Focussing on diseases

Further to Julian’s article about Giving What We Can, an important part of helping people as much as possible is to find out which charities do the most good for a certain amount of money. This has been in the news recently with this article. It claims that we are missing out on doing a lot of good by focussing exclusively on certain high-profile diseases, while other diseases impose a greater burden and are much cheaper to treat. This raises the question of why some diseases get much more attention and support than others.

There are many possible reasons. One is just simplicity – it is easier to concentrate on educating people about and trying to raise support for one particular disease than many different ones (particularly if they have rather forgettable names such as Schistosomiasis). Collecting together various conditions under the heading ‘Neglected Tropical Diseases’ may be useful from this view point.

A more likely reason for the focus on certain diseases is that those ones are more likely to affect us. TB, for example, is very catching, and so although many developed countries have tried to get rid of it entirely, just one person coming into the country with a bad case of it may infect many people. This is likely to increase the impetus to cure TB in other countries, as well as in one’s own. Even more likely to worry people are diseases which are incurable. This worry spurs people to invest in research into, for example, HIV. Another reason that support for a disease depends on how likely it is to affect us is that often the most ardent supporters of a charity are those who have firsthand experience of how it helps people. If people have known someone with a particular disease, and seen the suffering it caused, they are more likely to support the fight against that disease. Such firsthand experience is not often the case with NTDs. That is partly because people in the developed world very rarely contract them, and partly because they are often cheap and easy to treat. Therefore, people are unlikely to have known someone who suffered with them, and hence to see curing them as a priority.

Another reason why curing NTDs has not been as much of a focus as other diseases may be that they have lower death rates than those other diseases. Most people care about their lives being extended for as long as possible, and therefore care about other people’s claim to the same. In addition, it seems readily clear what is meant by ‘kills x number of people per year’, in a way that ‘infects/affects x number of people per year’ is not. However, a great deal of suffering can be caused without life being significantly shortened. The fact that many people are sympathetic to the idea of euthanasia indicates that they agree that sometimes suffering can be even worse than death. Therefore, just because NTDs are less likely to kill their victims than some other diseases does not necessarily mean that they merit less attention. Although it is difficult to compare the burdens imposed by different diseases, particularly if one wants to include both suffering and possibility of death in the measure, a possible way of doing so does exist in the form of DALYs.

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