good morning Hank it's Tuesday so a few
weeks ago I had to get a tetanus shot
because I was trying to harvest some
green beans and accidentally harvested
part of my abdomen it was an easy trip
to the doctor but while I was there I
kept thinking about all the systems that
had to be in place for me to get that
tetanus shot like there had to be a
system of roads and highways and bridges
for me to get to the clinic and a system
of gasoline distribution to fuel my car
an electricity system was necessary to
keep the lights on and refrigerate my
tetanus vaccine a sewage treatment
system allows for sanitary hand-washing
then there's the system that trains and
licenses health care workers and a
system that manufactures and distributes
the astonishing number of Goods
associated with my tetanus vaccine I
don't just mean the needle and the
syringe and the vaccine itself but also
a cotton ball and a band-aid and an
alcohol wipe and gloves for the
healthcare worker in the dreary grind of
daily life most of us do not talk or
think much about systems because you
know they're boring like medical
breakthroughs are fascinating improving
supply chains so that medical
breakthroughs that need to be
refrigerated can stay refrigerated not
as fascinating still I would argue that
healthy systems are kind of the key to
healthy and productive human lives they
are so central and so interdependent
that improving them can lead to this
massive virtuous cycle you can look at
almost any country and see this but
let's consider say Thailand between 1994
and 2014 Thailand's child mortality rate
decreased by more than 55 percent so
what got better
everything everything got better
transportation systems got better health
care delivery systems got better water
treatment systems got better
agricultural efficiency got better
because better health means more people
working which means a bigger economy
which means more tax revenue to invest
in things like still better health and
also say better roads better roads make
health care and food delivery and
everything else cheaper and faster
better agricultural yields and food
delivery systems means better health
which means more people working which
grows the economy and so on so okay
let's just improve all the systems but
yeah of course it's not that easy like
let's look at Sierra Leone for instance
about 11% of Sierra Leone's total
economy goes to spending on health care
which is similar percentage-wise to like
the UK Australia or France but because
Sierra Leone is a much poorer country
11% of their GDP is
to $54 per person per year for health
care I paid $75 just for that tetanus
shot which admittedly is extortion but
still $54 per person per year is not
enough to fund a robust health care
system and just as healthy systems can
create virtuous cycles weak systems can
create vicious ones if a country has
very little tax revenue to build systems
and lacks the political and economic
stability necessary to attract private
enterprise systems can weaken which
means less political and economic
stability like imagine you're in the
same situation I was in needing a
tetanus shot but in a community with
much weaker systems you may have to
travel on bad roads because the
transportation system isn't strong the
clinic might be understaffed because the
health worker training and employment
system isn't strong and even if the
clinic is adequately staffed and
supplied your tetanus shot might be
ineffective because it wasn't adequately
refrigerated because there wasn't
electricity investments that take a
really narrow view of health care like
health care is only tetanus shots may
not end up improving that situation much
and that's one of the reasons I admire
partners in health so much which
nerdfighteria has been working with for
a decade now Partners in Health is
systems focused they do not like drop-in
with solutions they listen to and invest
in communities and while learning about
global health over the last several
years I've seen again and again that
these fragile systems can get better and
that a focus on health in the largest
sense of the word can improve every
aspect of a community's life of course
investing in fragile systems sometimes
fails and the progress is often not
simple or linear but it is real so let's
stay excited about the breakthroughs and
innovations that will improve human life
but let us not forget the humble systems
that literally keep the lights on Hank
I'll see you on Friday