THE SINGLE PERSPECTIVE INSTINCT

 


CHAPTER EIGHT

THE SINGLE PERSPECTIVE INSTINCT

Why governments should not be mistaken for nails and why shoes and bricks sometimes tell you more than numbers


Who Can We Trust?

Forming your worldview by relying on the media would be like forming your view about me by looking only at a picture of my foot. Sure, my foot is part of me, but it’s a pretty ugly part. I have better parts. My arms are unremarkable but quite fine. My face is OK. It isn’t that the picture of my foot is deliberately lying about me. But it isn’t showing you the whole of me.

Where, then, shall we get our information from if not from the media? Who can we trust? How about experts? People who devote their working lives to understanding their chosen slice of the world? Well, you have to be very careful here too.

The Single Perspective Instinct

We find simple ideas very attractive. We enjoy that moment of insight, we enjoy feeling we really understand or know something. And it is easy to take off down a slippery slope, from one attention-grabbing simple idea to a feeling that this idea beautifully explains, or is the beautiful solution for, lots of other things. The world becomes simple. All problems have a single cause—something we must always be completely against. Or all problems have a single solution—something we must always be for. Everything is simple. There’s just one small issue. We completely misunderstand the world. I call this preference for single causes and single solutions the single perspective instinct.

For example, the simple and beautiful idea of the free market can lead to the simplistic idea that all problems have a single cause—government interference—which we must always oppose; and that the solution to all problems is to liberate market forces by reducing taxes and removing regulations, which we must always support.

Alternatively, the simple and beautiful idea of equality can lead to the simplistic idea that all problems are caused by inequality, which we should always oppose; and that the solution to all problems is redistribution of resources, which we should always support.

It saves a lot of time to think like this. You can have opinions and answers without having to learn about a problem from scratch and you can get on with using your brain for other tasks. But it’s not so useful if you like to understand the world. Being always in favor of or always against any particular idea makes you blind to information that doesn’t fit your perspective. This is usually a bad approach if you like to understand reality.

Instead, constantly test your favorite ideas for weaknesses. Be humble about the extent of your expertise. Be curious about new information that doesn’t fit, and information from other fields. And rather than talking only to people who agree with you, or collecting examples that fit your ideas, see people who contradict you, disagree with you, and put forward different ideas as a great resource for understanding the world. I have been wrong about the world so many times. Sometimes, coming up against reality is what helps me see my mistakes, but often it is talking to, and trying to understand, someone with different ideas.

If this means you don’t have time to form so many opinions, so what? Wouldn’t you rather have few opinions that are right than many that are wrong?

I have found two main reasons why people often focus on a single perspective when it comes to understanding the world. The obvious one is political ideology, and I will come to that later in this chapter. The other is professional.

The Professionals: Experts and Activists

I love subject experts, and as we all must do, I rely heavily on them to understand the world. When I know, for example, that all population experts agree that population will stop growing somewhere between 10 billion and 12 billion, then I trust that data. When I know, for example, that historians, paleodemographers, and archeologists have all concluded that until 1800, women had on average five or more children but only two survived, I trust that data. When I know that economists disagree about what causes economic growth, that is extremely useful too, because it tells me I must be careful: probably there is not enough useful data yet, or perhaps there is no simple explanation.

I love experts, but they have their limitations. First, and most obviously, experts are experts only within their own field. That can be difficult for experts (and we are all experts in something) to admit. We like to feel knowledgeable and we like to feel useful. We like to feel that our special skills make us generally better.

But …

Highly numerate people (like the super-brainy audience at the Amazing Meeting, an annual gathering of people who love scientific reasoning) score just as badly on our fact questions as everyone else.

Highly educated people (like the readers of Nature,one of the world’s finest scientific journals) score just as badly on our fact questions as everyone else, and often even worse.

People with extraordinary expertise in one field score just as badly on our fact questions as everyone else.

I had the honor of attending the 64th Lindau Nobel Laureate Meeting, and addressing a large group of talented young scientists and Nobel laureates in physiology and medicine. They were the acknowledged intellectual elite of their field, and yet on the question about child vaccination they scored worse than any public polls: 8 percent got the answer right. (After this I never take it for granted that brilliant experts will know anything about closely related fields outside their specializations.)

