by Hans Rosling
Wikipedia contains articles with long lists of recent terror attacks from all over the world. Volunteers update them amazingly quickly, just minutes after the first news is out. I love Wikipedia and if we could trust these lists, we wouldn’t have to wait so long to see the trend. To check their reliability we decided to compare (English) Wikipedia with the Global Terrorism Database for 2015. If the overlap was close to 100 percent, we could probably trust Wikipedia to be quite complete for 2016 and 2017 as well, and use it as a good-enough source for tracking more up-to-date terrorism trends.
It turned out Wikipedia unintentionally presented a very distorted worldview. It was distorted in a systematic way according to a Western mind-set. Our disappointment was huge. More precisely, it was 78 percent. That’s how many of the 2015 terrorism deaths were missing from Wikipedia. While almost all the deaths in the West were recorded, only 25 percent of those in “the rest” were there.
No matter how much I love Wikipedia, we still need serious researchers to maintain reliable data sets. But they need more resources so they can update them quicker.
However, while terrorism has been increasing worldwide, it has actually been decreasing on Level 4. In 2007 to 2016 a total of 1,439 people were killed by terrorists in countries on Level 4. During the ten years before that, 4,358 were killed. That includes the largest attack ever, the 2,996 people who died on 9/11 in 2001. Even if we exclude them, the death toll on Level 4 has remained the same between the two latest ten-year periods. It was on Levels 1, 2, and 3 that there was a terrible increase in terror-related deaths. Most of that increase was in five countries: Iraq (which accounted for almost half the increase), Afghanistan, Nigeria, Pakistan, and Syria.
Terrorism deaths in the richest countries—i.e., countries on Level 4—accounted for 0.9 percent of all terrorism deaths in 2007 to 2016. They have been decreasing through this century. Since 2001, no terrorist has managed to kill a single individual by hijacking a commercial airline. In fact, it is hard to think of a cause of death that kills fewer people in countries on Level 4 than terrorism. On US soil, 3,172 people died from terrorism over the last 20 years—an average of 159 a year. During those same years, alcohol contributed to the death of 1.4 million people in the United States—an average of 69,000 a year. This is not quite a fair comparison, because in most of those cases the drinker is also the victim. It would be fairer to look only at those deaths where the victim was not the drinker: car accidents and homicide. A very conservative estimate would give us a US figure of roughly 7,500 deaths a year. In the United States, the risk that your loved one will be killed by a drunk person is nearly 50 times higher than the risk he or she will be killed by a terrorist.
But dramatic terrorist incidents in countries on Level 4 receive widespread media coverage that is denied to most victims of alcohol. And the very visible security controls at airports, which make the risk lower than ever, might give an impression of increased danger.
One week after September 11, 2001, according to Gallup, 51 percent of the US public felt worried that a family member would become a victim of terrorism. Fourteen years later, the figure was the same: 51 percent. People are almost as scared today as they were the week after the Twin Towers came down.
Fear vs. Danger: Being Afraid of the Right Things
Fear can be useful, but only if it is directed at the right things. The fear instinct is a terrible guide for understanding the world. It makes us give our attention to the unlikely dangers that we are most afraid of, and neglect what is actually most risky.
This chapter has touched on terrifying events: natural disasters (0.1 percent of all deaths), plane crashes (0.001 percent), murders (0.7 percent), nuclear leaks (0 percent), and terrorism (0.05 percent). None of them kills more than 1 percent of the people who die each year, and still they get enormous media attention. We should of course work to reduce these death rates as well. Still, this helps to show just how much the fear instinct distorts our focus. To understand what we should truly be scared of, and how to truly protect our loved ones from danger, we should suppress our fear instinct and measure the actual death tolls.
Because “frightening” and “dangerous” are two different things. Something frightening poses a perceived risk. Something dangerous poses a real risk. Paying too much attention to what is frightening rather than what is dangerous—that is, paying too much attention to fear—creates a tragic drainage of energy in the wrong directions. It makes a terrified junior doctor think about nuclear war when he should be treating hypothermia, and it makes whole populations focus on earthquakes and crashing planes and invisible substances when millions are dying from diarrhea and seafloors are becoming underwater deserts. I would like my fear to be focused on the mega dangers of today, and not the dangers from our evolutionary past.
Factfulness
Factfulness is … recognizing when frightening things get our attention, and remembering that these are not necessarily the most risky. Our natural fears of violence, captivity, and contamination make us systematically overestimate these risks.
To control the fear instinct, calculate the risks.
• The scary world: fear vs. reality. The world seems scarier than it is because what you hear about it has been selected—by your own attention filter or by the media—precisely because it is scary.
• Risk = danger × exposure. The risk something poses to you depends not on how scared it makes you feel, but on a combination of two things. How dangerous is it? And how much are you exposed to it?
