What I learned while sick
Last week was the rare week I did not send a newsletter. That is because I was crippled with sickness. I woke up early Monday morning not feeling well, and by the time my kids woke up I was painting my bathroom with vomit. Since I was afraid I would throw up anything I ate, my diet consisted of a little bit of water and 6 Pringles chips. That evening, my two sons started vomiting too, lasting until about 3:30 in the morning.
While it was hard for me to think of anything that day, one thought did come to mind: the economics of health.
I'm not talking about the economics of health care. That would mean I was thinking about access to medication or physicians. I mean I was thinking about how our health affects our choices and productivity.
Obviously, on that day, my illness reduced my productivity. I spent my day on the couch, either sleeping or reading Brandon Sanderson's Rhythm of War. There were two moments I managed to pull myself out of my stupor to complete some essential tasks, but that total work time was less than an hour. It is not surprising that sickness reduces our productivity.
What did surprise me was how cognitively demanding the sickness was. I would have thought the main shock to productivity was the hit to energy levels. I was so lethargic that I couldn't bring myself to do much besides lie on the couch. But there were many moments when the only thing I could think about was my sickness. Some of this was conscious, like replaying my vomiting in the bathroom. But most of this was unconscious. When you're sick, your mind is constantly running diagnostics in the background. "Was that feeling in my stomach normal, or is that a sign I'm going to throw up again?"
This cognitive load is similar to the cognitive load that many people in poverty experience. Like sickness, poverty requires you to run mental background processes that assess your risks. There's an interesting study that shows how poverty depletes your scarce mental functions. Some economists went to Indian farmers right before the harvest, when the people were exhausting their savings from the previous harvest, and gave them an IQ test. Weeks later, after the harvest had replenished their income, they gave them another IQ test. Farmers performed significantly better after the harvest than they had before, leading the economists to argue that poverty, like sickness, uses up cognitive resources (to hear more about the studies and see examples of the IQ tests, you can watch the video I did last year on this study).
When poverty and sickness occupy your mental functions, it makes you less productive. This is a really important finding because productivity accounts for about 70% of the differences between rich and poor countries. By definition, poor countries have more people in poverty, and by consequence poor countries have more people in poor health. Poverty and health could be poverty traps. People with poor health become less productive, leading to poverty, and because they are poor they are unable to properly care for themselves or are in situations that expose them to greater health risks. Thus, they get sick again, trapping them in the cycle.
If we believe poverty traps exist (here's a video showing evidence for one, but note that it is not health related), then the key is a big push policy. You have to create an intervention that pushes people out of the trap and onto a self-sustaining path. For health, this means you need a policy that cures them of the chronic sickness and keeps them healthy long enough to support themselves. An example of such a push is deworming. Evidence from multiple countries showed that when you remove intestinal worms from kids, they attend school more. The mechanism is similar: if kids can actually focus in school, they stay longer. And since deworming is a cheap intervention (less than 25 cents per child per year), this is an example of a clear development policy win.
Now I have to confess something. The title of this essay is a lie. These insights did not come while I was sick. Yes, these insights came because I was sick, but it's only because I'm better that I am able to synthesize them and share them with you.