Factfulness: Ten Reasons We're Wrong About the World – and Why Things Are Better Than You Think (25 page)

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.

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 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?

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?

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.

Not long ago I was invited to the five-star Balmoral Hotel in Edinburgh to present to a gathering of capital managers and their wealthiest clients. As I set up my equipment in the magnificent high-ceilinged ballroom, I couldn’t help feeling a bit small, and I asked myself why a wealthy financial institution would want its clients to hear from a Swedish professor of public health. I had been carefully briefed weeks earlier, but to feel sure, I asked the conference organizer again as I got onstage for a final rehearsal. He had a straightforward explanation. He was having a hard time making his clients understand that the most profitable investments were no longer to be found in European capitals boasting medieval castles and cobbled streets, but in the emerging markets of Asia and Africa. “Most of our clients,” he said, “are unable to see or accept the ongoing progress in many African countries. In their minds, Africa is a continent that will never improve. I want your moving charts to change their static view of the world.”