• Get calm before you carry on. When you are afraid, you see the world differently. Make as few decisions as possible until the panic has subsided.
CHAPTER FIVE
THE SIZE INSTINCT
Putting war memorials and bear attacks in proportion using two magic tools that you already possess
The Deaths I Do Not See
When I was a young doctor in Mozambique in the early 1980s, I had to do some very difficult math. The math was difficult because of what I was counting. I was counting dead children. Specifically, I was comparing the number of deaths among children admitted to our hospital in Nacala with the number of children dying in their homes within the district we were supposed to serve.
At that time, Mozambique was the poorest country in the world. In my first year in Nacala district, I was the only doctor for a population of 300,000 people. In my second year, a second doctor joined me. We covered a population that in Sweden would have been served by 100 doctors, and every morning on my way to work I said to myself, “Today I must do the work of 50 doctors.”
We admitted around 1,000 very sick children each year to the district’s one small hospital, which meant around three per day. I will never forget trying to save the lives of those children. All had very severe diseases like diarrhea, pneumonia, and malaria, often complicated by anemia and malnutrition, and despite our best efforts, around one in 20 of them died. That was one child every week, almost all of whom we could have cured if we had had more and better resources and staff.
The care we could provide was rudimentary: water and salt solutions and intramuscular injections. We did not give intravenous drips: the nurses had not yet acquired the skills to administer them and it would have taken up too much of the doctors’ time to place and supervise the infusions. We rarely had oxygen tanks and we had limited capacity for blood transfusions. This was the medicine of extreme poverty.
One weekend, a friend came to stay with us—a Swedish pediatrician who worked in the slightly better hospital in a bigger city 200 miles away. On the Saturday afternoon, I had to go on an emergency call to the hospital and he came with me. When we arrived, we were met by a mother with fear in her eyes. In her arms was her baby who had severe diarrhea and was so weak that she could not breastfeed. I admitted the child, inserted a feeding tube, and ordered that oral rehydration solution should be given through the tube. My pediatrician friend dragged me into the corridor by the arm. He was very upset and angrily challenged the subs
tandard treatment I had prescribed, accusing me of skimping in order to get home for dinner. He wanted me to give the baby an intravenous drip.
I became angry at his lack of understanding. “This is our standard treatment here,” I explained. “It would take me half an hour to get a drip running for this child and then there would be a high risk that the nurse would mess it up. And yes, I do have to get home for dinner sometimes, otherwise my family and I would not last here more than a month.”
My friend couldn’t accept it. He decided to stay at the hospital struggling for hours to get a needle into a tiny vein.
When my colleague finally joined me back at home, the debate continued. “You must do everything you can for every patient who presents at the hospital,” he urged.
“No,” I said. “It is unethical to spend all my time and resources trying to save those who come here. I can save more children if I improve the services outside the hospital. I am responsible for all the child deaths in this district: the deaths I do not see just as much as the deaths in front of my eyes.”
My friend disagreed, as do most doctors and perhaps most members of the public. “Your obligation is to do everything for the patients in your care. Your claim that you can save more children elsewhere is just a cruel theoretical guess.” I was very tired. I stopped arguing and went to bed, but the next day I started counting.
Together with my wife, Agneta, who managed the delivery ward, I did the math. We knew that a total of 946 children had been admitted to the hospital that year, almost all of them below the age of five, and of those, 52 (5 percent) had died. We needed to compare that number with the number of child deaths in the whole district.
The child mortality rate of Mozambique was then 26 percent. There was nothing special about Nacala district, so we could use that figure. The child mortality rate is calculated by taking the number of child deaths in a year and dividing it by the number of births in that year.
So if we knew the number of births in the district that year, we could estimate the number of child deaths, using the child mortality rate of 26 percent. The latest census gave us a number for births in the city: roughly 3,000 each year. The population of the district was five times the population of the city, so we estimated there had probably been five times as many births: 15,000. So 26 percent of that number told us that I was responsible for trying to prevent 3,900 child deaths every year, of which 52 happened in the hospital. I was seeing only 1.3 percent of my job.
Now I had a number that supported my gut feeling. Organizing, supporting, and supervising basic community-based health care that could treat diarrhea, pneumonia, and malaria before they became life-threatening would save many more lives than putting drips on terminally ill children in the hospital. It would, I believed, be truly unethical to spend more resources in the hospital before the majority of the population—and the 98.7 percent of dying children who never reached the hospital—had some form of basic health care.
So we worked to train village health workers, to get as many children as possible vaccinated, and to treat the main child killers as early as possible in small health facilities that could be reached even by mothers who had to walk.
This is the cruel calculus of extreme poverty. It felt almost inhuman to look away from an individual dying child in front of me and toward hundreds of anonymous dying children I could not see.
