A review of Pharmacy on a Bicycle: Innovative Solutions for Global Health and Poverty, by Eric C. Bing and Marc J. Epstein
@@@@ (4 out of 5)
Despite the widespread conviction that the state of the world is deplorable and getting worse by the day, the human race has made measurable, even dramatic progress in some important ways. The collective state of our health is the most telling example. In part because of the eradication of smallpox, the near elimination of polio, and the significant recent progress on HIV/AIDS, humanity in general is living longer and healthier lives. Average life expectancy at birth in India around 1950 was 38 years; today it is 65. In China, it was 41; today it is 77. Over the same period, average life expectancy in the United States has risen from 65 to approximately 80. Numbers can be misleading, but these tell a compelling story.
Building on this amazing success story, major institutions — the United Nations, the U.S. Government, and the Bill and Melinda Gates Foundation, for example — have invested billions of dollars in recent years, targeting specific diseases, promoting the use of vaccines, and building public health infrastructure in developing nations. All these admirable efforts promise to continue the favorable trend in healthcare that has unfolded over the last half-century.
However, there is a hidden dimension in this picture. As Eric Bing and Marc Epstein explain in Pharmacy on a Bicycle, billions of poor people living in rural areas all too frequently fail to gain the benefit of these advances in healthcare. It’s fashionable to look on the world today from the perspective of the cities, but in spite of the massive migration of the last several decades, nearly half (49%) of the world’s population still resides in rural areas. Great numbers of these people live far from transportation hubs, often hours or even days of walking from the nearest road. It’s to these billions of people, nearly all of them desperately poor by American or European standards, that Bing and Epstein turn their attention in their illuminating little book.
Pharmacy on a Bicycle rests on a single, fundamental premise: “Most poor outcomes [in healthcare] are caused not by lack of effective medicines or medical know-how. The ability to prevent and treat many of these diseases inexpensively has been available for a very long time. But getting the right remedies to the right people in the locations where they are needed, in a way they will use them, and at a cost they can afford is continually a challenge. This is not a scientific problem. It’s a business challenge.”
Bing and Epstein argue that humankind has never before been in such a good position to meet this challenge. The costs of many widely-used drugs have fallen dramatically, and scientists have greatly simplified the treatment of many diseases by combining multiple drugs into single capsules or tablets. Extremely cheap diagnostic techniques that provide nearly instant assessments are now available. Through telemedicine, a single well-trained physician can now offer her or his expertise to much larger numbers of patients. The widespread use of clinical checklists and the application of franchising to the healthcare industry have both improved access and lowered costs. And new business models, successfully piloted in many countries, using bicycles, motorcycles, and trained village-level representatives, make it possible for healthcare agencies and for-profit companies to overcome the “last mile problem” that has traditionally limited most of the benefits of the market economy to population centers. “We are now at a tipping point to make lasting global health impacts,” the authors write.
One of the most promising recent developments is the now near-universal access to cell phones; by next year, the number of mobile phones is expected to be greater than the world’s population. “Mobile phones are now being used for patient education and awareness, treatment compliance, health care worker training, data collection, disease and epidemic outbreak tracking, and diagnostic and treatment support.”
Pharmacy on a Bicycle is intended to spark much wider adaptation of these advances by making them more widely known. The book presents a seven-point implementation model called IMPACTS, which encompasses innovation and entrepreneurship, maximizing efficiency and effectiveness, coordinating with partners, accountability, creating demand, task shifting (e.g., empowering nurses to take on some doctors’ responsibilities), and scaling. The book includes an abundance of excellent examples that bring these deadly-sounding prescriptions to life.
Eric Bing is an M.D. who also possesses a Ph.D. in epidemiology and an MBA. He’s the director of global health at the George W. Bush Institute at Southern Methodist University. His co-author, Marc Epstein, is an eminent and much-published professor of management at Rice University in Houston whose previous teaching posts were at the Harvard and Stanford business schools and INSEAD (European Institute of Business Administration).
Books that helped me understand the world
During the last several years — mostly after I bought my first Kindle — I’ve spent a great deal of time reading, roughly half of it fiction, the other half non. I’ve gotten through hundreds of books and have reviewed the last 200 or so in this blog. It feels like a good time to cast a backwards look and identify those books that remain vivid in my memory — books that helped me understand the way the world works. Though most of the fiction I’ve read has been simply enjoyable, a few have touched me. None, though, have really nestled deep into memory and changed the way I view life and the world. I learn mostly from nonfiction. Whatever that says about my character — so be it.
