The following information is used for educational purposes only.
Filmed February 2005 at TED2005
Bjorn Lomborg: Global priorities bigger than climate change
Given $50 billion to spend, which would you solve first, AIDS or global warming? Danish political scientist Bjorn Lomborg comes up with surprising answers.
Transcript:
What I'd like to talk about is really the biggest problems in the world. I'm not going to talk about "The Skeptical Environmentalist" — probably that's also a good choice. (Laughter)
But I am going talk about: what are the big problems in the world? And I must say, before I go on, I should ask every one of you to try and get out pen and paper because I'm actually going to ask you to help me to look at how we do that. So get out your pen and paper. Bottom line is, there is a lot of problems out there in the world. I'm just going to list some of them. There are 800 million people starving. There's a billion people without clean drinking water. Two billion people without sanitation. There are several million people dying of HIV and AIDS. The lists go on and on. There's two billions of people who will be severely affected by climate change — so on. There are many, many problems out there.
In an ideal world, we would solve them all, but we don't. We don't actually solve all problems. And if we do not, the question I think we need to ask ourselves — and that's why it's on the economy session — is to say, if we don't do all things, we really have to start asking ourselves, which ones should we solve first? And that's the question I'd like to ask you. If we had say, 50 billion dollars over the next four years to spend to do good in this world, where should we spend it? We identified 10 of the biggest challenges in the world, and I will just briefly read them: climate change, communicable diseases, conflicts, education, financial instability, governance and corruption, malnutrition and hunger, population migration, sanitation and water, and subsidies and trade barriers. We believe that these in many ways encompass the biggest problems in the world. The obvious question would be to ask, what do you think are the biggest things? Where should we start on solving these problems? But that's a wrong problem to ask. That was actually the problem that was asked in Davos in January.
But of course, there's a problem in asking people to focus on problems. Because we can't solve problems. Surely the biggest problem we have in the world is that we all die. But we don't have a technology to solve that, right? So the point is not to prioritize problems, but the point is to prioritize solutions to problems. And that would be — of course that gets a little more complicated. To climate change that would be like Kyoto. To communicable diseases, it might be health clinics or mosquito nets. To conflicts, it would be U.N.'s peacekeeping forces, and so on. The point that I would like to ask you to try to do, is just in 30 seconds — and I know this is in a sense an impossible task — write down what you think is probably some of the top priorities. And also — and that's, of course, where economics gets evil — to put down what are the things we should not do, first. What should be at the bottom of the list? Please, just take 30 seconds, perhaps talk to your neighbor, and just figure out what should be the top priorities and the bottom priorities of the solutions that we have to the world's biggest issues.
The amazing part of this process — and of course, I mean, I would love to — I only have 18 minutes, I've already given you quite a substantial amount of my time, right? I'd love to go into, and get you to think about this process, and that's actually what we did. And I also strongly encourage you, and I'm sure we'll also have these discussions afterwards, to think about, how do we actually prioritize? Of course, you have to ask yourself, why on Earth was such a list never done before? And one reason is that prioritization is incredibly uncomfortable. Nobody wants to do this. Of course, every organization would love to be on the top of such a list. But every organization would also hate to be not on the top of the list. And since there are many more not-number-one spots on the list than there is number ones, it makes perfect sense not to want to do such a list. We've had the U.N. for almost 60 years, yet we've never actually made a fundamental list of all the big things that we can do in the world, and said, which of them should we do first? So it doesn't mean that we are not prioritizing — any decision is a prioritization, so of course we are still prioritizing, if only implicitly — and that's unlikely to be as good as if we actually did the prioritization, and went in and talked about it.
So what I'm proposing is really to say that we have, for a very long time, had a situation when we've had a menu of choices. There are many, many things we can do out there, but we've not had the prices, nor the sizes. We have not had an idea. Imagine going into a restaurant and getting this big menu card, but you have no idea what the price is. You know, you have a pizza; you've no idea what the price is. It could be at one dollar; it could be 1,000 dollars. It could be a family-size pizza; it could be a very individual-size pizza, right? We'd like to know these things.
