by Hans Rosling
I told them that, globally, healthcare was improving steadily but they would argue back. My data must be wrong, they said, since they knew for a fact that environmental decay was causing more and more damage to public health. I also told them that the rate of population growth had been decreasing for the last twenty-five years and they countered by saying that no, the world’s population was growing faster than ever. Furthermore, they had learned that population growth was the major cause of environmental destruction. Some of them cared more for dead animals than the millions of dead children in poor countries. I tried to explain that the gorillas would have no future unless there were dramatic improvements in the living conditions of the people with whom they shared their habitat.
Time and time again, year after year, the same things were said in the same tone of voice. There were usually small groups of fanatical, emotional individuals and others who seemed calmer and more matter-of-fact. Each year, the majority of students tended to side with the activists.
This was during the 1990s, when a lot of public interest was focused on animal conservation rather than climate change. The extinction “red lists” were public and it was clear that many animals were at risk. Yet even organizations like the World Wide Fund for Nature grasped that saving the chimpanzees was impossible unless the people in the region had a decent standard of living. The activists, though, were not prepared to follow that line of thought.
For a few years, I would go home thinking about the students’ ideology and condemning it. Their most deeply rooted notion was that there were two different types of people, who lived in two different types of countries. When I sat in the cafes and listened to their conversations, I heard the world discussed in terms of “us” and “them”. The most common statements were endlessly repeated: “They simply can’t expect to live the way we do now, it wouldn’t work. Imagine if all Chinese people owned a car!”
In my view the students were right to say that it was going to be impossible for everyone to end up consuming resources at the current rate of the world’s wealthiest nations. But it was the wealthy nations who were going to have to reduce their consumption. The poorest should consume more while the large middle group should follow the wealthiest toward sustainable levels of consumption. Few students agreed with me, because the majority seemed convinced that the poor led contented lives in rain forests and small rural villages. Their insistence shocked me deeply. I remembered only too well how much people in poor parts of the world desired electricity, running water, roads, and access to education and healthcare.
Every academic year we created new courses and I took on the challenge of teaching a new batch of students about life at different levels of economic development. Above all, I tried to explain that there is no valid distinction between “us” and “them”. People are much the same all over the world, with standards of living that can be mapped on a continuous scale.
I would start my course by handing out oversize sheets of paper showing tables 1 to 5 from UNICEF’s annual report on children worldwide. The data sets for each country covered population size, economic development and health status, and included current data as well as the figures for the past year and twenty years ago. I asked the students to examine the tables and pick out the most successful countries. Clearly, if you looked at birth rates and child survival rates, the world could no longer be divided into two groups.
Most of the students proved resistant to facts. They claimed that the data from developing countries must be wrong. During the breaks and the Q&A sessions they explained to me that the population explosion was due to an increased birth rate among Africans, Muslims, and poor people—and that the rate at which these children died was the one thing that kept populations under control. I referred them to the data in front of them, which had come from the most reliable source within the United Nations, and said:
“Many decades have passed since child mortality acted as a check on population growth. The fastest population growth is now found in the poorest countries with the highest child mortality: people living in extreme poverty have more children because they need child labor and because they know some of their children might die. The only way forward is to carry on working to reduce both poverty and child deaths. Once parents see that children survive, they will want fewer, better-educated children. That is when you need to prioritize access to contraception.”
I was then, and still am, baffled at how hard this is to explain.
Several students would always reply that if these children lived, animals would die. I would go over it again: if more children lived, mothers would choose to have fewer children and the population size would stabilize, which would be in the interest of the animals as well. The main global health priority had to be to reduce child mortality in the poorest countries. One afternoon, a student stood up at the back of the theater and shouted at the top of his voice: “You’re like Hitler toward the animals!”
When I returned home at ten o’clock that evening, I realized it was time to accept that the way I was presenting the facts was not working. How could I demonstrate that their binary system did not exist? How could I show them that the world corresponded neither to the colonial concept of East and West, nor to the newer subdivision of North and South?
Then an idea came to me: I would represent each country as a bubble and its size would be proportional to the population size. If I drew a graph on which the horizontal axis showed income per head and the vertical axis provided an indicator of national health, like life expectancy or the number of surviving children per family, I could place the population bubbles onto it. That evening, I spent several hours on the first prototype. I used datasets from UNICEF’s yearbook and entered them into the statistics program StatView. By bedtime, I had printed out my prototype and put a copy in my rucksack. I wanted to test it out on my students as soon as possible.
The results were promising. The students seemed to like the idea of this new kind of world map. At that point, I could not foresee how significantly these bubbles would change my life.
