinics, where they are stored in refrigerators. These logistic distribution paths are called cool chains. For cool chains to work, you need all the basic infrastructure for transport, electricity, education, and health care to be in place. This is exactly the same infrastructure needed to establish new factories. The fact that 88 percent are vaccinated but major financial investors believe it is only 20 percent indicates that there is a big chance they are failing at their jobs by missing out on huge investment opportunities (probably the most profitable ones in the fastest-growing parts of the world).

You make this kind of false assumption when you have a “them” category in your head, into which you put the majority of humanity. What images are you using to imagine what life is like in this category? Are you perhaps recalling the most vivid and disturbing images from the news? I think that is exactly what’s going on when people on Level 4 answer this badly on this kind of fact question. The extreme deprivation we see on the news ends up stereotyping the majority of mankind.

Every pregnancy results in roughly two years of lost menstruation. If you are a manufacturer of menstrual pads, this is bad for business. So you ought to know about, and be so happy about, the drop in babies per woman across the world. You ought to know and be happy too about the growth in the number of educated women working away from home. Because these developments have created an exploding market for your products over the last few decades among billions of menstruating women now living on Levels 2 and 3.

But, as I realized when I attended an internal meeting at one of the world’s biggest manufacturers of sanitary wear, most Western manufacturers have completely missed this. Instead, when hunting for new customers they are often stuck dreaming up new needs among the 300 million menstruating women on Level 4. “What if we market an even thinner pad for bikinis? What about pads that are invisible, to wear under Lycra? How about one pad for each kind of outfit, each situation, each sport? Special pads for mountain climbers!” Ideally, all the pads are so small they need to be replaced several times a day. But like most rich consumer markets, the basic needs are already met, and producers fight in vain to create demand in ever-smaller segments.

Meanwhile, on Levels 2 and 3, roughly 2 billion menstruating women have few alternatives to choose from. These women don’t wear Lycra and won’t spend money on ultrathin pads. They demand a low-cost pad that will be reliable throughout the day so they don’t have to change it when they are out at work. And when they find a product they like, they will probably stick to that brand for their whole lives and recommend it to their daughters.

The same logic applies to many other consumer products, and I have given hundreds of lectures to business leaders making this same point. The majority of the world population is steadily moving up the levels. The number of people on Level 3 will increase from two billion to four billion between now and 2040. Almost everyone in the world is becoming a consumer. If you suffer from the misconception that most of the world is still too poor to buy anything at all, you risk missing out on the biggest economic opportunity in world history while you use your marketing spend to push special “yoga” pads to wealthy hipsters in the biggest cities in Europe. Strategic business planners need a fact-based worldview to find their future customers.

Reality Bites

You need the generalization instinct to live your everyday life, and occasionally it can save you from having to eat something disgusting. We always need categories. The challenge is to realize which of our simple categories are misleading—like “developed” and “developing” countries—and replace them with better categories, like the four levels.

One of the best ways to do this is to travel, if you possibly can. That’s why I made my global health students from Karolinska Institutet, the medical university in Stockholm, go on study visits to countries on Levels 1, 2, and 3, where they attended university courses, visited hospitals, and stayed with local families. Nothing beats a firsthand experience.

Those students are usually privileged young Swedes who want to do good in the world but don’t really know the world. Some of them say they have traveled: often they have had a cappuccino at a café next to an eco-tourism agency, but never entered a single family home.

On day one of a trip to Thiruvananthapuram in Kerala in India, or Kampala in Uganda, they usually express surprise that the city is so well organized. There are traffic lights and sewage systems and no one is dying in the street.

On day two, we usually visit a public hospital. When they see that there is no paint on the walls and no air-conditioning and 60 people to a room, my students whisper to each other that this place must be extremely poor. I have to explain that people living in extreme poverty have no hospitals at all. A woman living in extreme poverty gives birth on a mud floor, attended by a midwife with no training who has walked barefoot in the dark. The hospital administrator helps. She explains that not painting the walls can be a strategic decision in countries on Levels 2 and 3. It’s not that they can’t afford the paint. Flaking walls keep away the richer patients and their time-consuming demands for costly treatments, allowing hospitals to use their limited resources to treat more people in more cost-effective ways.

