The good news of the decade? - Hans Rosling

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We are here today because United Nations have defined goals for the progress of countries. They're called Millennium Development Goals, and the reason I really like these goals is that there are eight of them. By specifying eight different goals, the United Nations have said that there are so many things needed to change in a country in order to get a good life for people.

Look here, you have to end poverty, education, gender, child and maternal health, control infections, protect the environment, and get the good global links between nations in every aspect from aid to trade.

There's a second reason I like these Development Goals, and that is because each and every one is measured. Take child mortality; the aim here is to reduce child mortality by two thirds from 1990 to 2050. That's a 4% reduction per year, and this with measuring. That's what makes the difference between political talking like this and really going for the important thing: a better life for people.

What I'm so happy about with this is that we have already documented that there are many countries in Asia, in the Middle East, in Latin America, and Eastern Europe that are reducing with this rate. Even my T Brazil is going down with 5% per year, and Turkey with 7% per year. So there's good news.

But then I hear people saying there is no progress in Africa, and there's not even statistics in Africa to know what is happening. I'll prove them wrong on both points. Come with me to the wonderful world of statistics.

I bring you to the webpage child mortality dot or, you know where you can bag deaths in children below five years of age for all countries. It's done by UN specialists, you know. And I will take Kenya as an example. Here you see the data. Don't panic now; don't panic, you know. I'll help you through this. It looks, you know, nasty like in college when you did statistics, man.

But first thing, when you see dots like this, you have to ask yourself: from where do the data come? What is the origin of the data? Is it so that in Kenya there are doctors and other specialists who write the death certificates at the death of a child, and it's sent to the Statistical Office? No, low-income countries like Kenya still don't have that level of organization.

It exists, but it's not complete because so many deaths occur in the home with the family, and it's not registered. So what we rely on is not an incomplete system. We have interviews; we have surveys. In this, it is highly professional female interviewers who sit down for one hour with a woman and ask about birth history: how many children did you have, are they alive, if they died at what age and what year?

And then this is done in a representative sample of thousands of women in the country and put together in what used to be called a demographic Health Survey report. But these surveys are costly, so they can only be done with three to five years interval, but they have good quality. So this is a limitation.

All these colored lines here are results; each color is one survey. But that's too complicated for today, so I'll simplify for you and I give you one average point for each survey. This was 1977, 1988, 1992, 97, and 2002. And when the experts in the UN have got these surveys in place in their database, then they use advanced mathematical formulas to produce a trend line.

The trend line looks like this. See, here is the best fit they can get of this point. But watch out! They continue the line beyond the last point, out into nothing, and they estimated that in 2008 Kenya had a child mortality of 128. And I was sad because we could see this reversal in Kenya with an increased child mortality in the 90s. It was so tragic.

But in June, I got the mail in my inbox from the demographic Health Survey, and it showed good news from Kenya. I was so happy! This was the estimate of the new survey. Then it just took another three months for you and to get it into their server, and on Friday we got the new trend line. It was down here, isn't it nice? Isn't it nice?

Yeah, I was actually on Friday sitting in front of my computer, and I saw that the death rate fell from 128 to 84! Yes, that morning, you know, so we celebrated.

But now, when you have this trend line, how do we measure progress? I'm going into some details here because UN does it like this: they start 1992, they measure to 2009, they say 0.9% no progress. That's unfair. As a professor, I think I have the right to propose something differently.

I would say at least do this; ten years is enough to follow the trend. It's two surveys and you can see what's happening. Now they have 2.4 percent. Had I been in the Ministry of Health in Kenya, I may have joined these two points.

What I'm telling you is that we know the child mortality; we have a decent trend. It’s coming into some tricky things then when we are measuring MDGs. The reason here for Africa is especially important because the 90s was a bad decade, not only in Kenya but across Africa. The HIV epidemic peaked; that was resistant to the old malaria drugs until we got the new drugs.

We got late to the mosquito netting, and there were socio-economic problems which are now being solved at a much better scale. So, look at the average here; this is the average for all of sub-Saharan Africa, and UN says it's a reduction of 1.8 percent.

Now this sounds a little theoretical, but it's not so theoretically, you know. These economists, they love money; they want more and more of it. They want it to grow. So they calculate the percent annual growth rate of economy.

We in public health, we hate child death, so we want less and less and less of child deaths. So we calculate the percent reduction per year. But it's sort of the same percentage. If your economy grows with 4%, you ought to reduce child mortality by 4% if it's used well, and people are really involved and can get the use of the resources in the way they want.

So, is this fair now to measure this over 19 years? Economists would never do that. I have just divided it into two periods. In the 90s, only 1.2 percent; only 1.2 percent. Whereas now, the second gear is like Africa had first gear; now they go into second gear.

But even this is not a fair representation of Africa because it's an average; it's an average speed of reduction in Africa. Look here, when I take you into my bubble graphs, still here: child F per 1000 on that axis. Here we have year, and I'm now giving you a wider picture than the MDG. I start 50 years ago when Africa celebrated independence in most countries.

I give you Congo, which was high, Ghana lower, and Kenya even lower. And what has happened over the years since then? Here we go. You can see with independence literacy improved, you know, and vaccinations started. Smallpox was eradicated, hygiene was improved, and things got better.