And that is what the Copenhagen Consensus is really trying to do — to try to put prices on these issues. And so basically, this has been the Copenhagen Consensus' process. We got 30 of the world's best economists, three in each area. So we have three of world's top economists write about climate change. What can we do? What will be the cost and what will be the benefit of that? Likewise in communicable diseases. Three of the world's top experts saying, what can we do? What would be the price? What should we do about it, and what will be the outcome? And so on.
Then we had some of the world's top economists, eight of the world's top economists, including three Nobel Laureates, meet in Copenhagen in May 2004. We called them the "dream team." The Cambridge University prefects decided to call them the Real Madrid of economics. That works very well in Europe, but it doesn't really work over here. And what they basically did was come out with a prioritized list. And then you ask, why economists? And of course, I'm very happy you asked that question — (Laughter) — because that's a very good question. The point is, of course, if you want to know about malaria, you ask a malaria expert. If you want to know about climate, you ask a climatologist. But if you want to know which of the two you should deal with first, you can't ask either of them, because that's not what they do. That is what economists do. They prioritize. They make that in some ways disgusting task of saying, which one should we do first, and which one should we do afterwards?
So this is the list, and this is the one I'd like to share with you. Of course, you can also see it on the website, and we'll also talk about it more, I'm sure, as the day goes on. They basically came up with a list where they said there were bad projects — basically, projects where if you invest a dollar, you get less than a dollar back. Then there's fair projects, good projects and very good projects. And of course, it's the very good projects we should start doing. I'm going to go from backwards so that we end up with the best projects.
These were the bad projects. As you might see the bottom of the list was climate change. This offends a lot of people, and that's probably one of the things where people will say I shouldn't come back, either. And I'd like to talk about that, because that's really curious. Why is it it came up? And I'll actually also try to get back to this because it's probably one of the things that we'll disagree with on the list that you wrote down.
The reason why they came up with saying that Kyoto — or doing something more than Kyoto — is a bad deal is simply because it's very inefficient. It's not saying that global warming is not happening. It's not saying that it's not a big problem. But it's saying that what we can do about it is very little, at a very high cost. What they basically show us, the average of all macroeconomic models, is that Kyoto, if everyone agreed, would cost about 150 billion dollars a year. That's a substantial amount of money. That's two to three times the global development aid that we give the Third World every year. Yet it would do very little good. All models show it will postpone warming for about six years in 2100. So the guy in Bangladesh who gets a flood in 2100 can wait until 2106. Which is a little good, but not very much good. So the idea here really is to say, well, we've spent a lot of money doing a little good.
And just to give you a sense of reference, the U.N. actually estimate that for half that amount, for about 75 billion dollars a year, we could solve all major basic problems in the world. We could give clean drinking water, sanitation, basic healthcare and education to every single human being on the planet. So we have to ask ourselves, do we want to spend twice the amount on doing very little good? Or half the amount on doing an amazing amount of good? And that is really why it becomes a bad project. It's not to say that if we had all the money in the world, we wouldn't want to do it. But it's to say, when we don't, it's just simply not our first priority.
The fair projects — notice I'm not going to comment on all these — but communicable diseases, scale of basic health services — just made it, simply because, yes, scale of basic health services is a great thing. It would do a lot of good, but it's also very, very costly. Again, what it tells us is suddenly we start thinking about both sides of the equation. If you look at the good projects, a lot of sanitation and water projects came in. Again, sanitation and water is incredibly important, but it also costs a lot of infrastructure. So I'd like to show you the top four priorities which should be at least the first ones that we deal with when we talk about how we should deal with the problems in the world.
The fourth best problem is malaria — dealing with malaria. The incidence of malaria is about a couple of [million] people get infected every year. It might even cost up towards a percentage point of GDP every year for affected nations. If we invested about 13 billion dollars over the next four years, we could bring that incidence down to half. We could avoid about 500,000 people dying, but perhaps more importantly, we could avoid about a [million] people getting infected every year. We would significantly increase their ability to deal with many of the other problems that they have to deal with — of course, in the long run, also to deal with global warming.