My students then learn that one of the patients cannot afford to pay for the insulin he has been prescribed for his newly diagnosed diabetes. The students don’t understand: this must be an advanced hospital if it can diagnose diabetes. But how bizarre if the patient cannot then afford the treatment. Yet this is very common on Level 2: the public health system can pay for some diagnosis, for emergency care, and for inexpensive drugs. This leads to great improvements in survival rates. But there’s simply not enough money (unless the costs come down) for expensive treatments for lifelong conditions like diabetes.

On one particular occasion a student’s misunderstanding of life in countries on Level 2 nearly cost her very dearly. We were visiting a beautiful and modern private hospital in Kerala, India, eight stories tall. We waited some time in the lobby for a student in our group who was late. After 15 minutes, we decided not to wait for her any longer and walked down a corridor and got into a large elevator, big enough to take several hospital beds. Our host, the head of the intensive care unit, pressed the button for the sixth floor. Just as the doors were sliding closed, we saw the young blond Swede rush into the hospital lobby. “Come, run faster!” shouted her friend from the door of the elevator, and she stretched her leg out to stop the doors from closing. Everything then happened very quickly. The doors just continued to close tightly around my student’s leg. She cried out in pain and fear. The elevator started moving upward. She cried out louder. Just as I realized this young woman’s leg was going to get crushed against the top of the doorway, our host leaped across the elevator and hit the red emergency stop button. He hissed at me to help and between us we prised the doors far enough apart to release my student’s bleeding limb.

Afterward, our host looked at me and said, “I have never seen that before. How can you admit such stupid people for medical training?” I explained that all elevators in Sweden had sensors on the doors. If something were put between them, they would instantaneously stop closing and open instead. The Indian doctor looked doubtful. “But how can you be sure that this advanced mechanism is working every single time?” I felt stupid with my reply: “It just always does. I suppose it’s because there are strict safety rules and regular inspections.” He didn’t look convinced. “Hmmm. So your country has become so safe that when you go abroad the world is dangerous for you.”

I can assure you that the young woman was not at all stupid. She had simply, and unwisely, generalized from her own Level 4 experience of elevators to all elevators in all countries.

On the last day, we have a little ceremony to say goodbye where I sometimes learn something about the generalizations other people make about us. On this particular occasion in India, my female students arrived on time, beautifully dressed in colorful saris they had bought locally. (The elevator-door leg injury was nicely healed.) They were followed ten minutes later by the male students, evidently hungover and dressed in torn jeans and dirty T-shirts. India’s leading professor of forensic medicine leaned over to me and whispered, “I hear you have love marriages in your country but that must be a lie. Look at these men. What woman would marry them if their parents didn’t make them?”

When visiting reality in other countries, and not just the backpacker cafés, you realize that generalizing from what is normal in your home environment can be useless or even dangerous.

My First Time

I do not mean to sound critical about my students. I am no better myself.

In 1972, as a fourth-year medical student, I studied at the medical school in Bangalore. The first class I attended was on examining kidney X-rays. Looking at the first image, I realized this must be kidney cancer. I decided to wait a while before telling the class, out of respect. I didn’t want to show off. Several hands then went into the air and the Indian students one by one explained how best to diagnose this cancer, how and where it usually spreads, and how best to treat it. On and on they went for 30 minutes, answering questions I thought only chief physicians knew. I realized my embarrassing mistake. I must have come to the wrong room. These must not be fourth-year students, these must be specialists. I had nothing to add to their analysis.

On our way out, I told a fellow student I was supposed to be with the fourth-years. “That’s us,” he said. I was stunned. They had caste marks on their foreheads and lived where exotic palm trees grew. How could they know much more than me? Over the next few days I learned that they had a textbook three times as thick as mine, and they had read it three times as many times.

I remember this whole experience as the first time in my life that I suddenly had to change my worldview: my assumption that I was superior because of where I came from, the idea that the West was the best and the rest would never catch up. At that moment, 45 years ago, I understood that the West would not dominate the world for much longer.