Being intelligent—being good with numbers, or being well educated, or even winning a Nobel Prize—is not a shortcut to global factual knowledge. Experts are experts only within their field.

And sometimes “experts” are not experts even in their own fields. Many activists present themselves as experts. I have presented at all kinds of activist conferences because I believe educated activists can be absolutely crucial for improving the world. Recently I presented at a conference on women’s rights. I strongly support their cause. Two hundred ninety-two brave young feminists had traveled to Stockholm from across the world to coordinate their struggle to improve women’s access to education. But only 8 percent knew that 30-year-old women have spent on average only one year less in school than 30-year-old men.

I am absolutely not saying that everything is OK with girls’ education. On Level 1, and especially in a small number of countries, many girls still do not go to primary school, and there are huge problems with girls’ and women’s access to secondary and higher education. But in fact, on Levels 2, 3, and 4, where 6 billion people live, girls are going to school as much as, or more than, boys. This is something amazing! It is something that activists for women’s education should know and celebrate.

I could have picked other examples. This is not about activists for women’s rights, in particular. Almost every activist I have ever met, whether deliberately or, more likely, unknowingly, exaggerates the problem to which they have dedicated themselves.

FACT QUESTION 11

In 1996, tigers, giant pandas, and black rhinos were all listed as endangered. How many of these three species are more critically endangered today?

A: Two of them

B: One of them

C: None of them

Humans have plundered natural resources across the planet. Natural habitats have been destroyed and many animals hunted to extinction. This is clear. But activists who devote themselves to protecting vulnerable animals and their habitats tend to make the same mistake I’ve just described: desperately trying to make people care, they forget about progress.

A serious problem requires a serious database. I strongly recommend visiting the Red List, where you can access the status of all endangered species in the world, as updated by a global community of high-quality researchers who track the wild populations of different animals and collaborate to monitor the trend. Guess what? If I check the Red List or World Wildlife Fund (WWF) today, I can see how, despite declines in some local populations and some subspecies, the total wild populations of tigers, giant pandas, and black rhinos have all increased over the past years. It was worth paying for all those panda stickers on the doors all around Stockholm. Yet only 6 percent of the Swedish public knows that their support has had any effect.

There has been progress in human rights, animal protection, women’s education, climate awareness, catastrophe relief, and many other areas where activists raise awareness by saying that things are getting worse. That progress is often largely thanks to these activists. Maybe they could achieve even more, though, if they did not have such a singular perspective—if they had a better understanding themselves of the progress that had been made, and a greater willingness to communicate it to those they seek to engage. It can be energizing to hear evidence of progress rather than a constant restatement of the problem. UNICEF, Save the Children, Amnesty, and the human rights and environmental movements miss this opportunity again and again.

Hammers and Nails

You probably know the saying “give a child a hammer and everything looks like a nail.”

When you have valuable expertise, you like to see it put to use. Sometimes an expert will look around for ways in which their hard-won knowledge and skills can be applicable beyond where it’s actually useful. So, people with math skills can get fixated on the numbers. Climate activists argue for solar everywhere. And physicians promote medical treatment where prevention would be better.

Great knowledge can interfere with an expert’s ability to see what actually works. All these solutions are great for solving some problem, but none of them will solve all problems. It is better to look at the world in lots of different ways.

Numbers Are Not the Single Solution

I don’t love numbers. I am a huge, huge fan of data, but I don’t love it. It has its limits. I love data only when it helps me to understand the reality behind the numbers, i.e., people’s lives. In my research, I have needed the data to test my hypotheses, but the hypotheses themselves often emerged from talking to, listening to, and observing people. Though we absolutely need numbers to understand the world, we should be highly skeptical about conclusions derived purely from number crunching.

The prime minister of Mozambique from 1994 to 2004, Pascoal Mocumbi, visited Stockholm in 2002 and told me that his country was making great economic progress. I asked him how he knew; after all, the quality of the economic statistics in Mozambique was probably not very good. Had he looked at GDP per capita?

“I do look at those figures,” he said. “but they are not so accurate. So I have also made it a habit to watch the marches on May first every year. They are a popular tradition in our country. And I look at people’s feet, and what kind of shoes they have. I know that people do their best to look good on that day. I know that they cannot borrow their friend’s shoes, because their friend will be out marching too. So I look. And I can see if they walk barefoot, or if they have bad shoes, or if they have good shoes. And I can compare what I see with what I saw last year.

