Wednesday, November 29, 2006

marginal dollar

It's rare that such an intense admiration for a writer and such a spittle-inducing frustration with her words coexist in my soft & misshapen head. I know it's just an honest and human yowl, and mostly a frustrated blog post about Iraq.* Plus, everybody wants to give the pious a good cockpunch. But come on. There's plenty of low-hanging fruit for you do-gooders, and none of it involves marching.

This is true even if you're fucking stupid, breathtakingly lazy, and possessed of only the wherewithal to plop your gym-toned asses on your Brno chairs and give money. I'd like to create a site called "Marginal Dollar." It would employ a small team of smartypants economists & epidemiologists & such to identify a weekly Worthy Recipient of one's donations. The choice would be as scientific as possible but ultimately one of arbitrary taste. Usually small programs but not necessarily. Click to donate. Leave the thinkin' to others, who will be wrong much of the time but right some of the time. At the moment, it's hard to go wrong giving money to "orphan disease" mitigation programs like those for childhood helminth infections, expansion of DOTS TB control programs, &c.

I know it may sound like I've sipped the Public Health Kool-Aid. But it's hard to ignore that self-righteous pricks like Jeffrey Sachs are right (in overall message, even if you argue with the details): international health is grossly, obscenely underfunded. Though we may rightly gnash our teeth about Iraq, malnutrition and disease are the biggest evils in the world. That is staggeringly obvious. And it's not only recalcitrant and/or malevolent geopolitical forces that dictate outcomes. A huge part of it is simply money.

It is incredibly pathetic that Bill Gates has revolutionized the scope of public health research through his donations. To repeat myself, it is incredibly pathetic that the payroll of the AL East is half the annual budget for the WHO. It is incredibly pathetic that the CGIAR network loses core funding from country donors every year. It is incredibly pathetic that two days of US military spending in Iraq would be sufficient to meet the annual spending goals set to wipe out TB & thus save 2 million lives a year. The only silver lining is that marginal dollars count. Marginal dollars that you can give, and that might actually do something useful besides making Sally Struthers stop weeping.

Look, I oversimplify, and I am not arguing that we should remove attention from Iraq. But what little I've said is true. Give me that. And give me your money so I can buy some small-batch bourbon instead of this rail "whiskey," which I'm pretty sure is just ethanol.

*State-sponsored violence, and violence in general, arouses more outrage than state-condoned passivity in the face of massive human suffering. Easier to let a man get hit by a train than to push him in front of it. Maybe this makes ethical sense. I dunno.