How to Control the Generalization Instinct

If you can’t travel, please do not worry. There are other ways to avoid using wrong categories.

Find Better Categories: Dollar Street

Anna would always insist that the trips I did with my students were a naïve and unrealistic way to teach most people about the world. Few people wanted to spend their hard-earned money traveling to far-flung places only to try a pit latrine and experience the unglamorous everyday life on Levels 1, 2, or 3, far from the beach, the great cuisine and bars, and the fairy-tale-like wildlife.

Most people were just as uninterested in studying the data about global trends and proportions. And anyway, even looking at the data, it was pretty hard to understand what it meant for everyday life on different levels.

Remember the photos used to describe the levels in the chapter on the gap instinct? They all come from Dollar Street, a project that Anna developed to teach armchair travelers about the world. Now you can understand how people live without leaving your home.

Imagine all the homes in the world lined up on one long street, sorted by income. The poorest live at the left end of the street and the richest live at the right end. Everybody else? Of course, you know it by now: most people live somewhere in the middle. Your house number on this street represents your income. Your neighbors on Dollar Street are people from all over the world with the same income as you.

Anna has so far sent photographers out to visit about 300 families in more than 50 countries. Their photos document how people eat, sleep, brush their teeth, and prepare food. They capture what their homes are made of, how they heat and light their homes, their everyday items like toilets and stoves, and in total more than 130 different aspects of their daily lives. We could fill a whole book with images showing the striking similarities between the lives of people living on the same incomes in different countries, and the huge differences in how people live within countries. We have over 40,000 photos.1

What the photos make clear is that the main factor that affects how people live is not their religion, their culture, or the country they live in, but their income.

Here are some toothbrushes from families with different income levels. On Level 1 you brush with your finger or a stick. On Level 2 you get a plastic toothbrush. On Level 3 you get one each. And Level 4 you are already familiar with.

The bedrooms (or kitchens or living rooms) of families living on Level 4 look very similar in the United States, Vietnam, Mexico, South Africa, or anywhere else in the world.

The way a family living on Level 2 in China stores and prepares food looks very similar to the way a family living on Level 2 in Nigeria stores and prepares food.

In fact, when you are one of the 3 billion people living on Level 2, whether you live in the Philippines, Colombia, or Liberia, the basic facts about your life are quite similar.

Your house has a patchwork roof, so if it’s raining you might well get wet and cold.

When you go to the toilet in the morning it is smelly and full of flies, but at least there are some walls to give you some privacy.

You eat the same for almost every meal, every day of every week. You dream about food that is more varied and more delicious.

The light flickers because the electricity is unstable. You have to rely on moonlight on the nights when the power is out. You secure the door using a padlock.

When you go to bed in the evening you might brush your teeth with the same toothbrush as the rest of the family. You dream about the day when you don’t have to share your toothbrush with Grandma anymore.

In the media, we see photos of everyday life on Level 4 and crisis on the other levels all the time. Google toilet, bed, or stove. You will get images from Level 4. If you want to see what everyday life is like on the other levels, Google won’t help.

Question Your Categories

It will be helpful to you if you always assume your categories are misleading. Here are five powerful ways to keep questioning your favorite categories: look for differences within and similarities across groups; beware of “the majority”; beware of exceptional examples; assume you are not “normal”; and beware of generalizing from one group to another.

Look for Differences Within Groups and Similarities Across Groups 

Country stereotypes simply fall apart when you look at the huge differences within countries and the equally huge similarities between countries on the same income level, independent of culture or religion.

Remember the similarities between the cooking pots of families on Level 2 in Nigeria and China? If you saw just the picture from China you would probably think, “Oh, that’s how they heat water in China. In an iron pot on a tripod over a fire. That’s their culture.” No. It is a common way to heat water on Level 2, all over the world. It’s a question of income. And in China, as elsewhere, people also cook in several other ways, depending not on their “culture” but on their income level.

When someone says that an individual did something because they belong to some group—a nation, a culture, a religion—take care. Are there examples of different behavior in the same group? Or of the same behavior in other groups?