“Also, when I travel across the country, I look at the construction going on. If the grass is growing over new foundations, that is bad. But if they keep putting new bricks on, then I know people have money to invest, not just to consume day to day.”

A wise prime minister looks at the numbers, but not only at the numbers. And of course some of the most valued and important aspects of human development cannot be measured in numbers at all. We can estimate suffering from disease using numbers. We can measure improvements in material living conditions using numbers. But the end goal of economic growth is individual freedom and culture, and these values are difficult to capture with numbers. The idea of measuring human progress in numbers seems completely bizarre to many people. I often agree. The numbers will never tell the full story of what life on Earth is all about.

The world cannot be understood without numbers. But the world cannot be understood with numbers alone.

Medicine Is Not the Single Solution

Medical professionals can become very single-minded about medicine, or even a particular kind of medicine.

In the 1950s, a Danish public health doctor, Halfdan Mahler, suggested to the World Health Organization a way to eradicate tuberculosis. His project sent small buses with X-ray machines trundling around villages in India. It was a simple idea: eradicate one disease, and it’s gone. The plan was to X-ray the whole population, find those with TB, and treat them. But it failed because the people got angry. They all had tons of urgent health problems, and finally here was a bus with nurses and doctors. But instead of fixing a broken bone, or giving fluids for diarrhea, or helping a woman in childbirth, they wanted to X-ray everyone for a disease they had never heard of.

Out of the failure of this attempt to eradicate one single disease came the insight that, instead of fighting this disease or that disease, it is wiser to provide and gradually improve primary health care for all.

In another part of the medical world, the profits of Big Pharma companies have been dropping. Most of them are fixated on developing a new, revolutionary, life-prolonging medicine. I try to persuade them that the next big boost in world life expectancy (and their profits) will probably come not from a pharmacological breakthrough but from a business model breakthrough. Big Pharma is currently failing to reach huge markets in countries on Levels 2 and 3, where hundreds of millions of people, like the diabetes patient we met in Kerala, need drugs that have already been discovered, but at more reasonable prices. If the pharmaceutical companies were better at adjusting their prices for different countries and different customers, they could make their next fortune with what they already have.

Experts in maternal mortality who understand the point about hammers and nails can see that the most valuable intervention for saving the lives of the poorest mothers is not training more local nurses to perform C-sections, or better treatment of severe bleeding or infections, but the availability of transport to the local hospital. The hospitals were of limited use if women could not reach them: if there were no ambulances, or no roads for the ambulances to travel on. Similarly, educators know that it is often the availability of electricity rather than more textbooks or even more teachers in the classroom that has the most impact on learning, as students can do their homework after sunset.

Where Gynecologists Never Put Their Fingers

I was talking to some gynecologists whose job it was to collect data about sexually transmitted diseases in poor communities. These professionals were ready to put their fingers anywhere on people, and to ask them all kinds of questions about their sexual activities. I was interested to know whether some STDs were more common in some income groups, and so I asked them to include a question about income on their forms. They looked at me and said, “What? You can’t ask people about their incomes. That is an extremely private question.” The one place they didn’t want to put their fingers was in people’s wallets.

Some years later, I met the team at the World Bank who organized the global income surveys and I asked them to include questions about sexual activity in their survey. I was still wondering about any relationships between sexual behavior and income levels. Their reaction was more or less the same. They were happy to ask people all kinds of questions about their income, the black market, and so on. But sex? Absolutely not.

It’s strange where people end up drawing their lines and how well behaved they feel if they stay inside their boxes.

The Ideologues

A big idea can unite people like nothing else and allow us to build the society of our dreams. Ideology has given us liberal democracy and public health insurance.

But ideologues can become just as fixated as experts and activists on their one idea or one solution, with even more harmful outcomes.

The absurd consequences of focusing fanatically on a single idea, like free markets or equality, instead of on measuring performance and doing what works are obvious to anyone who spends much time looking at the realities of life in Cuba and the United States.

Cuba: The Healthiest of the Poor

I spent some time in Cuba in 1993, investigating a devastating epidemic that was affecting 40,000 people. I had several encounters with President Fidel Castro himself, and I met many skilled, highly educated, and dedicated professionals at the Ministry of Health doing their best within an inflexible and oppressive system. Having lived and worked in a communist country (Mozambique), I went to Cuba with great curiosity but no romantic ideas whatsoever, and I didn’t develop any while I was there.

