Immunization, Inequality, and Invisible Paternalism: Connecting the Dots

QOTD: “Aren’t we, those who live in the rich world, the constant beneficiaries of paternalism now so thoroughly embedded into the system that we hardly notice it?”

Yesterday we ended with the idea that incentives aren’t the most effective in increasing immunization rates, which is why the full immunization rate does not go beyond 38%. What’s most important is getting people to complete it. 

An easy way to explain why a small cost discourages the use of a life-saving device is because our natural inclination is to postpone small costs. “It makes sense, from today’s perspective, to wait for tomorrow. Unfortunately, when tomorrow becomes today, the same logic applies.”

This also explains why small incentives encourage the usage of a life-saving device, and that even though they can push individuals to take some action they deem desirable, they may postpone taking the action. 

Time inconsistency is what prevents our going from intention to action. However, for the case of immunization, for people to continuously postpone getting their children immunized, they would need to be constantly fooled by themselves as well. The book suggests that the reason the poor procrastinate is because they aren’t fully convinced that immunization is as wonderful as WHO believes it to be, so they can’t find a way to overcome the procrastination. Therefore, procrastination and the underestimation of beliefs influence each other. 

Wrapping up what we’ve explored over the past few days, the poor seem to be trapped by the same kinds of problems: lack of information, weak beliefs, and procrastination. Compared to the poor, we view the many things that we take as given.

Our primary goal of health-care policy in poor countries should be to make it as easy and convenient as possible for the poor to obtain preventive, quality care. And we can start by getting them the “natural default option,” which is to deliver the services for free or distribute rewards. For example, we should put free Chlorin dispensers next to water sources, reward parents for immunizing their children, give children free nutritional supplements at school, etc.

Our challenge is to make sure that people can afford the medicines they need, while also having limited access to the medicines they don’t need. The only way to control the overuse of high-potency drugs is to control the sale of those drugs. 

Back to the QOTD — privilege is unnoticed by those who have it. The mechanisms of invisible paternalism outline how the wealthy world benefits from systemic structures that perpetuate inequality. We tend to normalize cheap clothes, electronics and food as just “how things are” — we don’t see the labor behind them. 

We are officially done with our blogs on health — next time, we will shift to education!