Africa is a huge continent of 54 countries and 1 billion people. In Africa we find people living at every level of development: in the bubble chart above I have highlighted all the African countries. Look at Somalia, Ghana, and Tunisia. It makes no sense to talk about “African countries” and “Africa’s problems” and yet people do, all the time. It leads to ridiculous outcomes like Ebola in Liberia and Sierra Leone affecting tourism in Kenya, a 100-hour drive across the continent. That is farther than London to Tehran.

Beware of “The Majority”

When someone says that a majority of a group has some property it can sound like most of them have something in common. Remember that majority just means more than half. It could mean 51 percent. It could mean 99 percent. If possible, ask for the percentage.

For example, here’s a fact: In all countries in the world, a majority of women say their needs for contraceptives are met. What does that tell us? Does it mean nearly everyone? Or does it mean a little over half? The reality differs widely from one country to another. In China and France, an impressive 96 percent of women say their needs for contraception are being met. Just below that, at 94 percent, are the United Kingdom, South Korea, Thailand, Costa Rica, Nicaragua, Norway, Iran, and Turkey. But in Haiti and Liberia, “the majority” means just 69 percent, and in Angola it means only 63 percent.

Beware of Exceptional Examples

Beware of exceptional examples used to make a point about a whole group. Chemophobia, the fear of chemicals, is driven by generalizations from a few vivid but exceptional examples of harmful substances. Some people become frightened of all “chemicals.” But remember that everything is made from chemicals, all “natural” things and all industrial products. Here are some of my favorites that I would rather not live without: soap, cement, plastic, washing detergent, toilet paper, and antibiotics. If someone offers you a single example and wants to draw conclusions about a group, ask for more examples. Or flip it over: i.e., ask whether an opposite example would make you draw the opposite conclusion. If you are happy to conclude that all chemicals are unsafe on the basis of one unsafe chemical, would you be prepared to conclude that all chemicals are safe on the basis of one safe chemical?

Assume You Are Not “Normal” and Other People Are Not Idiots

To avoid getting your leg crushed in an elevator and other bad mistakes, stay open to the possibility that your experience might not be “normal.” Be cautious about generalizing from Level 4 experiences to the rest of the world. Especially if it leads you to the conclusion that other people are idiots.

If you were to visit Tunisia, a country where you find people living on every level from 1 to 4, you might come across houses that were half-built—like this one, belonging to the Salhi family, who live in the capital, Tunis. You might conclude that Tunisians were lazy or disorganized.

You can visit the Salhi family on Dollar Street and see how they live. Mabrouk is 52 years old and is a gardener. His wife, Jamila, is 44 years old and runs a home-based bakery. Most of their neighbors have similar half-built second floors on their houses. You see this everywhere on Levels 2 and 3 across the world. In Sweden, if someone built their house like that, we would think they had a severe planning problem, or maybe the builders had run away. But you can’t generalize from Sweden to Tunisia.

The Salhis, and many others living in similar circumstances, have found a brilliant way to solve several problems at once. On Levels 2 and 3, families often do not have access to a bank to put their savings and cannot get a loan. So, to save up to improve their home, they must pile up money. Money, though, can be stolen or lose its value through inflation. So, instead, whenever they can afford them, the Salhis buy actual bricks, which won’t lose their value. But there is no space inside to store the bricks and the bricks might get stolen if they are left in a pile outside. Better to add the bricks to the house as you buy them. Thieves can’t steal them. Inflation won’t change their value. No one needs to check your credit rating. And over 10 or 15 years you are slowly building your family a better home. Instead of assuming that the Salhis are lazy or disorganized, assume they are smart and ask yourself, How can this be such a smart solution?

Beware of Generalizing from One Group to Another

I once used to believe and promote a fatally incorrect generalization that cost 60,000 lives. Some of those lives could have been saved if the public health community had been keener to question its misleading generalizations.

One evening in 1974, I was shopping for bread at a supermarket in a small Swedish town when I suddenly discovered a baby in a life-threatening situation. In a stroller in the bread aisle. The mother had turned her back and was busy deciding which loaf to buy. An untrained eye couldn’t see the danger, but fresh out of medical school, I heard my alarm bells go off. I restrained myself from running, to not scare the mother. Instead I walked over to the stroller as quickly as I could and I lifted up the baby, who was asleep on his back. I turned him over and put him down on his tummy. The little fellow didn’t even wake up.