* * *
The crucial step was taken one winter day in Stockholm in 1996. I hurried through the slushy snow, clutching a bundle of documents, on my way to the Karolinska Institute, where I was to be interviewed for the position of Chair in International Health. Being short-listed was more than I had expected, because several of the other applicants were much better qualified than me. So I had a plan for how to make a good impression.
When I arrived, the chairman of the committee, Professor Erling Norrby, asked me to step inside and sit at one end of an oval table. Eight professors, all older than me, were seated around the table. The sharp light of the winter day flooded in through a large widow and made their faces indistinct. Professor Norrby addressed me:
“Hans Rosling, you are our last candidate. We would like you to explain to us what you consider to be the core issues in the field of international health. And then please tell us why you are the right person to be appointed.”
I replied that the key fields of study were global variations in health and healthcare provision, and how best to promote and restore health among the poorest people. Then I continued:
“However, I don’t plan to convince you why I should be appointed. I’m aware that several of the other applicants are much better qualified than me. Instead, I am going to put you in the best possible position to choose the right person for the post by using my twenty minutes to teach you some fundamental things about global variations in health. I have studied the lists of your publications and know that none of you is an expert in this area. So, I have prepared copies of a colored bubble graph for you. Every bubble is a country and the color denotes its continent. The vertical axis shows life expectancy and the horizontal shows per capita income.”
I pointed to some examples: “Look, the range of countries runs from the Congo in the bottom left, where lives are short and the population is very poor, up to Japan in the top right, where lives are
long and average income is high.”
I went on to explain the irrelevance of a binary division of the world into developed and underdeveloped countries, pointing out that most countries were clustered in the middle of the chart. I also argued that the disease burden gradually changed as economic development progressed, shifting from infections with or without malnutrition to non-infectious diseases, or predominantly late-onset, chronic conditions.
I kept the tempo up so that none of my interviewers would have time to be annoyed at the implication that they were incompetent. I actually found it good fun. My talk held their attention and even got a few positive comments. At the end, they asked me a few more questions and thanked me for my contribution. That same evening I learned that my friend Staffan Bergström had been appointed to the chair, as expected.
The true surprise, though, came the following morning when the telephone rang.
“Good morning, Hans. This is Erling, chairman of the international health appointment committee. You did not get the post, but we were so impressed by your presentation that we would like to offer you a six-year contract as Senior Lecturer.”
I took the post. A few years later, I was appointed to a professorship at the Karolinska Institute. My research had taken me as far as the interview short list but my teaching idea, with its use of colorful bubbles, had made me a professor.
6
From the Lecture Theater to Davos
The decisive reactions to my bubble graph were neither those of the Karolinska Institute professors nor those of my students. The responses which had by far the biggest influence on my future professional life came from my son, Ola, and perhaps even more so, from his wife, Anna.
Ola and Anna, both twenty-three years old, had come for supper one evening in September 1998. They lived in Gothenburg at the time but were visiting Uppsala for the weekend. Anna had completed a course in cultural sociology and was now studying at the School of Photography at the university. Ola was studying economic history but his plan was simply to accumulate enough university exam passes to qualify for grants. He wanted to use the money to buy paint and, with his new portfolio, apply for a place at the College of Art, where he had already been short-listed for two years running.
We were about to start on the dessert when I showed them my new, excitingly colorful bubble graph. Instantly, I caught their attention. They were even more curious when I outlined the fact-resistant attitudes of my students who refused to accept that the countries of the world were scattered along a continuous line, from poverty to wealth. Anna asked for a copy to take back to Gothenburg. She displayed it on the wall in their apartment, where their friends would easily see it. At the time, I had no notion that this would be the start of a lifelong collaboration with Anna and Ola, marrying together my obsession with numbers and their artistic talents. You never know where supper with the family might take you.
A couple of weeks later, on September 16, 1998, I received an email from Ola with the subject line: “Ola tries something new.” Ola recounted enthusiastically how he had joined an instructive session in a magazine production workshop, run by the Gothenburg Cultural Center, and had heard about a new computer animation program. He ended the email with: “And this is the good news. In the next two months, I plan to use the animation program Director 6.0 and make your graph of Child Mortality v. GNP come alive. If you’d like me to, that is? Please let me know.” My boring reply was: “Sounds great, go ahead.” I had not the slightest clue what Ola was on about.
A few more weeks had passed when Ola phoned to tell me that he could make the bubbles move but to work on it he needed a more powerful home computer. He wanted to follow up his idea of tweaking the digital version of the graph to make the country bubbles move from one year to the next. The user could then see how and where the world was changing with time. He asked me nicely if I would lend him the money for a new computer. His computer had been a gift from me twelve years ago.
