Low-Hanging Fruit for Better (Global) Health?

This chapter focuses on the “low hanging fruit” of health care available to poor people.  Preventive technologies such as bed nets and chlorine are cheap and readily available yet despite their affordability, demand remains low.  Poor people instead devote considerable resources to “often expensive cures rather than cheap prevention” (51).  Banerjee and Duflo examine how governments, psychology, beliefs and time inconsistency contribute to this underutilization of affordable health care and thus argue that the lack of information is an adequate explanation for poor people not taking advantage of low hanging fruit.

Surveys of poor people suggest they are very concerned about their health but high rates of absenteeism and low motivation hinder preventive care.  More importantly, the authors suggest that the poor do not go to public health centers because “they are not particularly interested in receiving the services they offer” (56).  Rather, they rely on private health care centers and Bengali doctors.  Even when NGOs such as Seva Mandir provided free immunizations, 80% of the children were not fully immunized.  One of the key reasons for this has to do with belief.

In order for poor people to trust prescriptions of doctors they must first trust them.  This is hard to accomplish if doctors are never around or show only passing interest in their patients when they are present.  Faith is also important because people may be reluctant to adopt modern medical technology in place of traditional healing rituals and practices.  However, the coexistence between bhopa diseases and doctor diseases suggests people are willing to use both methods.  Thus while beliefs offer some explanation for the negligence of low hanging fruit, there must be a more significant factor.

Time inconsistency contributes to underutilization of affordable health care because “our natural inclination is to postpone small costs, so that they are borne not by our today but by our tomorrow instead” (65).  People may want to purchase bed nets but may view other purchases as more important and tell themselves they will buy the nets tomorrow.  The authors discuss how “nudges” can remedy this time inconsistency.  Simply informing poor people about low hanging fruit is not enough and it is clear that the notion of doctor diseases is compatible with bhopa diseases.  The main reason people fail to take advantage of affordable health care is because it is something they feel they can delay investing in.

The most startling statistic I found in the chapter was the absentee rate of health workers in government health centers.  Banerjee and Duflo introduce this statistic by discussing the possible reasons for the underuse of affordable health care technologies.  With absentee rates of 35% in places like Bangladesh and Uganda, and 43% in India (56% in Udaipur), it is easy to see how government incompetence can be to blame.  The role of government is to ensure the welfare of its citizens; no wonder poor people prefer Bengali doctors and private clinics.  This statistic reinforces the thesis of the chapter because it shows that much more than simply informing the poor about modern medical practices is needed to improve their health care.  Yet even the disturbingly high absentee rates may not accurately depict the lack of government commitment to health care.  Knowing government expenditures on these health centers would help provide a clearer picture of  the commitment the government has to these health centers.  Given the high rate of absenteeism found by Banerjee and Duflo in Udaipur, these statistics definitely seem reasonable.  One alternative explanation may be that the rate of presence is 65% and 57%, respectively, means that over half the time a health care worker is present at government health centers.  However, this is not exactly resounding argument in support of the current performance of the centers.


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