I remember the words of Ingegerd Rooth, who had been working as a missionary nurse in Congo and Tanzania before she became my mentor. She always told me, “In the deepest poverty you should never do anything perfectly. If you do you are stealing resources from where they can be better used.”
Paying too much attention to the individual visible victim rather than to the numbers can lead us to spend all our resources on a fraction of the problem, and therefore save many fewer lives. This principle applies anywhere we are prioritizing scarce resources. It is hard for people to talk about resources when it comes to saving lives, or prolonging or improving them. Doing so is often taken for heartlessness. Yet so long as resources are not infinite—and they never are infinite—it is the most compassionate thing to do to use your brain and work out how to do the most good with what you have.
This chapter is full of data about dead children because saving children’s lives is what I care about most in the whole world. It seems heartless and cruel, I know, to count dead children and to talk about cost-effectiveness in the same sentence as a dying child. But if you think about it, working out the most cost-effective way of saving as many children’s lives as possible is the least heartless exercise of them all.
Just as I have urged you to look behind the statistics at the individual stories, I also urge you to look behind the individual stories at the statistics. The world cannot be understood without numbers. And it cannot be understood with numbers alone.
The Size Instinct
You tend to get things out of proportion. I do not mean to sound rude. Getting things out of proportion, or misjudging the size of things, is something that we humans do naturally. It is instinctive to look at a lonely number and misjudge its importance. It is also instinctive—like in the hospital in Nacala—to misjudge the importance of a single instance or an identifiable victim. These two tendencies are the two key aspects of the size instinct.
The media is this instinct’s friend. It is pretty much a journalist’s professional duty to make any given event, fact, or number sound more important than it is. And journalists know that it feels almost inhuman to look away from an individual in pain.
The two aspects of the size instinct, together with the negativity instinct, make us systematically underestimate the progress that has been made in the world. In the test questions about global proportions, people consistently say about 20 percent of people are having their basic needs met. The correct answer in most cases is close to 80 percent or even 90 percent. Proportion of children vaccinated: 88 percent. Proportion of people with electricity: 85 percent. Proportion of girls in primary school: 90 percent. The use of numbers that sound enormous, together with constant images of individual suffering presented by the charities and the media, distort people’s view of the world and they systematically underestimate all these proportions and all this progress.
At the same time, we systematically overestimate other proportions. The proportion of immigrants in our countries. The proportion of people opposed to homesexuality. In each of these cases, at least in the United States and Europe, our interpretations are more dramatic than the reality.
The size instinct directs our limited attention and resources toward those individual instances or identifiable victims, those concrete things right in front of our eyes. Today there are robust data sets for making the kinds of comparisons I made in Nacala on a global scale, and they show the same thing: It is not doctors and hospital beds that save children’s lives in countries on Levels 1 and 2. Beds and doctors are easy to count and politicians love to inaugurate buildings. But almost all the increased child survival is achieved through preventive measures outside hospitals by local nurses, midwives, and well-educated parents. Especially mothers: the data shows that half the increase in child survival in the world happens because the mothers can read and write. More children now survive because they don’t get ill in the first place. Trained midwives assist their mothers during pregnancy and delivery. Nurses immunize them. They have enough food, their parents keep them warm and clean, people around them wash their hands, and their mothers can read the instructions on that jar of pills. So if you are investing money to improve health on Level 1 or 2, you should put it into primary schools, nurse education, and vaccinations. Big impressive-looking hospitals can wait.
How to Control the Size Instinct
To avoid getting things out of proportion you need only two magic tools: comparing and dividing. What did you say? You already know both of them? Great, then all you need is to start using them. Make it a habit! I’ll show you how.
Compare the Numbers
The most important thing you can do to avoid misjudging something’s importance is to avoid lonely numbers. Never, ever leave a number all by itself. Never believe that one number on its own can be meaningful. If you are offered one number, always ask for at least one more. Something to compare it with.
Be especially careful about big numbers. It is a strange thing, but numbers over a certain size, when they are not compared with anything else, always look big. And how can something big not be important?
4.2 Million Dead Babies
Last year, 4.2 million babies died.
That is the most recent number reported by UNICEF of deaths before the age of one, worldwide. We often see lonely and emotionally charged numbers like this in the news or in the materials of activist groups or organizations. They produce a reaction.
Who can even imagine 4.2 million dead babies? It is so terrible, and even worse when we know that almost all died from easily preventable diseases. And how can anyone argue that 4.2 million is anything other than a huge number? You might think that nobody would even try to argue that, but you would be wrong. That is exactly why I mentioned this number. Because it is not huge: it is beautifully small.
If we even start to think about how tragic each of these deaths is for the parents who had waited for their newborn to smile, and walk, and play, and instead had to bury their baby, then this number could keep us crying for a long time. But who would be helped by these tears? Instead let’s think clearly about human suffering.
