This is my visualisation of the top 50 countries of the world and life expectancy over the last 218 years.
I’ve used the gapminder data source, but OECD, Worldbank an dothers have similar.
This is my visualisation of the top 50 countries of the world and life expectancy over the last 218 years.
I’ve used the gapminder data source, but OECD, Worldbank an dothers have similar.
This Ray Dalio piece on the problems and solutions for modern capitalism is an important piece of insight. It builds on his work on inequality and populism.
It is important as (1) he is a billionaire with considerable weight and clout
(2) it highlights the problems of both growing the (economic) pie and splitting the pie fairly
(Me: He omits natural/environmental capital in his primary analysis as a weakness)
(3) he observes social democratic/socialism ideas are better at (or at least focused on) pie splitting but free market type ideas have been better at (or at least focused on) pie growing
He pulls this together with a few other observations (amongst others) that
the left and right have never been further apart since the 1930s - they are entrenched and polarised
Technology (and other forces of capitalism) is continuing to disproportionately benefit the “haves”/rich ie owners of capital, automation will continue to displace workers
The US and China are at loggerheads with unknown outcomes
He has strong focus on the education inequality in the US amongst other insightful data (particularly on the bottom 60% and other data on the poor) and some insightful data on food poverty
(The childhood poverty rate in the US is now 17.5% and has not meaningfully improved for decades. In the US in 2017, around 17% of children lived in food-insecure homes where at least one family member was unable to acquire adequate food due to insufficient money or other resources.Unicef reports that the US is worse than average in the percent of children living in a food-insecure household (with the US faring worse than Poland, Greece, and Chile).
He then draws the important insight that it is systems problem:
“Contrary to what populists of the left and populists of the right are saying, these unacceptable outcomes aren’t due to either a) evil rich people doing bad things to poor people or b) lazy poor people and bureaucratic inefficiencies, as much as they are due to how the capitalist system is now working.”
He sketches out some solutions to work on including:
-i Leadership from the top
-ii Bipartisan working groups (ie left and right together)
-iii Co-ordination of fiscal and monetary policy together
-iv Clear metrics for success and accountability
-v Redistribution of resources that will improve both the well-beings and the productivities of the vast majority of people.
And within that a focus on good “double bottom line outcomes”
Ie outcomes that have good economic return and good social return
(for instance education fits that well)
(Again he misses out environment unfortunately, although many double bottom line ideas could be triple bottom line as well)
Create private-public partnerships (including governments, philanthropists, and companies) that would jointly vet and invest in double bottom line projects that would be judged on the basis of their social and economic performance results relative to clear metrics. That would both increase the funding for and the quality of projects because people who have to put their own money on the line would be responsible for them.
Raise money in ways that both improve conditions and improve the economy’s productivity by taking into consideration the all-in costs for the society (e.g., I’d tax pollution and various causes of bad health that have sizable economic costs for the society).
Raise more from the top via taxes that would be engineered to not have disruptive effects on productivity and that would be earmarked to help those in the middle and the bottom primarily in ways that also improve the economy’s overall level of productivity, so that the spending on these programs is largely paid for by the cost savings and income improvements that they create. Having said that, I also believe that the society has to establish minimum standards of healthcare and education that are provided to those who are unable to take care of themselves.
While you can argue about the diagnosis and cause of the problem, the data is insightful, and the solutions are food for thought.
Unfortunately, I am fairly pessimistic about most of those solutions given what I can see about the politics of the UK and US (and others) although some countries may fare better (eg New Zealand which I feel is working on i and iv)
But there are elements of v. I can see working although this may only come through if our leaders can take a longer view and whole-view lens (for instance, increasing educational and social resources in areas of poverty brings long term returns but is short term costly and painful; carbon taxes are hard to fall progressively on society)).
And in theory there’s no reason why i - iv couldn’t happen but it would take a moment or time of social cohesion and cultural change to get there. We don’t have that. But it could happen as I talk about in my performance-lecture Thinking Bigly.
Full Essay by Dalio here:
A blog on his populism work:
UK life expectancy expanded - in line with the OECD average (more or less, there was a little catch up) until recently where (like in a few countries) it seems to be flattening. This is a blunt but well understood measure of a population’s health.
