Health

When Politics Saves Lives: a Good-News Story

Published

2 years ago

June 7, 2023

When Politics Saves Lives: a Good-News Story

Here is something I don’t write about very often: a situation in which unpredictable, seemingly irrational politics saved millions of the poorest and most vulnerable people on earth.

In a recent blog post, Justin Sandefur, a senior fellow at the Center for Global Development, a think tank based in Washington, D.C., examined the record of the President’s Emergency Plan for AIDS Relief, or PEPFAR. The program, started by President George W. Bush, paid for antiretroviral medications for millions of H.I.V. positive people in sub-Saharan Africa and the Caribbean, and is now seen as one of the most important foreign-aid efforts in American history, notable both for its generosity and its effectiveness.

Setting it up at all flew in the face of many experts’ advice at the time.

“The conventional wisdom within health economics was that sending AIDS drugs to Africa was a waste of money,” Sandefur wrote. It wasn’t that the drugs didn’t work: Antiretroviral therapy had achieved revolutionary results in controlling H.I.V.-AIDS, and had the potential to save the lives of infected people and prevent new infections. But the medications were extremely expensive, so experts believed that it would be more efficient to spend aid dollars on prevention instead. Money spent on condom distribution, awareness campaigns, or antibiotics to treat bacterial infections that made H.I.V. transmission more likely, data suggested, would save more lives per dollar than treatment would.

In a now-infamous 2005 Forbes Op-Ed titled “Treating H.I.V. doesn’t pay,” Emily Oster, the Brown University economist who is now best known for her guides to parental decision-making, wrote that “as cold and callous as this may sound, after comparing the number of years saved by antiretrovirals with years saved by other interventions like education, I found that treatment is not an effective way to combat the epidemic.”

She, like many other economic experts, assumed that policymakers were working with two constraints: a global health disaster on a massive scale, and a limited budget for addressing it. And because it was much more expensive to treat existing H.I.V.-AIDS patients than to prevent new infections, the grim conclusion was that to save the most lives possible, the best thing to do would be to focus on prevention — even though that would effectively mean letting infected people die.

As it turned out, that argument was based on an erroneous assumption. In fact, the Bush administration was willing to find money for treatment that would never have otherwise been spent on prevention.

The Bush administration had been the target of sustained political lobbying from interest groups and activists like Bono, the U2 frontman, and Franklin Graham, the son of the Rev. Billy Graham. Their reasoning was primarily moral, not economic, and they emphasized the plight of people who needed treatment. If antiretroviral medications existed, they argued, it was wrong for the wealthiest country in the world to leave poor people to die.

So it turned out that the question was not just whether a dollar was most efficiently spent on treatment or prevention, but whether treatment or prevention would be the most politically compelling case for getting more dollars allocated. And on that latter question, treatment won hands down.

Bush created PEPFAR, a new, multibillion dollar program to fund AIDS treatment in poor countries. And it ultimately not only saved lives, but also did so more cheaply than the initial cost-benefit analysis suggested. Over the course of the program, the cost of H.I.V. treatment fell rapidly — a change that may have been due partly to PEPFAR creating new demand for the medications, particularly cheaper generic drugs that came a few years later.

Sometimes most efficient isn’t most effective

When I asked Sandefur about the broader lessons, he said that sometimes an effective, easy-to-implement solution can be the best choice, even if it flies in the face of a cost-benefit analysis.

“Close to home for me, working a lot on education, are school meals, which are, I think, fairly well demonstrated to be effective,” he said. “They help kids learn. They help get more kids in school. And they help with nutrition outcomes, clearly.”

But programs like India’s midday meal scheme, which feeds more than 100 million school children each day, often come up short on cost-benefit analyses, because other programs are seen as a more efficient way to improve educational outcomes.

Salience over science

The PEPFAR case also carries another lesson: Sometimes politics matter more than economics.

The constituency for AIDS treatment included evangelical groups with a lot of political influence within the Republican Party. Having Franklin Graham make calls alongside Bono probably made it easier to get the Bush administration’s attention, but it also lowered the political costs of spending U.S. government money on a huge new foreign-aid program.

In political science terms, saving the lives of H.I.V.-AIDS patients had better “salience”: activists connected with the cause emotionally, making it a priority for them.

My anecdotal experience definitely bears that out: I was a student in that era, and I remember many passionate debates among my classmates about how best to get treatment for people in poor countries. I’m sure that, if asked, all of them would have supported prevention measures too, but that wasn’t where their energy was focused. The bulk of people’s excitement and urgency were focused on the issue of getting medications to people who would otherwise die. That felt like an emergency.

So perhaps the bigger lesson here is just that policy is, at the end of the day, not divorced from politics. And that means that political costs and benefits will often beat out economic ones — even when that might seem irrational.

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Water for Weight Loss? How Much You Should Drink to Shed More Weight

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January 19, 2025

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Ivanka Trump stays fit with this self-defense practice: ‘Moving meditation’

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2 hours ago

January 19, 2025

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Ivanka Trump stays fit with this self-defense practice: ‘Moving meditation’

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Ivanka Trump, the daughter of incoming President Donald Trump, has been known to lead an active life.

As the mother of three kids and a lover of outdoor sports, the 43-year-old is always on the move, recently adding jiu-jitsu to her mix of physical activity.