So, what did I say? Just a few years later I would be lauded for showing off the very program that Ola and Anna went on to build for me. At the time, I suspected that Ola wanted the computer to make an animated cartoon to add to his art portfolio. He had already studied at a few different colleges, taken a handful of courses and then worked with a theater in Stockholm. “He had better get used to being short of money if he plans to make a living as an artist,” I said to myself, my mind clouded by dull parental thoughts. “No, Ola. I’ve already given you my old computer,” I told him. “Surely that will do.” Ola tried to explain that creating moving images required something more sophisticated but I didn’t really listen.
The following day, Ola phoned again to tell me that a bank had agreed to lend him the money but they wanted the signature of a guarantor. I still did not listen properly and blocked off his enthusiasm and persistence. Once more, my reply was “No.”
It still pains me to confess my behavior. The sum he wanted wouldn’t have been a big drain on the family coffers. I was showing a complete inability to hear what Ola was really saying. Still, he did not give up and bought a computer on credit, from a friend. Then he managed to get himself a key to the Cultural Center’s magazine workshop, where he taught himself programming at night during the autumn of 1998. There he wrote the code for the first animated graph of what he called the “Historical World Health Chart.” Anna designed the links. They showed it to me when they were staying with us that Christmas. I remember catching my breath and my eyes widening as the bubbles slowly, smoothly moved from illness and poverty in the lower left-hand corner of the graph, and up toward wealth and longevity in the upper right-hand corner.
“And, look at this—you can track a country! I’ll do Sweden for you,” Ola said, and smiled. The bubbles moved from 1820 to 1997 again for all the countries, but this time Sweden left a trail of bubble markers, one every five years. It was a small innovation but it enabled us to follow the course of Sweden’s path through the last two centuries and compare it with the development of other countries. As the cursor stopped on a bubble, you saw the name of the country and, when the cursor followed the Swedish trail, it showed the year Sweden had reached this or that level of public health or average income.
Wow!
“We must apply for money to develop this idea even further!” I exclaimed spontaneously.
But it turned out to be extremely difficult to get any funding from the sources that would usually give me research grants. As the funding delay continued, Agneta decided to lend Anna and Ola enough for a computer each so that they could work from home, and I began to use the animated bubble graph in my lectures.
Previously, I had been invited to speak only as far afield as Copenhagen. My new tool kit changed this. Out of the blue, I heard from Geneva. The head of statistics at the WHO wanted me to give a talk and later commented: “I’ve never seen anything like it.”
Then Sida—Sweden’s state aid organization—decided to support our peculiar project. Anna and Ola gave up their studies and employed skilled coders to work on new visualizations of the data set. Dollar Street, Anna’s idea, was one of these programs.
These applications elevated my lectures to new levels and made it much easier for me to complete what I saw as my vocation: raising awareness among university students and aid workers as to what was really happening in global development. That was why I held out against a request from the Ministry of Foreign Affairs to appear on the so-called International Square at that year’s book fair in Gothenburg.
Why would I hire myself out to chat about world development to the public at large? I had only ever given talks to academic audiences. Besides, I was skeptical about private enterprise: even the book fair seemed too commercial for my liking. The foreign affairs people had to nag me to attend, but finally I caved in and went to Gothenburg.
The hall housing the International Square was large enough for all conceivable aid organizations and international charities to set out their stalls. In front of the speakers’ stage, tw
enty chairs had been arranged for the audience, yet people moving around on the “square” were unable to see the screen on which I projected my imagery. I disapproved of this and twisted the screen to face outward. It meant that my audience had to stand to see but, because the screen could now be seen from the walkway connecting the hall to the rest of the fair, my audience was now almost a hundred rather than just twenty people.
On that day in September 2003, a man called Bo Ekman stopped to listen to my talk. When I had finished speaking, people queued to talk to me and Ekman waited his turn.
“Heads of industry should hear you speak,” he said. “What I heard was awfully good.”
He surprised me. Bo Ekman, a conventional-looking man in an unremarkable suit, was a major name in Swedish industry. He certainly did not fit easily into the group of a hundred-odd people who had listened to me. He looked ordinary but everything he said was interesting.
Bo asked me to come and speak at the next AGM of Tällberg, a foundation he had started twenty years earlier. The annual meeting was a kind of forum where politicians, academics, and industrialists met and discussed the great issues of the future. I was curious and accepted his invitation.
I suddenly had a completely new audience, including the bosses of Sweden’s biggest industries, men and women I had only read about in the newspapers. After my account of the world, they approached me with very insightful questions. That meeting at Tällberg was the start of a fascinating journey.
* * *
I was surprised and dismayed to find that the executives of the very largest companies were very well-informed about how the world was changing, much more so than my committed, internationally minded students and aid-organization staff. These business executives needed a grip on facts or their firms would collapse. They had to keep track.