This third best one was free trade. Basically, the model showed that if we could get free trade, and especially cut subsidies in the U.S. and Europe, we could basically enliven the global economy to an astounding number of about 2,400 billion dollars a year, half of which would accrue to the Third World. Again, the point is to say that we could actually pull two to three hundred million people out of poverty, very radically fast, in about two to five years. That would be the third best thing we could do.
The second best thing would be to focus on malnutrition. Not just malnutrition in general, but there's a very cheap way of dealing with malnutrition, namely, the lack of micronutrients. Basically, about half of the world's population is lacking in iron, zinc, iodine and vitamin A. If we invest about 12 billion dollars, we could make a severe inroad into that problem. That would be the second best investment that we could do.
And the very best project would be to focus on HIV/AIDS. Basically, if we invest 27 billion dollars over the next eight years, we could avoid 28 new million cases of HIV/AIDS. Again, what this does and what it focuses on is saying there are two very different ways that we can deal with HIV/AIDS. One is treatment; the other one is prevention. And again, in an ideal world, we would do both. But in a world where we don't do either, or don't do it very well, we have to at least ask ourselves where should we invest first. And treatment is much, much more expensive than prevention. So basically, what this focuses on is saying, we can do a lot more by investing in prevention. Basically for the amount of money that we spend, we can do X amount of good in treatment, and 10 times as much good in prevention. So again, what we focus on is prevention rather than treatment, at first rate.
What this really does is that it makes us think about our priorities. I'd like to have you look at your priority list and say, did you get it right? Or did you get close to what we came up with here? Well, of course, one of the things is climate change again. I find a lot of people find it very, very unlikely that we should do that.
We should also do climate change, if for no other reason, simply because it's such a big problem. But of course, we don't do all problems. There are many problems out there in the world. And what I want to make sure of is, if we actually focus on problems, that we focus on the right ones. The ones where we can do a lot of good rather than a little good. And I think, actually — Thomas Schelling, one of the participants in the dream team, he put it very, very well. One of things that people forget, is that in 100 years, when we're talking about most of the climate change impacts will be, people will be much, much richer. Even the most pessimistic impact scenarios of the U.N. estimate that the average person in the developing world in 2100 will be about as rich as we are today. Much more likely, they will be two to four times richer than we are. And of course, we'll be even richer than that.
But the point is to say, when we talk about saving people, or helping people in Bangladesh in 2100, we're not talking about a poor Bangladeshi. We're actually talking about a fairly rich Dutch guy. And so the real point, of course, is to say, do we want to spend a lot of money helping a little, 100 years from now, a fairly rich Dutch guy? Or do we want to help real poor people, right now, in Bangladesh, who really need the help, and whom we can help very, very cheaply? Or as Schelling put it, imagine if you were a rich — as you will be — a rich Chinese, a rich Bolivian, a rich Congolese, in 2100, thinking back on 2005, and saying, "How odd that they cared so much about helping me a little bit through climate change, and cared so fairly little about helping my grandfather and my great grandfather, whom they could have helped so much more, and who needed the help so much more?"
So I think that really does tell us why it is we need to get our priorities straight. Even if it doesn't accord to the typical way we see this problem. Of course, that's mainly because climate change has good pictures. We have, you know, "The Day After Tomorrow" — it looks great, right? It's a good film in the sense that I certainly want to see it, right, but don't expect Emmerich to cast Brad Pitt in his next movie digging latrines in Tanzania or something. (Laughter) It just doesn't make for as much of a movie. So in many ways, I think of the Copenhagen Consensus and the whole discussion of priorities as a defense for boring problems. To make sure that we realize it's not about making us feel good. It's not about making things that have the most media attention, but it's about making places where we can actually do the most good.
The other objections, I think, that are important to say, is that I'm somehow — or we are somehow — positing a false choice. Of course, we should do all things, in an ideal world — I would certainly agree. I think we should do all things, but we don't. In 1970, the developed world decided we were going to spend twice as much as we did, right now, than in 1970, on the developing world. Since then our aid has halved. So it doesn't look like we're actually on the path of suddenly solving all big problems.