In a recent appearance on The Skinny Confidential Him & Her podcast, Trump shared how her daughter, Arabella, expressed interest in learning self-defense when she was 11.

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“I’m just so in awe of [her],” Trump said about her daughter. “She came to me and said, ‘As a woman, I feel like I need to know how to defend myself, and I don’t have a confidence level yet that I can do that.’”

Ivanka Trump plays with her daughter, Arabella Rose Kushner, in the Rose Garden during a Congressional Picnic on the South Lawn of the White House in June 2017. (Alex Wong/Getty Images)

Trump responded, “At 11 … I was not thinking about how to physically defend myself, and I thought it was the coolest thing.”

After researching self-defense options, Trump enrolled Arabella, now 13, in jiu-jitsu (martial arts) classes with the Valente Brothers in Miami, Florida – and soon the whole family joined in.

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“[Arabella] started asking me to join – I joined,” she said. “Then my two sons wanted to do what their older sister was doing. Then my husband joined … It is good for everyone.”

“It’s almost like a moving meditation.”

Trump, who is now a blue belt in jiu-jitsu, described that she likes how the sport “meshes physical movement.”

“It’s almost like a moving meditation because the movements are so micro,” she said. “It’s like three-dimensional chess.”

“There’s like a real spiritualism to it … The grounding in sort of samurai tradition and culture and wisdom.”

During President Trump’s first term in the White House, Ivanka Trump noted that she had very little focus on fitness, only taking weekly runs with husband Jared Kushner and “chasing the kids around the house.”

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Trump shared that she was “never a gym person,” but always loved sports, which still holds true today.

She said she enjoys skiing, surfing and racquet sports like padel tennis (a hybrid of tennis and squash) and pickle ball, which she described as “fun and social.”

Ivanka Trump and Jared Kushner are seen out for a walk with their children on Dec. 10, 2022, in Miami, Florida. (MEGA/GC Images)

‘Elevating awareness’

On the podcast, Trump said she was drawn to jiu-jitsu because it combines physical fitness and philosophy.

It also focuses more on how to extract yourself from a dangerous situation before having to harm someone who’s a threat, she noted.

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“Having these skills makes you less likely to get into a fight, not more likely to,” Trump went on.

“Once you have the confidence that you can sort of move out of a situation, there’s a real focus on elevating awareness.”

Ivanka Trump waves as she arrives at Joint Base Andrews in Maryland for US President Donald Trump’s departure on Jan. 20, 2021. (ALEX EDELMAN/AFP via Getty Images)

In a previous interview with Fox News Digital, Rener Gracie, head instructor of jiu-jitsu at Gracie University in California, stressed that the only truly reliable skills are those that have been “mastered into muscle memory.”

This occurs through extensively practicing self-defense methods like Brazilian jiu-jitsu, which are “leverage-based and don’t rely on you having a physical advantage over the subject,” he noted.

“Having these skills makes you less likely to get into a fight, not more likely to.”

“And by that, I mean strength, speed, power and size — because in almost every case, the attacker is going to target someone who they feel is physically inferior to them.”

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Gracie, whose family created Brazilian jiu-jitsu and the UFC (Ultimate Fighting Championship), shared that jiu-jitsu is “highly sought after” because it only takes weeks or months for someone to “develop the core skills that could keep them safe in a violent physical encounter.”

‘Transformative’ strength training

In addition to mastering self-defense skills, Ivanka Trump recently revealed a shift in her fitness routine to include weightlifting and resistance training.

On Instagram, Trump posted a video displaying different exercises with various equipment in the gym, noting in the caption that she used to focus primarily on cardio, yoga and Pilates.

“Since moving to Miami, I have shifted my focus to weightlifting and resistance training, and it has been transformative in helping me build muscle and shift my body composition in ways I hadn’t imagined,” she wrote.

“I believe in a strength training approach built on foundational, time-tested and simple movements – squats, deadlifts, hinges, pushes and pulls. These are the cornerstones of my workout, emphasizing functional strength for life.”

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Trump added that prioritizing form is “essential” to ensure results before adding on weight.

“This ensures a safe and steady progression while maintaining the integrity of each movement,” she continued. “I incorporate mobility work within my sessions to enhance range of motion.”

“I believe in a strength training approach built on foundational, time-tested and simple movements – squats, deadlifts, hinges, pushes and pulls,” Ivanka Trump wrote in an October Instagram post. (Ivanka Trump/Instagram)

“Weightlifting has enhanced not just my strength but my overall athleticism and resilience,” she added.

Trump said she dedicates three to four days a week to strength training, including two solo sessions and two with a personal trainer.

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She also said that increasing her protein intake has also been “critical” to her progress.

“I now consume between 30 and 50 grams of protein a meal,” she said. “It works … I’ve never been stronger!”

Jared Kushner and Ivanka Trump are seen arriving at the beachside eatery on May 2, 2024, in Miami Beach, Florida. (MEGA/GC Images)

Trump also still enjoys weekly yoga sessions, spending time outdoors with her children and playing sports with friends, she said.

“I also incorporate a couple of short (10-minute), high-intensity interval training sessions (such as sprints) each week to keep my cardiovascular fitness sharp and dynamic,” she noted.

“This balanced approach has infused new energy into my fitness routine and yielded great results.”

Fox News Digital reached out to Ivanka Trump for comment.

Health

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