Why we should downplay anecdotal evidence by looking at scientific data that gives a broader picture
So last week the cancer machine at Mulago Hospital collapsed, causing uproar in mainstream and social media. Every newspaper columnist or television/radio pundit of any heft weighed in. Daily Monitor devoted its whole Thursday opinions page on this subject. Pundits outdid each other in over-stating how this is a sign that the entire health sector “has fallen apart”. Yet cancer is not a major killer, not even among the top 20 killer diseases. So why all this self-righteous indignation?
I think it is because cancer is a disease the elite pay attention to – because it can kill them. So the outrage is not about the ordinary masses but the interests of those that control weapons of mass propaganda.
The eight most common killer diseases in our country in order of their killing rate are maternal mortality, malaria, tuberculosis, pneumonia, kids dying during child birth, injuries due to motor accidents, cardiovascular diseases, and HIV/AIDS. How often does the punditry address them? Hardly!
The thing I admire about Ugandan elites is our self-indulgence. We write in holierthan-thou tones, appealing to public emotions domestically and perhaps for recognition among the donor elite. We denounce those who have “failed the public trust” insinuating that if we were in their positions things would do better. Our audiences applaud us in silent (sometimes loud) admiration. This is the political point-scoring and public grand-standing we hypocritically indulge in to deceive ourselves that we care more about “the common man” than those who are elected to serve him.
Our health sector is not managed by people from England or Chad but by our alumni, friends, relatives, relatives of friends, neighbours, in-laws etc. They are not mean, cruel and heartless people out to destroy the country and harm its citizens. Besides the people who die are their friends, family and fellow citizens. It is true some are corrupt, others negligent and many incompetent and this causes myriad dysfunctions in our public health sector. But equally many public servants try to do a good job.
Secondly, Uganda is governed largely by elected public officials. Our citizens have a very high anti-incumbency bias – over 65% of incumbent MPs including ministers and powerful opposition figures – are not returned in every election. This is the opposite of countries like USA where only about 10% of incumbent congressmen and women lose their seats in an election. Hence we cannot say our country is saddled with entrenched politicians who are resisting reform.
So what have been the implications of elections on health policy? There has been a massive shift of focus from high-value elite based clinical medical treatment (like for cancer) to low-value mass-based preventive health and clinical medicine strategies. This has gone unnoticed by our elites because it addresses the needs of the common man. Democratically elected politicians can be corrupt and selfish but at least their bread is buttered by voters. So they cannot ignore the majority interest.