If the infant is saved from diarrhea and dies 20 years later in a genocide, I’d say that is good for the infant. Perhaps one should be careful about calling that 20 DALYs, rather than one life. Of course, increased population may make war more likely. If one is a total utilitarian, the repugnant conclusion seems to me like a slam-dunk here. If one is an average utilitarian, this looks at first like a poor trade (let’s average just over a country, not the world).
Treating diarrhea probably has the effect of reducing not just mortality, but morbidity. When we saved the infant, we treated 100 other infants who would have lived. But now they’ll have healthier lives, probably happier and more productive. I think that should satisfy the average utilitarian. They’ll be more productive if all things are equal, but the increased expectation of catastrophe—famine or war—decreases perceived life-expectancy, and thus productivity. War is worse than famine in that it destroys property as well as people. I’m not sure where the balance lies, but I think productivity is improved by choosing war over diarrhea.
Productivity is important because it seems linked to demographic transition. Maybe malthusian concerns say that the best interventions are those which are best connected demographic transition, like girls’ education. But as to the question of whether curing diarrhea is a net benefit, I think it quite likely.
Amartya Sen is quite enthusiastic in choosing acute famine over chronic malnutrition (and China over India more generally). Disease is quite like chronic malnutrition in its effects on health and productivity. The more serious malthusian complaint is if we end up with chronic malnutrition. If we’re trading disease for chronic malnutrition, I don’t think we’re making things worse, though it may not be worth the bother. Solving acute famines to leave chronic ones is probably making things worse.
If the infant is saved from diarrhea and dies 20 years later in a genocide, I’d say that is good for the infant. Perhaps one should be careful about calling that 20 DALYs, rather than one life. Of course, increased population may make war more likely. If one is a total utilitarian, the repugnant conclusion seems to me like a slam-dunk here. If one is an average utilitarian, this looks at first like a poor trade (let’s average just over a country, not the world).
Treating diarrhea probably has the effect of reducing not just mortality, but morbidity. When we saved the infant, we treated 100 other infants who would have lived. But now they’ll have healthier lives, probably happier and more productive. I think that should satisfy the average utilitarian. They’ll be more productive if all things are equal, but the increased expectation of catastrophe—famine or war—decreases perceived life-expectancy, and thus productivity. War is worse than famine in that it destroys property as well as people. I’m not sure where the balance lies, but I think productivity is improved by choosing war over diarrhea.
Productivity is important because it seems linked to demographic transition. Maybe malthusian concerns say that the best interventions are those which are best connected demographic transition, like girls’ education. But as to the question of whether curing diarrhea is a net benefit, I think it quite likely.
Amartya Sen is quite enthusiastic in choosing acute famine over chronic malnutrition (and China over India more generally). Disease is quite like chronic malnutrition in its effects on health and productivity. The more serious malthusian complaint is if we end up with chronic malnutrition. If we’re trading disease for chronic malnutrition, I don’t think we’re making things worse, though it may not be worth the bother. Solving acute famines to leave chronic ones is probably making things worse.