On prevention

The New York Times had an article on Sunday on the old theme, "earthquakes don't kill people; falling buildings kill people." This saying is somewhat less applicable to the horrible tsunami disaster last week, because really, huge ocean waves actually do kill people, but it's still true that things like better house construction, public health infrastructure, etc. really can prevent a lot of the damage that natural disasters cause, and could have saved a lot of lives last week (and in the coming weeks as the threat of infectious disease among the survivors looms large). I saw a picture in the Times today of a village in Aceh, where the entire village was gone except for a single mosque that was made of concrete. Would people have been safer if the whole village was made of concrete? (Maybe; maybe not...)

This is a theme that keeps cropping up. I remember after the floods in Haiti this past summer, people lamented that Haiti's poverty meant that the temptation would be to rebuild in a way that the next inevitable disaster would also be deadly: reconstruction on the cheap leaves residents in flimsy shacks that are okay as temporary makeshifts, but no good once the disaster aid money dries up and residents are still stuck in flimsy shacks. Same thing after the earthqauke in Bam about a year ago. (I get the sense that the sudden inflows and outflows of money are actually destructive, in some ways worse than doing nothing at all, kind of like yo-yo dieting.) And on a more global scale, the temptation is always to provide money for HIV/AIDS treatment, but not prevention, when in fact the cost-effectiveness of prevention in terms of lives saved is on the order of 25 times better than the cost-effectiveness of treatment. Of course, the point isn't to replace post-disaster aid with pre-disaster prevention, but to add prevention to emergency aid (with the expectation that in the future, less emergency aid would be necessary).

There is a psychological barrier, of course, to prevention: you'll never know if it worked. People feel the pressure to donate money after the emergency, but not to invest money in infrastructure that would prevent or mitigate future emergencies. I was struck by the following absurd statistic from the New York Times article:

Mozambique, anticipating major flooding in 2002, asked for $2.7 million to make basic emergency preparations. It received only half that amount from international donor organizations. After the flood, those same organizations ended up committing $550 million in emergency assistance, rehabilitation and reconstruction financing.

This is a real problem, perhaps too deeply rooted in human psychology to get around. Perhaps all we can do is to try to remember to continue giving money even after the immediate emergency has passed (both by giving money privately and by pressuring our governments to give more money). World poverty requires sustained aid and policy commitments, not passing waves of sympathy.