people, and to ask them all kinds of questions about their sexual activities. I was interested to
know whether some STDs were more common in some income groups, and so I asked them to
include a question about income on their forms. They looked at me and said, “What? You can’t ask
people about their incomes. That is an extremely private question.” The one place they didn’t want
to put their fingers was in people’s wallets.
Some years later, I met the team at the World Bank who organized the global income surveys
and I asked them to include questions about sexual activity in their survey. I was still wondering
about any relationships between sexual behavior and income levels.
Their reaction was more or
less the same. They were happy to ask people all kinds of questions about their income, the black
market, and so on. But sex? Absolutely not.
It’s strange where people end up drawing their lines and how well behaved they feel if they stay
inside their boxes.
The Ideologues
A big idea can unite people like nothing else and allow us to build the society
of our dreams. Ideology has given us liberal democracy and public health
insurance.
But ideologues can become just as fixated as experts and activists on their
one idea or one solution, with even more harmful outcomes.
The absurd consequences of focusing fanatically on a single idea, like free
markets or equality, instead of on measuring performance and doing what
works are obvious to anyone who spends much time looking at the realities of
life in Cuba and the United States.
Cuba: The Healthiest of the Poor
I spent some time in Cuba in 1993, investigating a devastating epidemic that
was affecting 40,000 people. I had several encounters with President Fidel
Castro himself,
and I met many skilled, highly educated, and dedicated
professionals at the Ministry of Health doing their best within an inflexible
and oppressive system. Having lived and worked in a communist country
(Mozambique), I went to Cuba with great curiosity
but no romantic ideas
whatsoever, and I didn’t develop any while I was there.
I could tell you countless stories of the nonsense I saw in Cuba: the local
moonshine, a toxic fluorescent concoction brewed inside TV tubes using
water, sugar, and babies’ poopy diapers to provide the yeast required for
fermentation; the hotels that hadn’t planned for any guests and so had no
food, a problem we solved by driving to an old people’s home and eating their
leftovers from the standard adult food rations; my Cuban colleague who knew
his children would be expelled from university if he sent a Christmas card to
his cousin in Miami; the fact that I had to explain
my research methods to
Fidel Castro personally to get approval. I will restrain myself and just tell you
why I was there and what I discovered.
In late 1991, the poor farmers in the tobacco-growing province of Pinar del
Río had started to go color blind and then experience neurological problems
with a loss of feeling in the arms and legs. Cuban epidemiologists had
investigated and were now seeking outside help. Since the Soviet Union had
just collapsed, no help could come from that direction, and in searching the
literature for the few researchers in the world with experience of neurological
pandemics among poor farmers, they hit on me. Conchita Huergo, a member
of
the Cuban politburo, met me at the airport, and on my first day Fidel
himself appeared, accompanied by armed guards, to check me over. His black
sneakers squeaked on the cement floor as he circled round me.
I spent three months investigating. I concluded that the poor farmers were
suffering not from a mass poisoning from black market food (as rumor had
it), nor from some germ causing metabolic problems,
but from simple
nutritional deficiency caused by global macroeconomics. The Soviet boats
that had until recently been arriving full of potatoes and leaving full of Cuban
sugar and cigars had not come this year. All food was strictly rationed. The
people had given what little nutritious food they had to the children, the
pregnant, and the old, and the heroic adults had eaten only rice and sugar. I
presented this all as carefully as I could because the clear implication was that
government planning had failed to provide enough food for its people. The
planned economy had failed. I was thanked and sent home.
One year later I was invited back to Havana to give a presentation to the
Ministry of Health on “Health in Cuba in a Global Perspective.” The Cuban
government
had by this point, with the help of the Venezuelan government,
regained the ability to feed the Cuban people.
I showed them Cuba’s special position on my health and wealth bubble
chart. It had a child survival rate as high as that of the United States, on only
one-quarter of the income. The minister of health jumped onstage directly
after I had finished and summarized my message. “We Cubans are the
healthiest
of the poor,” he said. There was a big round of applause and that
turned out to be the end of the session.
However, that was not the message that everyone had taken from my
presentation. As I moved toward the refreshments, a young man gently
grabbed my arm. He softly dragged me
out of the flow of the crowd,
explaining that he worked with health statistics. Then he leaned his head close
to mine and with his mouth close to my ear he courageously whispered, “Your
be pleased with being the healthiest of the poor? Don’t the Cuban people
deserve to be as rich, and as free, as those in other healthy states?
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