Here, then, are the 20 nonfiction books that have impressed me the most in recent years. They’re arranged in alphabetical order by the authors’ last names. Those I’ve reviewed are boldfaced and linked.
Alexander, Michelle, The New Jim Crow. A shocking survey of the consequences of America’s so-called War on Drugs and the racism in our justice system
Banerjee, Abhijit, and Esther Duflo, Poor Economics: A Radical Rethinking of the Way to Fight Global Poverty. A rigorous and balanced view of both top-down and bottoms-up development policies in the light of field research
Clark, Gregory, A Farewell to Alms: A Brief Economic History of the World. History as I like it: painted in broad swaths across the millennia, rejecting the myth that the “West” was destined to rule the world
Diamond, Jared, Guns, Germs, and Steel: The Fates of Human Societies. A brilliantly original view of world history from a geographer’s perspective, ascribing variable levels of development primarily to environmental and geographical factors
Easterly, William, The White Man’s Burden: Why the West’s Efforts to Aid the Rest Have Done So Much Ill and So Little Good. The case against foreign aid and top-down development, by a former World Bank economist
Elkington, John, and Pamela Hartigan, The Power of Unreasonable People: How Social Entrepreneurs Create Markets That Change the World. The liveliest and most insightful of several books on social entrepreneurs
Gladwell, Malcolm, The Tipping Point: How Little Things Can Make a Big Difference. The seminal book on understanding “six degrees of separation” and the way networks work
Harden, Blaine, Escape from Camp 14: One Man’s Remarkable Odyssey from North Korea to Freedom in the West. A riveting tale of the North Korean gulag, spotlighting the reality of repression in the Kim family’s private kingdom
Hochschild, Adam, King Leopold’s Ghost: A Story of Greed, Terror, and Heroism in Colonial Africa. One of the most troubling books I’ve ever read about the legacy of colonialism: the harrowing story of how the Belgian King destroyed the Congo and murdered millions of its people
Johnson, Chalmers, Blowback: The Costs and Consequences of American Empire. A scholar and former U.S. official demonstrates how the U.S. dominates the world through hundreds of military bases, undermining our nation’s reputation and robbing our society of the means to address pressing social problems
Larson, Erik, In the Garden of Beasts: Love, Terror, and an American Family in Hitler’s Berlin. An eye-opening account of U.S. official anti-Semitism in FDR’s Administration that shackled our Ambassador in Berlin who witnessed the outrageous acts unfolding in Nazi Germany
Mann, Charles C., 1491: New Revelations of the Americas Before Columbus. A revisionist view of Native American society in both North and South America, offering proof of huge populations and sophisticated civilizations in the present-day U.S. and in the Amazon Basin
Miller, Brian, and Mike Lapham, The Self-Made Myth: And the Truth about How Government Helps Individuals and Businesses Succeed. A clear-eyed look beyond the bounds of Right-Wing ideology at the immeasurable benefits and services every “self-made man” has received from U.S. society
Mukherjee, Siddhartha, The Emperor of All Maladies. An oncologist’s brilliant history of cancer and of the medical profession’s slowly developing success in treating it
Polak, Paul, Out of Poverty: What Works When Traditional Approaches Fail. How a former psychiatrist, laboring face-to-face with $1-a-day farmers in some of the world’s poorest countries, helped 17 million families escape from poverty
Priest, Dana, and William M. Arkin, Top Secret America: The Rise of the New American Security State. A Pulitzer-Award-winning Washington Post reporter and her researcher rip the cover from the enormous intelligence establishment built after 9-11
Skloot, Rebecca, The Immortal Life of Henrietta Lacks. A science reporter’s captivating ten-year search to understand the consequences of a medical crime committed in an overtly racist era before the rise of medical ethics
Ward, Vicky, The Devil’s Casino: Friendship, Betrayal, and the High Stakes Games Played Inside Lehman Brothers. The most intimate and candid account of how Wall Street played the central role in launching the Great Recession
Wrong, Michela, It’s Our Turn to Eat: The Story of a Kenyan Whistle-Blower. A vivid account by a Financial Times reporter of how corruption holds sway even in one of Africa’s most developed economies
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Tagged as abhijit banerjee, Adam Hochschild, Africa, books, business, Chalmers Johnson, CIA, current-events, Dana Priest, Erik Larson, espionage, esther duflo, foreign aid, History, Jared Diamond, John Elkington, national security, Nazi Germany, Nonfiction, nonfiction books, Paul Polak, politics, poverty, Rebecca Skloot, science, social enterprise, Wall Street, William Easterly