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SYSTEMS!!!!

2018-08-21 · letter vlog · John · 3:58 · watch on YouTube

Topic: Global development · mode: Explainer

Starting from his own tetanus shot, John argues that boring, interdependent systems (roads, electricity, supply chains, health-worker training) are the key to healthy, productive lives: improving them creates virtuous cycles, as in Thailand, while weak systems, as in Sierra Leone, create vicious ones; he praises Partners In Health's systems focus and says progress is real.

What is said

The parts of the video and what is said in each (★ — how much it matters to the video).

00:00:00 — John's tetanus shot and all the systems it depended on; systems are boring

  • ★★ A few weeks ago John needed a tetanus shot after, trying to harvest green beans, he accidentally "harvested part of his abdomen". (playful) — 00:00:03 · vaccine
  • ★★★ At the clinic John kept thinking of the systems the shot required: roads, highways and bridges, gasoline distribution, electricity to light and refrigerate the vaccine, and sewage treatment for handwashing. — 00:00:10
  • ★★ Further systems train and license health workers and make and distribute the many goods of a shot: needle, syringe, vaccine, cotton ball, band-aid, alcohol wipe, gloves. — 00:00:29
  • ★★ Most people rarely think about systems because they are boring: medical breakthroughs fascinate, while supply chains that keep them refrigerated do not. (playful) — 00:00:44

00:00:58 — Healthy systems as key to healthy lives; virtuous cycle; Thailand's child mortality

  • ★★★ John argues that healthy systems are the key to healthy and productive human lives. (hedged) — 00:00:58
  • ★★★ Systems are so central and interdependent that improving them can set off a massive virtuous cycle. — 00:01:03
  • ★★★ Between 1994 and 2014, Thailand's child mortality rate fell by more than 55%. — 00:01:13 · child mortality
  • ★★★ In Thailand everything got better: transportation, health-care delivery, water treatment and agricultural efficiency. — 00:01:24
  • ★★★ Better health means more people working, a bigger economy and more tax revenue for still better health and roads; better roads make health care and food delivery cheaper and faster. — 00:01:36

00:01:56 — Sierra Leone's health spending; weak systems and vicious cycles; the same shot with weak systems

  • ★★ John says simply improving all the systems is, of course, not that easy. — 00:01:56
  • ★★★ About 11% of Sierra Leone's economy goes to health-care spending, a share similar to the UK, Australia or France. — 00:02:00 · Sierra Leone, United Kingdom, Australia
  • ★★★ Because Sierra Leone is much poorer, 11% of its GDP equals $54 per person per year for health care. — 00:02:12 · Sierra Leone
  • ★★ John paid $75 just for his tetanus shot, which he admits is extortion. (playful) — 00:02:20
  • ★★ John says $54 per person per year is not enough to fund a robust health-care system. — 00:02:22 · Sierra Leone
  • ★★★ Weak systems create vicious cycles: with little tax revenue and too little stability to attract private enterprise, systems weaken, which further reduces stability. — 00:02:27
  • ★★ With weaker systems, the same tetanus shot means bad roads, an understaffed clinic, and perhaps an ineffective vaccine left unrefrigerated for lack of electricity. (hypothetical, hedged) — 00:02:41 · vaccine
  • ★★★ Investments that take a narrow view of health care, as if it were only tetanus shots, may not improve that situation much. (hedged) — 00:03:07 · global health

00:03:09 — Partners In Health's systems focus; fragile systems can improve; progress is real; sign-off

  • ★★★ John admires Partners In Health because it is systems-focused: it does not drop in with solutions but listens to and invests in communities. — 00:03:15 · Partners In Health
  • ★★ Nerdfighteria has been working with Partners In Health for a decade. — 00:03:16 · Partners In Health, Nerdfighteria
  • ★★★ Learning about global health, John has seen again and again that fragile systems can improve and that a focus on health in the largest sense can improve every part of community life. — 00:03:26 · global health
  • ★★★ Investing in fragile systems sometimes fails and progress is often not simple or linear, but it is real. — 00:03:38 · progress
  • ★★★ John urges staying excited about breakthroughs and innovations while not forgetting the humble systems that literally keep the lights on. — 00:03:46

In the description and comments

  • ★ The description credits Our World in Data as the source of most of the video's information. — video description
  • ★ John cites the World Health Organization for Sierra Leone's per-person health spending and Trading Economics for the size of Sierra Leone's economy. — video description · Sierra Leone

Threads in this video

Mentioned

Central: Partners In Health · systems thinking · vicious circle

Also: Concepts: child mortality · global health · gross domestic product · health care prices in the United States · progress · vaccine

Places: Australia · France · Sierra Leone · Thailand · United Kingdom

Only in the description or credits: Our World in Data · Trading Economics · World Health Organization

Also centred on systems thinking: The Things that People Do (Thoughts from New York City) (Pizzamas Day 7) · The Only Psychiatric Hospital in Sierra Leone · It's My Fault Too

Also centred on vicious circle: Stimulus Plan Explained · Understanding Donald Trump and Hillary Clinton's Tax Plans

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