Wednesday, December 2, 2009

Looking Around and Thinking

The scientific method in action:

In Vietnam, they would identify children who had somehow managed to be well nourished. Then they would try to figure out what those families were doing right.

During this process, which Monique Sternin refers to as a "treasure hunt," the Sternins went to the families' homes, looked closely for clues, and asked many questions. One home did not even have full walls, but it housed healthy children. Seeing a crab crawling out of a basket, Sternin said, as she recently recalled, "Oh! What about that? Do you by any chance feed your children crab?" Reluctantly, the father admitted that yes, he scavenged for shrimp and crabs while he was farming in the rice paddies.

"These are protein bombs," says Dirk Schroeder, a professor of global health at Emory University who later conducted a study showing the project's effectiveness. "When parents were first asked, they were really embarrassed about it. It was considered a low-class food, rather than buying Nestle baby food in a jar. In fact, it was a perfect thing to do."

This Vietnamese father was one of the "positive deviants" identified by the Sternins. Other strategies emerged too: distributing the available food into more portions; keeping chickens outdoors, which is more hygienic. Once these behaviors were discovered, the outliers shared them with their neighbors. They all ate together at the homes of the positive deviants. "As the price of admission you would have to bring shrimp," Sternin says. The community developed its own system for weighing and monitoring the children. Based on encouraging early results, this pilot project was expanded to other villages.

When the two-year intervention ended, rates of malnutrition had declined substantially. One evaluation found that in four of the communities, severe malnutrition had dropped from 23 percent to 6 percent. The change was durable: When Schroeder and his colleagues conducted a study three years later, they found that children in participating villages were doing better than their counterparts in a similar village. Strikingly, younger children, who were born after the initiative concluded, enjoyed an even more pronounced edge than their older siblings.
There are so many things to think about here.  The first is the power of the scientific method.  You can cause massive improvements in people's lives just by looking around and seeing what happens as a result of different activities.  The aid workers did not use any technology or spend any money.  They just identified the people who were doing things right and told everyone else about it.

The second is about the perversity of human thinking in the absence of the scientific method.  Why would someone be ashamed to feed his children crab meat, when anyone can see that they are healthier than the other children?  Why would the villagers automatically adopt the practice of feeding their children bottled baby food, while consistently refusing to accept the scientific advice of aid workers? 

It really does appear that they were mainly using their children to play status games with other adults.  Instead of doing what was right for the children, they did what would make the parents appear wealthy and successful.  A similar thing has been observed with the practice of sterilizing water.  You can make dirty water safe to drink by putting it in a plastic bottle and leaving it on a hot metal roof for a few hours.  The heat and UV radiation kill all the dangerous microbes.  But people in poor countries often refuse to do this, because it tells the neighbors that they are too poor to afford clean water.  They would rather risk their child's death than admit that they don't have money.

Of course, this phenomenon is not limited to poor societies.  It seems to be quite common in our own as well.  Parents often do things that do not add any value to the lives of the child or parent, just because they think society expects them to do it.

But that is another topic.  The third thing to consider in the Vietnam story is the actions of Nestle.  From one point of view, they didn't do anything wrong.  They simply sold baby food.  I am guessing that they didn't do much to advertise it either.  It sells because people associate Western stuff with being rich and successful.  The baby food probably has plenty of good vitamins and would work fine if it was used as it was meant to be used.  I would guess that the best strategy for a poor family would be to feed the children a mash of crab meat, rice, and veggies, and top it off with maybe one bottle of baby food a month to round out the vitamins. 

Yet, for some reason, the introduction of canned baby food made people ashamed to feed the children crab meat, and the loss or protein led to malnutrition, with all of its associated morbidity and mortality.  There was a clear harm to the society.  How can we prevent this?  It does not make much sense to prevent the sale outright.  Strict controls on labeling, advertising and marketing might help a little, but they would not stop people from associating the product with wealth and success.

I guess the only real solution is to teach people to think critically and evaluate things based on evidence rather than image or social pressure.  That is a long, slow process, but anything else just will not work in the end.

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