Heroes Not Zombies

 Now, here’s an interesting study. It’ll soon be published in the November issue of the American Journal of Public Health. There’s a way of considering the amount of health benefit from an intervention. It’s to assess the number quality-adjusted life-year gains per dollar invested. That is, not just benefits in terms of greater life expectancy, but also a measure of quality of life in those years. It’s a cost benefit analysis so the economic payoff is measured by assessing how much the intervention costs so you can work out how much it would cost to get the benefit of the better, longer lives. These researchers claim to have found an intervention which brings greater payoffs in these terms than most other interventions. What amazing new drug is this? Or is it a life-style change?

Nope.

You’re going to be surprised.  It’s reducing class sizes at school!

The class size reduction was from 22 – 25 kids per class, down to 13 – 17. From kindergarten through to Grade 3. The better education, produced better educational outcomes leading to better, less hazardous jobs and the ability to move out of poorer housing etc. I won’t bother you with the details of the figures here (you can follow the link and read more yourself if you like). But what I think makes this study especially fascinating is thinking out of the box.

These days we hear endless claims for technological fixes – from wonder drugs, to vaccines, to new claims for possible genetic engineering. But, historically, the greatest improvements in the health of populations do not come from medical interventions, they come from things like improving water supplies, sanitation, reducing overcrowding and so on. There’s been an enormous movement towards looking at smaller and smaller parts over the last couple of hundred years – reductionism. In the future we’ll see the greatest health gains by focusing holistically, considering the environments and contexts in which individuals are embedded and studying what happens within these systems instead of exclusively studying what happens at molecular levels.