I could tell you countless stories of the nonsense I saw in Cuba: the local moonshine, a toxic fluorescent concoction brewed inside TV tubes using water, sugar, and babies’ poopy diapers to provide the yeast required for fermentation; the hotels that hadn’t planned for any guests and so had no food, a problem we solved by driving to an old people’s home and eating their leftovers from the standard adult food rations; my Cuban colleague who knew his children would be expelled from university if he sent a Christmas card to his cousin in Miami; the fact that I had to explain my research methods to Fidel Castro personally to get approval. I will restrain myself and just tell you why I was there and what I discovered.

In late 1991, the poor farmers in the tobacco-growing province of Pinar del RΓ­o had started to go color blind and then experience neurological problems with a loss of feeling in the arms and legs. Cuban epidemiologists had investigated and were now seeking outside help. Since the Soviet Union had just collapsed, no help could come from that direction, and in searching the literature for the few researchers in the world with experience of neurological pandemics among poor farmers, they hit on me. Conchita Huergo, a member of the Cuban politburo, met me at the airport, and on my first day Fidel himself appeared, accompanied by armed guards, to check me over. His black sneakers squeaked on the cement floor as he circled round me.

I spent three months investigating. I concluded that the poor farmers were suffering not from a mass poisoning from black market food (as rumor had it), nor from some germ causing metabolic problems, but from simple nutritional deficiency caused by global macroeconomics. The Soviet boats that had until recently been arriving full of potatoes and leaving full of Cuban sugar and cigars had not come this year. All food was strictly rationed. The people had given what little nutritious food they had to the children, the pregnant, and the old, and the heroic adults had eaten only rice and sugar. I presented this all as carefully as I could because the clear implication was that government planning had failed to provide enough food for its people. The planned economy had failed. I was thanked and sent home.

One year later I was invited back to Havana to give a presentation to the Ministry of Health on “Health in Cuba in a Global Perspective.” The Cuban government had by this point, with the help of the Venezuelan government, regained the ability to feed the Cuban people.

I showed them Cuba’s special position on my health and wealth bubble chart. It had a child survival rate as high as that of the United States, on only one-quarter of the income. The minister of health jumped onstage directly after I had finished and summarized my message. “We Cubans are the healthiest of the poor,” he said. There was a big round of applause and that turned out to be the end of the session.

However, that was not the message that everyone had taken from my presentation. As I moved toward the refreshments, a young man gently grabbed my arm. He softly dragged me out of the flow of the crowd, explaining that he worked with health statistics. Then he leaned his head close to mine and with his mouth close to my ear he courageously whispered, “Your data is correct but the conclusion of the minister is completely wrong.” He looked at me as if it were a quiz, then answered his own question. “We are not the healthiest of the poor, we are the poorest of the healthy.”

He let go of my arm and swiftly walked away, smiling. Of course, he was right. The Cuban minister had described things from the government’s single-minded perspective, but there was also another way of looking at things. Why be pleased with being the healthiest of the poor? Don’t the Cuban people deserve to be as rich, and as free, as those in other healthy states?

The United States: The Sickest of the Rich

Which brings us to the United States. Just as Cuba is the poorest of the healthy because of its commitment to a single idea, the United States is the sickest of the rich.

Ideologues will invite you to contrast the United States with Cuba. They will insist you must be for one or the other. If you would prefer to live in the United States than in Cuba, they say, then you must reject everything the government does in Cuba, and you must support what Cuba’s government rejects—the free market. To be clear, I would definitely prefer to live in the United States than in Cuba, but I don’t find it helpful to think like this. It is single-minded and very misleading. If it is being ambitious, the United States should seek to compare itself not to Cuba, a communist country on Level 3, but to other capitalist countries on Level 4. If US politicians want to make fact-based decisions, they should be driven not by ideology but by the numbers. And if I were to choose where to live, I would choose based not on ideology but on what a country delivers to its people.

The United States spends more than twice as much per capita on health care as other capitalist countries on Level 4—around $9,400 compared to around $3,600—and for that money its citizens can expect lives that are three years shorter. The United States spends more per capita on health care than any other country in the world, but 39 countries have longer life expectancies.