The mother turned toward me with a loaf in her hand, ready to attack. I quickly explained to her that I was a physician and I told her about the so-called sudden infant death syndrome and the new public health advice to parents: not to put sleeping babies on their backs due to the risk of suffocation from vomiting. Now her baby was safe. The mother was both scared and comforted. On trembling legs she continued her shopping. Proudly I completed my own purchases, unaware of my huge mistake.

During the Second World War and the Korean War, doctors and nurses discovered that unconscious soldiers stretchered off the battlefields survived more often if they were laid on their fronts rather than on their backs. On their backs, they often suffocated on their own vomit. On their fronts, the vomit could exit and their airways remained open. This observation saved many millions of lives, not just of soldiers. The “recovery position” has since become a global best practice, taught in every first-aid course on the planet. (The rescue workers saving lives after the 2015 earthquake in Nepal had all learned it.)

But a new discovery can easily be generalized too far. In the 1960s, the success of the recovery position inspired new public health advice, against most traditional practices, to put babies to sleep on their tummies. As if any helpless person on their back needed just the same help.

The mental clumsiness of a generalization like this is often difficult to spot. The chain of logic seems correct. When seemingly impregnable logic is combined with good intentions, it becomes nearly impossible to spot the generalization error. Even though the data showed that sudden infant deaths went up, not down, it wasn’t until 1985 that a group of pediatricians in Hong Kong actually suggested that the prone position might be the cause. Even then, doctors in Europe didn’t pay much attention. It took Swedish authorities another seven years to accept their mistake and reverse the policy. Unconscious soldiers were dying on their backs when they vomited. Sleeping babies, unlike unconscious soldiers, have fully functioning reflexes and turn to the side if they vomit while on their backs. But on their tummies, maybe some babies are not yet strong enough to tilt their heavy heads to keep their airways open. (The reason the prone position is more dangerous is still not fully understood.)

It’s difficult to see how the mother in the bread aisle could have realized I was putting her baby at risk. She could have asked me for evidence. I would have told her about the unconscious soldiers. She could have asked, “But dear doctor, is that really a valid generalization? Isn’t a sleeping baby very different from an unconscious soldier?” Even if she had put this to me, I strongly doubt I would have been able to think it through.

With my own hands, over a decade or so, I turned many babies from back to tummy to prevent suffocation and save lives. So did many other doctors and parents throughout Europe and the United States, until the advice was finally reversed, 18 months after the Hong Kong study was published. Thousands of babies died because of a sweeping generalization, including some during the months when the evidence was already available. Sweeping generalizations can easily hide behind good intentions.

I can only hope that the baby in the bread aisle survived. And I can only hope that people are willing to learn from this huge public health mistake in modern times. We must all try hard not to generalize across incomparable groups. We must all try hard to discover the hidden sweeping generalizations in our logic. They are very difficult to discover. But when presented with new evidence, we must always be ready to question our previous assumptions and reevaluate and admit if we were wrong.


Factfulness is … recognizing when a category is being used in an explanation, and remembering that categories can be misleading. We can’t stop generalization and we shouldn’t even try. What we should try to do is to avoid generalizing incorrectly.

To control the generalization instinct, question your categories.

• Look for differences within groups. Especially when the groups are large, look for ways to split them into smaller, more precise categories. And …

• Look for similarities across groups. If you find striking similarities between different groups, consider whether your categories are relevant. But also …

• Look for differences across groups. Do not assume that what applies for one group (e.g., you and other people living on Level 4 or unconscious soldiers) applies for another (e.g., people not living on Level 4 or sleeping babies).

• Beware of “the majority.” The majority just means more than half.

Ask whether it means 51 percent, 99 percent, or something in between.

• Beware of vivid examples. Vivid images are easier to recall but they might be the exception rather than the rule.

• Assume people are not idiots. When something looks strange, be curious and humble, and think, In what way is this a smart solution?





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