But then, in the eighties, watch out! Here Congo got into a civil war, and they leveled off. Fear Ghana got very help fast; this was the backlash in Kenya, and go on a bypass. But then Kenyan going down together still the standstill in Congo—that's why we are today.

You can see it doesn't make sense to make an average of this series improvement and this very fast improvement. The time has come to stop thinking about sub-Saharan Africa as one place; their countries are so different, and they need to be recognized.

In the same way we don't talk about Europe as one place. I can tell you that the economy in Greece and Sweden are very different; everyone knows that. And they are judged, each country on how they are doing, you know.

So, let me show why the picture. My country, Sweden, 1800, we were up there. What the strange personality disorder we must have counting the children so meticulously in spite of a high child death rate? It's very strange; it's sort of embarrassing.

But we had that habit in Sweden, you know, that we counted all the child deaths even if we didn't do anything about it. Then you see these are famine years; these were bad years, and people got fed up with freedom. My ancestors moved to the United States, you know.

Eventually, soon they started to get better and better here. Here we got better education, and we got health service, and child mortality came down. Though we never had a war, Sweden was in peace all this time.

But look, the rate of lowering in Sweden was not fast. Sweden achieved a low child mortality because we started early. We had primary school actually starting 1842, and then you get that wonderful effect. When we got female literacy one generation later, you have to realize that the investments we do in progress for long term investments is not about just five years; it's long term investments.

And Sweden never reached Millennium Development Goal rate of 3.1 percent when I calculate, so we are off track. That was Sweden, but you don't talk about it so much. You know, we want others to be better than we were, and indeed others have been better.

Let me show you Thailand. See what a success story in Thailand from the 1960s, how they went down here and reached almost the same child mortality levels of Sweden.

I'll give you another story: Egypt, the most hidden glorious success in public health. Egypt was up here in 1960, higher than Congo. The Nile Delta was a misery for children with diarrheal disease, you know, and malaria, and a lot of problems.

Then they got the Aswan Dam; they got electricity in the homes, the increased education, and they got primary health care, and down they went. You know, and they got safer water; they eradicated malaria. Isn't it a success story?

Millennium Development Goal rates for child mortality are fully possible. The good thing is that Ghana today is going with the same rate as Egypt did; it's fastest, you know. Kenya is now speeding up.

Here we have a problem: we have a severe problem in countries which are at a standstill. Now, let me bring you to a wider picture, a wider picture of child mortality.

I'm going to show you the relation between child mortality on this axis here. This here is child mortality, and here I have the family size—the relation between child mortality and family size. One, two, three, four children per woman; six, seven, eight children per woman.

This is once again 1960, 50 years ago—each bubble is a country. The color you can see is the continent; the dark blue here is sub-Saharan Africa, you know, and the size of the bubble is the population.

These are the so-called developing countries. They had high or very high child mortality and family sizes of six to eight. The ones over there were the so-called Western countries; they had low child mortality and small families.

What has happened? What I want you now is to see with your own eyes the relation between falling child mortality and decrease in family size. I just want not to have any ruby—you have to see that for yourself.

This is what happened. Now I start the world. Here we come down with their educational smallpox, better education, you know, health service. It got on there. China comes, India to the Western box here, you know.

And here Brazil is in the west of all. India's approach, the first African countries coming into the Western ball, and we get a lot of new neighbors. Welcome to a decent life! Come on, we want everyone down here; this is the vision we have, isn't it?

Look now! The first African countries here are coming in. There is no such thing as a Western world and developing world. This is the report from UN which came out on Friday; it's very good levels.

Friends, on child mortality, except this page, this page is very bad; it's the categorization of countries. It labels developing countries. I can read from the listed developing countries: Republic of Korea, South Korea—now they get some.

How can they be developing countries? They have here Singapore; the lowest child mortality in the world is Singapore. They bypassed Sweden five years ago, and they are labeled developing country.

They have here Qatar; it's the richest country in the world with Al Jazeera. How the heck could they be developing? This is crap! The rest there is good. The rest is good.

We have to have a modern concept which fits to the data, you know, and we have to realize that we are all going to live down to here. What is the importance now with the relations here?

Look, even if we look in Africa, these are the African countries. You can clearly see the relation with falling child mortality and decreasing family size. Even within Africa, it's very clear that this is what happens.

And a very important piece of research came out on Friday from the Institute of Health Metrics and Evaluation in Seattle showing that almost 50% of the fallen child mortality can be attributed to female education.

That is, when we get girls in school, we will get an impact 15 to 20 years later, which is a secular trend which is very strong. That's why we must have that long-term perspective, but we must measure the impact over ten-year periods.

It's fully possible to get child mortality down in all of these countries and to get them down into the corner why we all would like to live together.

Of course, lowering child mortality is a matter or actor, most importantly, from humanitarian aspects. It's a decent life for children we are talking about.

But it is also a strategic investment in the future of all mankind because it's about the environment. We will not be able to manage the environment and avoid the terrible climate crisis if we don't stabilize the world population.

Let's be clear about that. And the way to do that is to get child mortality down, get access to family planning, and behind that, a drive of female education.

And that is fully possible. Let's do it. Thank you very much.

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