Book Review: Millions Saved
Posted by chads on July 12, 2007
There are few books that I would recommend everyone interested in global health have on their bookshelves. “Millions Saved: Proven Successes in Global Health” by Ruth Levine and the What Works Working Group is one such book.
You see, my experience in global health suggests that the main barrier to success in combating needless suffering and early death in developing countries lies not so much in identifying the need. It seems to me that most people recognize at least superficially the disparities in health globally. The main barrier lies in convincing funders that the cause is worth funding, and in reaching a consensus among those that implement global health programs. A first step in breaking those barriers is to identify prior successes and examine why they were successful. “Millions Saved” does just that.
Ruth Levine and her colleagues at the Center for Global Development have identified a series of 17 successful global health cases – interventions that have actually saved lives. From eradicating small pox world-wide to eliminating measles in Southern Africa, they give us a brief introduction to the scope of the problem, share how the intervention was implemented, and show how and why it was successful. They then share six common characteristics, lessons learned:
- Success is possible even in the poorest countries
- Governments in poor countries can do the job – and in some cases are the chief funders
- Technology, yes – but behavior change, too
- International coalitions have worked
- Attribution is possible
- Success comes in all shapes
The book is a short, easy read at about 150 pages. Each chapter explains a case, and both qualitative and quantitative aspects (with limitations) of the successes are discussed. There is currently a new edition out (I have not yet read it) which is being used in college courses.
“Millions Saved” answers critics, inspires idealists, and reminds those working in the often frustrating field of global health that a healthier world is, in fact, possible. I highly recommend this book.
Utah Valley Global Health Group 
ryanlindsay said
Chad,
I also loved this book. Evidence-based success stories are exactly what we need more of.
chads said
For a more critical book review, see (2006) ‘Millions saved: proven successes in global health’, Global Public Health, 1:1, 109 — 112
benjamincrookston said
From James Fuller
Chad,
We read several sections of this book in Ben’s International Health class at BYU. I enjoyed the brief yet descriptive summaries of the case studies. Unfortunately, I came across some pretty shaky evidence in this “evidence-based” book. My group paper and presentation was based on ‘Reducing fertility in Bangladesh.’ The program began in 1975 and claimed responsibility for the drastic reduction in fertility over the next 3 decades. What the case study did not report was that fertility was already sharply declining, and the downward trend did not change at all through the life of the project. It seems likely that the outcome would have been achieved without a $150 million per year program. In essence, there was actually little evidence that the program had any effect at all.
I think this case expresses the need for more truly evidence-based programs. Unfortunately data is a two-edged sword. It may indicate which projects and programs are successful, but it may also be used to give credit where credit is not due. In fact, many projects that claim to be evidence-based have no real evidence.
I’m certainly not a quantitative expert, and that makes me pretty vulnerable to misleading statistics. I had an insightful stats teacher who always said, “If you torture the data, it will confess.” What suggestions do you have for ensuring that evidence is valid and not misleading?
chads said
Great comment, James. While I am not familiar with the Bangladesh experience and data, your point is well taken. Here are my suggestions for “ensuring that evidence is valid and not misleading?”: We need people like you, Dr. Mosely (see the review above), and others to challenge claims. There are limitations and biases with every scientific study. For a good discussion and overview of the scientific process and its limitations in epidemiology see this NYT editorial: http://www.nytimes.com/2007/09/16/magazine/16epidemiology-t.html?pagewanted=1&sq=epidemiology%20Gary%20Taubes&st=cse&scp=1
I think there should be more emphasis on the PROCESS than on the OUTCOME. That is, present data with its limitations, implement programs realizing those limitations, and include simple, locally relevant monitoring and evaluation in the program. Then, adjust as needed.
Great question, though; it’s at the heart of public health!