Instead of comparing themselves with extreme socialist regimes, US citizens should be asking why they cannot achieve the same levels of health, for the same cost, as other capitalist countries that have similar resources. The answer is not difficult, by the way: it is the absence of the basic public health insurance that citizens of most other countries on Level 4 take for granted. Under the current US system, rich, insured patients visit doctors more than they need, running up costs, while poor patients cannot afford even simple, inexpensive treatments and die younger than they should. Doctors spend time that could be used to save lives or treat illness providing unnecessary, meaningless care. What a tragic waste of physician time.

Actually, to be completely accurate I should say that there is a small number of rich countries with life expectancies as low as that in the United States: the rich Gulf states of Oman, Saudi Arabia, Bahrain, United Arab Emirates, and Kuwait. But these states have a very different history. Until the 1960s when they really started getting rich on oil, their populations were poor and illiterate. Their health systems have been built in just two generations. Unlike the United States, these states are not constrained by a suspicion of anything governmental and I would not be surprised if within a couple of years they all had higher life expectancies than the United States. Perhaps the United States will then be less reluctant to learn from them than it is to learn from Western European countries.

The communist system in Cuba is an example of the danger of getting hooked on a single perspective: the seemingly reasonable but actually bizarre idea that a central government can solve all its people’s problems. I can understand why people looking at Cuba and its inefficiencies, poverty, and lack of freedom would decide that governments should never be allowed to plan societies.

The health-care system in the United States is also suffering from the single-perspective mind-set: the seemingly reasonable but actually bizarre idea that the market can solve all a nation’s problems. I can understand why people looking at the United States and its inequalities and health-care outcomes would decide that private markets and competition should never be allowed anywhere near the delivery of public goods.

As with most discussions about the private versus the public sector, the answer is not either/or. It is case-by-case, and it is both. The challenge is to find the right balance between regulation and freedom.

Even Democracy Is Not the Single Solution

This is risky, but I am going to argue it anyway. I strongly believe that liberal democracy is the best way to run a country. People like me, who believe this, are often tempted to argue that democracy leads to, or is even a requirement for, other good things, like peace, social progress, health improvements, and economic growth. But here’s the thing, and it is hard to accept: the evidence does not support this stance.

Most countries that make great economic and social progress are not democracies. South Korea moved from Level 1 to Level 3 faster than any country had ever done (without finding oil), all the time as a military dictatorship. Of the ten countries with the fastest economic growth in 2016, nine of them score low on democracy.

Anyone who claims that democracy is a necessity for economic growth and health improvements will risk getting contradicted by reality. It’s better to argue for democracy as a goal in itself instead of as a superior means to other goals we like.

There is no single measure—not GDP per capita, not child mortality (as in Cuba), not individual freedom (as in the United States), not even democracy—whose improvement will guarantee improvements in all the others. There is no single indicator through which we can measure the progress of a nation. Reality is just more complicated than that. 

The world cannot be understood without numbers, nor through numbers alone. A country cannot function without a government, but the government cannot solve every problem. Neither the public sector nor the private sector is always the answer. No single measure of a good society can drive every other aspect of its development. It’s not either/or. It’s both and it’s case-by-case.

Factfulness

Factfulness is … recognizing that a single perspective can limit your imagination, and remembering that it is better to look at problems from many angles to get a more accurate understanding and find practical solutions.

To control the single perspective instinct, get a toolbox, not a hammer.

• Test your ideas. Don’t only collect examples that show how excellent your favorite ideas are. Have people who disagree with you test your ideas and find their weaknesses.

• Limited expertise. Don’t claim expertise beyond your field: be humble about what you don’t know. Be aware too of the limits of the expertise of others.

• Hammers and nails. If you are good with a tool, you may want to use it too often. If you have analyzed a problem in depth, you can end up exaggerating the importance of that problem or of your solution. Remember that no one tool is good for everything. If your favorite idea is a hammer, look for colleagues with screwdrivers, wrenches, and tape measures. Be open to ideas from other fields.

• Numbers, but not only numbers. The world cannot be understood without numbers, and it cannot be understood with numbers alone. Love numbers for what they tell you about real lives.

• Beware of simple ideas and simple solutions. History is full of visionaries who used simple utopian visions to justify terrible actions. Welcome complexity. Combine ideas. Compromise. Solve problems on a case-by-case basis.









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