A similar type of trend can be seen in childhood mortality. Although experts can gripe with the data, the overall trend is likely robust. There is also some catch up from OECD average from a poorer start.
This is a good achievement by the UK given what the UK has spent on healthcare since the 1970s.
My general observation here is that the UK has underspend / invested less in healthcare but has managed to obtain an average to above average results.
The under spend as % GDP has been 2 to 4 percent points lower than OECD peers on average. This has been going on since the 1970s. (The World bank data is from 2000, sourced from WHO)
There are many factors that combine to impact life expectnacy and health. Correlation is not causation.
However, I think there is enough data and evidence to suggest that given the amount the UK has invested in health (and social care and education) that if the UK wants to continue the positive trends in health, it will likely have to spend more or at current levels of spend the health out comes will - in my view - likely to continue to tail off.
In this sense, the UK’s NHS has been a unique system that has enabled outsized gains in health outcomes for the amount of spend over the last 50 years.
I can’t make a nice graph widget, but I can show how this % spend on GDP goes back to the 1970s. so this is arguably about 50 years of under spend, at even the lower end of 2% of GDP that’s somewhere in the region of £500bn to £1,000 bn (yes 1 £trillion) in culmulative under spend compared to what would have been spent on the OECD average %.
(Now whether it would have been well spent or what else the UK spent the money on is another debate - maybe the OECD over spent given its outcomes… but given the UK is uniquely low (though Italy is close in some years and has slightly worse outcomes broadly) .
You can see how Germany is approx matching the UK since 1970 on life expectancy and trend (OK it did slowly gain beofre mathcing), but was spending much more of GDP to achieve that.
Major cross-discipline EAT-Lancet Commission on Sustainable Food has published its findings (Jan 2019). I give a summary review. With a fairly broad scientific consensus, the report establishes 3 significant items.
The major items the paper establishes are
A healthy reference diet
This diet is considered to sustainably feed likely world populations from 2050 and beyond, and give a broadly correct amount of nutrition. The paper evidences that there would like be
Health benefits from this diet
In rich nations, this would be from better nutrition helping obesity and cardiovascular disease and the second order benefits of this. And in poorer nations, this would be from decreasing malnutrition.
The diet mainly due to a extremely large pivot away from red meat also establishes
a sustainable agriculture supports this diet
Where the environmental impacts of such a proposed diet are kept within likely carbon budgets and other planetary considerations.
While the report mentions several cultures that eat within the reference diet, in my view, a major weakness is little acknowledgment of the scale of socio-cultural change this diet suggests. To me, a cross-disciplinary socio-anthropologist or cultural philosopher would have made a great addition as a major component of why we eat what we eat is conditioned by social and cultural value.
This healthy reference diet largely consists of:
vegetables, fruits, whole grains, legumes, nuts, and unsaturated oils,
includes a low to moderate amount of seafood and poultry,
includes no or a low quantity of red meat, processed meat, added sugar, refined grains, and starchy vegetables.
Summary values are in table above.
If you look at the carbon impacts of various foods, you can see below that the move to vegetables over red meat is very positive for the environment. This is also because of the second order effects of growing grain to feed beef or other animals, which is environmentally intense both in land use and energy use. (See Fig. 4 below)
The “Business as usual” modelling shows the huge impact from animals on greenhouse gases.
There are strong second order health effects deriving from this as well - many fewer deaths - although I suspect keeping within the energy intake limit and cutting out added sugar and processed foods would achieved a fair amount of this benefit. Cutting out processed foods and added sugar and eating about the correct amount of calories is almost universally favoured in all diets (even low carb, high fat diets as fat is high satiety) Still the economic benefits of lower health costs, and a more productive workforce.
In terms of where we need to get to…There is a long way to go (See below). Rich nations eat too much red meat and potatoes. Parts of Africa are too reliant on low nutritional-value cassava (starchy vegetables).
