The Wrong Kind of Outlier

It's been a while since I made a good old-fashioned health care post. So for today, here's a single graph from the book Factfulness by the late Hans Rosling, with Ola Rosling and Anna Rosling Rönnlund:


Orientation: The bubbles represent countries, with the sizes scaled to represent each country's population. Life expectancy is graphed up the Y axis, so you can see it ranges from a few outliers below 50 years to well over 80 years. Health care spending as a percent of GDP for each country is across the X axis. The U.S. — outlier of outliers — spends at least 40 percent more than the next-highest-spending countries, yet has a lower level of life-expectancy than several dozen countries, some of which spend well under half what we spend.

I recommend Factfulness highly. It's charmingly written and based on deep knowledge not just of global data but direct reporting from the field, all over the world. It overlaps with work on cognitive biases to show how our brains help fool us (and allow us to be manipulated) into thinking things are worse than they are.

This graph is not representative of its content: it's mostly about how worldwide statistics show things are better, on average, almost everywhere. Health care in the U.S. is not one of those things, however.

A few quotes from the book:

I don't tell you not to worry. I tell you to worry about the right things (page 241).

Look for causes, not villains. Look for systems, not heroes (page 222).

Be cautious about generalizing from Level 4 ["developed" world] experiences to the rest of the world. Especially if it leads you to the conclusion that other people are idiots (pages 160–161).

I am...not advocating looking away from the terrible problems in the world. I am saying that things can be both bad and better (page 71).... I see no conflict between celebrating...progress and continuing to fight for more (page 70).

Alongside all the other improvements, our surveillance of suffering has improved tremendously. This improved reporting is itself a sign of human progress, but it creates the impression of the exact opposite (page 67).

I want people, when they realize they have been wrong about the world, to feel not embarrassment, but that childlike sense of wonder, inspiration, and curiosity that I remember from the circus, and that I still get every time I discover I have been wrong: "Wow, how is that even possible?" (page 17).

Do yourself a favor and read this book, which summarizes succinctly Rosling's and Gap Minder's work.