“Pound of Cure” Politics

Who hasn’t heard this one: An ounce of prevention is worth a pound of cure. The old adage presents a truism well relevant to the world of international aid. Ebola comes quickly to mind as the latest in a long list of lessons not learned. To wit, at what point – March? May? – would a fairly modest ten million or so have staved off the need for the $1.3B intervention that has been launched to date?

But the proverbial equation generates a false comparison. The “pound of cure” logic dissimulates. That tail of the proverb represents the cost of an intervention at a later stage – the bill for the fix (i.e., action after the problem has materialized). The mistake is to confuse the cost of the fix with the value of the damage. Pound of cure thinking hides ten, twenty or maybe thousands of pounds of loss – 11,000 orphans, schools shuttered, crops unsown or harvests unharvested, businesses bankrupted, national economic growth about-faced. And over 9600 people who are no longer people.

Let’s not be too hard on the proverb. Let’s be hard on ourselves. In the deeply politicized world of international aid and emergency response, the availability of the proverbial ounce of prevention turns out to be part mirage, hence a solid track record of paying for pounds of cure. This study of the 2011 famine in Somalia seems clear enough: Famine early warning systems clearly identified the risk of famine in South Central Somalia in 2010–2011 but timely action to prevent the onset of famine was not taken.

It too often proves more difficult from a political perspective to prevent a problem from arising than to deal later with the consequences of the problem itself. That is because mobilizing preventative action often proves trickier than launching a curative response. Humans seem hardwired to contend with the urgent at the expense of the important. In proverbial terms, that is also because frogs don’t hop out of water brought slowly to boil. And because screeching wheels get the grease before those that merely squeak. Tired yet? How about this? In the aid world, few will pay the early bird to catch the worm.

Enough of the proverbs. Let’s try fairytales. Is it even fair to balance a pound of cure against one sole ounce of prevention? What does the story of the Boy who cried “Wolf!” tell us? If not a boy, then what about the Western NGO? We belong to a business that depends on the production of a veritable smorgasbord of impending disasters; of persistent, strident calls for action (read: squeaky wheels in search of grease). That makes for a fast drip of public alarm, elbow-steered lobbying, and celebrity-endorsed impending doom. Act now! (Or: Send cash!). How many cures – how many actual crises – have actually been averted? Perhaps this is not just a tale of a Boy. Perhaps this is also the work of Chicken Little.

If we flip this around: the emergency aid business is of necessity an industry of alarm. Is there today a cacophony of alarm and media hype that deadens the ear? Have we reached the point where it is actually more efficient and more financially prudent for key donor governments and international institutions to wait and pay for the cure?

And what about the lessons of those fairytales? Cries of “Wolf!” or “The sky is falling” became quite pertinent in the Ebola crisis, where MSF’s early alarm was derided or dismissed in some quarters as yet another NGO fundraising ploy. The NGO cried out that Ebola was real and nobody listened. Real it was. A ton of cure that could have been averted by an ounce of prevention? Seems so. And maybe also a ton of cure that was necessitated by the perception of too many false ounces?

 

2 thoughts on ““Pound of Cure” Politics”

  1. Great post, as always – I agree that in the case of many humanitarian crises that the wording might be changed from “pound” to “tons” of cure. However, I’m not sure the analogy of crying “Wolf!” is fully accurate when describing MSF’s plea for attention to the impending Ebola crisis earlier in 2014, as MSF has a better foundation of public funding than does most other Western NGOs. There are certainly other NGOs for whom that description would be accurate and are perceived to exaggerate for their own fundraising purposes. From speaking with institutional donor reps, I get the sense that folks were hoping the established early warning systems that were in place would function as designed and were waiting for WHO to make a timely declaration. Folks clearly weren’t focused on the right “canary in the mineshaft”. I think there would be a great deal of value in sitting with key decision-makers to analyze the information that was being shared at the time in order to improve (or change) the early warning system as it exists now, perhaps allowing for information from a variety of sources to be reviewed by a wider range of humanitarian professionals – I’m not sure, and welcome your thoughts on this. Same thing with the Horn of Africa famine – I’m not sure the traditional IPC scale/triggers are the best way to predict the shift toward famine conditions. My livelihoods colleagues have been trying to suggest a more nuanced way of measuring this, but have not been able to make much headway with the gatekeepers of the established system.

    1. Hi Linda. Thx for the comment. I didn’t mean that MSF was the boy who cried wolf. But ebola deniers were able to use the narrative — to convince people in power that MSF was just trying to get attention because that’s what NGOs do. Unfortunately, when some cry wolf, all the shepherd boys lose cred.
      Building a better canary seems highly sensible, given tech advances. But not sure if the canary is the bigger problems. Will they also create political change?

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