The overall paper is a fascinating read as it takes in the intersectional nature of food and the environment and health and proposes concrete guidance that enables a growing population. As I mentioned earlier, its weakness is in not weighting the cultural change factors in a strong enough way. For instance, many Americans and Europeans know they eat too much to be healthy but there is a learnt cultural attitude and difficulty in enabling change. Still, at least a good road map has been laid out. In terms of behaviours everyone can play a part in, food waste is important no matter what diet or scenario is chosen (grpah below).
I end on the important summary messages below from the paper:
Unhealthy and unsustainably produced food poses a global risk to people and the planet. More than 820 million people have insufficient food and many more consume an unhealthy diet that contributes to premature death and morbidity. Moreover, global food production is the largest pressure caused by humans on Earth, threatening local ecosystems and the stability of the Earth system.
Current dietary trends, combined with projected population growth to about 10 billion by 2050, will exacerbate risks to people and planet. The global burden of non-communicable diseases is predicted to worsen and the effects of food production on greenhouse-gas emissions, nitrogen and phosphorus pollution, biodiversity loss, and water and land use will reduce the stability of the Earth system.
Transformation to healthy diets from sustainable food systems is necessary to achieve the UN Sustainable Development Goals and the Paris Agreement, and scientific targets for healthy diets and sustainable food production are needed to guide a Great Food Transformation.
Healthy diets have an appropriate caloric intake and consist of a diversity of plant-based foods, low amounts of animal source foods, unsaturated rather than saturated fats, and small amounts of refined grains, highly processed foods, and added sugars.
Transformation to healthy diets by 2050 will require substantial dietary shifts, including a greater than 50% reduction in global consumption of unhealthy foods, such as red meat and sugar, and a greater than 100% increase in consumption of healthy foods, such as nuts, fruits, vegetables, and legumes. However, the changes needed differ greatly by region.
Dietary changes from current diets to healthy diets are likely to substantially benefit human health, averting about 10·8–11·6 million deaths per year, a reduction of 19·0–23·6%.
With food production causing major global environmental risks, sustainable food production needs to operate within the safe operating space for food systems at all scales on Earth. Therefore, sustainable food production for about 10 billion people should use no additional land, safeguard existing biodiversity, reduce consumptive water use and manage water responsibly, substantially reduce nitrogen and phosphorus pollution, produce zero carbon dioxide emissions, and cause no further increase in methane and nitrous oxide emissions.
Transformation to sustainable food production by 2050 will require at least a 75% reduction of yield gaps, global redistribution of nitrogen and phosphorus fertiliser use, recycling of phosphorus, radical improvements in efficiency of fertiliser and water use, rapid implementation of agricultural mitigation options to reduce greenhouse-gas emissions, adoption of land management practices that shift agriculture from a carbon source to sink, and a fundamental shift in production priorities.
The scientific targets for healthy diets from sustainable food systems are intertwined with all UN Sustainable Development Goals. For example, achieving these targets will depend on providing high-quality primary health care that integrates family planning and education on healthy diets. These targets and the Sustainable Development Goals on freshwater, climate, land, oceans, and biodiversity will be achieved through strong commitment to global partnerships and actions.
Achieving healthy diets from sustainable food systems for everyone will require substantial shifts towards healthy dietary patterns, large reductions in food losses and waste, and major improvements in food production practices. This universal goal for all humans is within reach but will require adoption of scientific targets by all sectors to stimulate a range of actions from individuals and organisations working in all sectors and at all scales.
And important strategies identified:
Three lessons can be learned from other examples of societal responses to global changes. First, no single actor or breakthrough is likely to catalyse systems change. Second, science and evidence-gathering are essential for change. Third, a full range of policy levers, from soft to hard, will be needed. ...we outline five specific and implementable strategies, which are supported by a strong evidence base….These strategies are:
(1) Seek international and national commitment to shift towards healthy diets. The scientific targets set by this Commission provide guidance for the necessary shift, which consists of increasing consumption of plant-based foods and substantially reducing consumption of animal source foods. Research has shown that this shift will reduce environmental effects and improve health outcomes. This concerted commitment can be achieved by investment in public health information and sustainability education, and improved coordination between departments of health and environment.
(2) Re-orient agricultural priorities from producing high quantities of food to producing healthy food. Production should focus on a diverse range of nutritious foods from biodiversity-enhancing food production systems rather than increased volume of a few crops, most of which are used for animal production.
(3) Sustainably intensify food production to increase high-quality output. The current global food system is unsustainable and requires an agricultural revolution that is based on sustainable intensification and driven by sustainability and system innovation. This change would entail reducing yield gaps on cropland, radical improvements in the efficiency of fertiliser and water use, recycling phosphorus, redistributing global use of nitrogen and phosphorus, implementing climate mitigation options, including changes in crop and feed management, and enhancing biodiversity within agricultural systems.
(4) Strong and coordinated governance of land and oceans. Such governance includes implementing a zero-expansion policy of new agricultural land into natural ecosystems and species-rich forests, management policies aimed at restoring and re-foresting degraded land, establishing mechanisms of international land-use governance, and adopting a Half Earth strategy for biodiversity conservation to safeguard resilience and productivity in food production. The world's oceans need to be effectively managed to ensure that fisheries do not negatively affect ecosystems, fish stocks are used responsibly, and global aquaculture production is expanded sustainably given its effect on and linkage to both land and ocean ecosystems.
(5) At least halve food losses and waste, in line with global sustainable development goals. Substantially reducing the amount of food lost and wasted across the food supply chain, from production to consumption, is essential for the global food system to stay within its safe operating space. Technological solutions will need to be applied along the food supply chain and public policies implemented to achieve a 50% reduction in food loss and waste.
Link to paper here in Lancet
And a summary on the EAT site.
Blog on living longer through diet: https://www.thendobetter.com/blog/2018/1/6/how-to-live-longer
Two short papers for ESG/IMpact and one for healthcare specialists
Impact funds earn 4.7% lower IRRs compared to traditional VC funds (Barber et al, 2015, update 2018)
“We document that investors derive nonpecuniary utility from investing in dual-objective venture/growth equity funds, thus sacrificing financial returns. In reduced form, impact funds earn 4.7% lower IRRs compared to traditional VC funds. Likewise, random utility/willingness-to-pay (WTP) models of investment choice indicate investors accept 3.4% lower IRRs for impact funds. We rule out alternative interpretations of risk, liquidity, and naiveté. Development organizations, banks, public pensions, Europeans, and UNPRI signatories have high WTP; endowments and private pensions have none. ..”
“…Over the past two years the organizations we work for—the Rise Fund, a $2 billion impact-investing fund managed by TPG Growth, and the Bridgespan Group, a global socialimpact advisory firm—have attempted to bring the rigor of financial performance measurement to the assessment of social and environmental impact. Through trial and error, and in collaboration with experts who have been working for years in the field, the partnership between Rise and Bridgespan has produced a methodology to estimate—before any money is committed—the financial value of the social and environmental good that is likely to result from each dollar invested. Thus social-impact investors, whether corporations or institutions, can evaluate the projected return on an opportunity. We call our new metric the impact multiple of money (IMM)….” Note, TPG are actively promoting their fund - serious investors, but expect them to be arguing this case.
One confounding problem on IRR, returns is that the idea of the risk taken to achieve those returns is difficult to assess - one could argue practially impossible - and thus risk-adjusted comparisons which would better will never be known and thus this question not ever fully answered.
Two Hundred Years of Health and Medical Care: The Importance of Medical Care for Life Expectancy Gains (Catillon, 2018)
H/T Tyler Cowen, is a long reaching look at how medical care has impacted life expectancy (or not) over 200 years of data in the state of Mass, US.
“Using two hundred years of national and Massachusetts data on medical care and health, we examine how central medical care is to life expectancy gains. While common theories about medical care cost growth stress growing demand, our analysis highlights the importance of supply side factors, including the major public investments in research, workforce training and hospital construction that fueled a surge in spending over the 1955-1975 span. There is a stronger case that personal medicine affected health in the second half of the twentieth century than in the preceding 150 years. Finally, we consider whether medical care productivity decreases over time, and find that spending increased faster than life expectancy, although the ratio stabilized in the past two decades. “
Cancer survival rates and cures have enormously improved over the last 40 years. From 5 out of 10, 5 year survival rates to close to 7 out of 10 5 year survival rates (although sadly not for pancreatic).
Much like the Hans Rosling Factfulness book argues, we should acknowledge how much better certain items are despite considerable challenges going forward.
I think there are some hard conversations to be had on the allocation of resources on aspects of innovation, especially towards very end of life care.
This you can sense from Atul Gawande’s book, Mortality (Gawande Mortality blog post ). If someone is facing average survival of 3 to 6 months, and the tail chances of survival of eg. 2 years are extremely low then a balanced conversation is needed.
One parallel to this can be seen in the Biomedical Bubble paper. I have several critiques, which I haven’t the capacity to spell out properly here, but one of the central ideas could be epitomised by the notion of spending $1bn on development a treatment that increases survival, say 6-12 months, and is not a cure vs spending that money on prevention or other system innovations is a mis-allocation of capital. I think that argument has some validity - although the pricing of life and innovation is a tricky area particularly in second order insights and technology from biomedical research (and that plenty of biomedical cost is late stage and undertaken by private companies). Perhaps, that needs more input from philosophers (some of the basis of the UK’s NICE framework of pricing Quality Life Adjusted Years springs from this philosophy work and ideas of distributive justice, as well as the value/costs of road building - see Value of life, under constrained budgets )
Some provoking reads on health innovation in those above/below links.
Blog on Rosling data
Value of life, under constrained budgets - see the work of philosopher Jonathan Wolff on a somewhat accessible look at this.
The current Arts blog, cross-over, the current Investing blog. Cross fertilise, some thoughts on autism. Discover what the last arts/business mingle was all about (sign up for invites to the next event in the list below).
My Op-Ed in the Financial Times (My Financial Times opinion article) about asking long-term questions surrounding sustainability and ESG.
A thought on how to die well and Mortality
How to live a life, well lived. Thoughts from a dying man. On play and playing games.
A provoking read on how to raise a feminist child.
Some popular posts: the commencement address; by NassimTaleb (Black Swan author, risk management philosopher), Neil Gaiman on making wonderful, fabulous, brilliant mistakes; JK Rowling on the benefits of failure. Charlie Munger on always inverting; Sheryl Sandberg on grief, resilience and gratitude.
Buy my play, Yellow Gentlemen, (amazon link) - all profits to charity
“Everything is not fine. We should still be very concerned. As long as there are plane crashes, preventable child deaths, endangered species, climate change deniers, male chauvinists, crazy dictators, toxic waste, journalists in prison, and girls not getting an education because of their gender, as long as any such terrible things exist, we cannot relax. But it is just as ridiculous, and just as stressful, to look away from the progress that has been made.”
These 32 charts suggest the world is better over the last 50 years and that the best time in the world to be born is now.
Source: Hans Rosling’s book Factfulness
Worth a read if interested in the area: my previous blog (including Rosling's quiz) on Rosling’s book.
What’s the length of a patent? 20 years. What’s the social contract behind patents ? Society gives you a time-limited monopoly to incentivise you to invest in R&D and intangibles and enable you to profit at higher levels due to lack of competition.
Drug development takes 8 to 12 years on average, so the average commercial life of a drug based on its first composition of matter patent should run approx 10 years.
Noticeable how many best selling drugs have 20+ years protection. Oft involving long litigation.
One way the pharma industry erodes the social contract is by NOT meaningful innovation and by extending monopolies beyond expectations.
One way it can strengthen trust is by developing life saving medicines and ensuring access.
It’s an active debate what creates more long-term value for shareholders and society.
I’ve written about the history of patents and patent philosophy here.
If you'd like to feel inspired by commencement addresses and life lessons try: Neil Gaiman on making wonderful, fabulous, brilliant mistakes; or Nassim Taleb's commencement address; or JK Rowling on the benefits of failure. Or Charlie Munger on always inverting; Sheryl Sandberg on grief, resilience and gratitude or investor Ray Dalio on Principles.
Cross fertilise. Read about the autistic mind here.
More thoughts: My Financial Times opinion article on the importance of long-term questions to management teams and Environment, Social and Governance capital.