Likewise, people are also saying, but what about the Iraq war? You know, we spend 100 billion dollars — why don't we spend that on doing good in the world? I'm all for that. If any one of you guys can talk Bush into doing that, that's fine. But the point, of course, is still to say, if you get another 100 billion dollars, we still want to spend that in the best possible way, don't we? So the real issue here is to get ourselves back and think about what are the right priorities. I should just mention briefly, is this really the right list that we got out? You know, when you ask the world's best economists, you inevitably end up asking old, white American men. And they're not necessarily, you know, great ways of looking at the entire world.
So we actually invited 80 young people from all over the world to come and solve the same problem. The only two requirements were that they were studying at the university, and they spoke English. The majority of them were, first, from developing countries. They had all the same material but they could go vastly outside the scope of discussion, and they certainly did, to come up with their own lists. And the surprising thing was that the list was very similar — with malnutrition and diseases at the top and climate change at the bottom. We've done this many other times. There's been many other seminars and university students, and different things. They all come out with very much the same list. And that gives me great hope, really, in saying that I do believe that there is a path ahead to get us to start thinking about priorities, and saying, what is the important thing in the world? Of course, in an ideal world, again we'd love to do everything. But if we don't do it, then we can start thinking about where should we start?
I see the Copenhagen Consensus as a process. We did it in 2004, and we hope to assemble many more people, getting much better information for 2008, 2012. Map out the right path for the world — but also to start thinking about political triage. To start thinking about saying, "Let's do not the things where we can do very little at a very high cost, not the things that we don't know how to do, but let's do the great things where we can do an enormous amount of good, at very low cost, right now."
At the end of the day, you can disagree with the discussion of how we actually prioritize these, but we have to be honest and frank about saying, if there's some things we do, there are other things we don't do. If we worry too much about some things, we end by not worrying about other things. So I hope this will help us make better priorities, and think about how we better work for the world. Thank you.
In this blog, teachers, students and all those who have some kind of interest in the English language will find useful, interesting, curious and funny things to be used in their classes or for their personal enjoyment.
Sunday, March 26, 2017
POL/GINT-TED Talks-Simon Anholt: Which country does the most good for the world?
The following information is used for educational purposes only.
Filmed June 2014 at TEDSalon Berlin 2014
Simon Anholt: Which country does the most good for the world?
It's an unexpected side effect of globalization: problems that once would have stayed local—say, a bank lending out too much money—now have consequences worldwide. But still, countries operate independently, as if alone on the planet. Policy advisor Simon Anholt has dreamed up an unusual scale to get governments thinking outwardly: The Good Country Index. In a riveting and funny talk, he answers the question, "Which country does the most good?" The answer may surprise you (especially if you live in the US or China).
Transcript:
I've been thinking a lot about the world recently and how it's changed over the last 20, 30, 40 years. Twenty or 30 years ago, if a chicken caught a cold and sneezed and died in a remote village in East Asia, it would have been a tragedy for the chicken and its closest relatives, but I don't think there was much possibility of us fearing a global pandemic and the deaths of millions. Twenty or 30 years ago, if a bank in North America lent too much money to some people who couldn't afford to pay it back and the bank went bust, that was bad for the lender and bad for the borrower, but we didn't imagine it would bring the global economic system to its knees for nearly a decade.
This is globalization. This is the miracle that has enabled us to transship our bodies and our minds and our words and our pictures and our ideas and our teaching and our learning around the planet ever faster and ever cheaper. It's brought a lot of bad stuff, like the stuff that I just described, but it's also brought a lot of good stuff. A lot of us are not aware of the extraordinary successes of the Millennium Development Goals, several of which have achieved their targets long before the due date. That proves that this species of humanity is capable of achieving extraordinary progress if it really acts together and it really tries hard. But if I had to put it in a nutshell these days, I sort of feel that globalization has taken us by surprise, and we've been slow to respond to it. If you look at the downside of globalization, it really does seem to be sometimes overwhelming. All of the grand challenges that we face today, like climate change and human rights and demographics and terrorism and pandemics and narco-trafficking and human slavery and species loss, I could go on, we're not making an awful lot of progress against an awful lot of those challenges.
So in a nutshell, that's the challenge that we all face today at this interesting point in history. That's clearly what we've got to do next. We've somehow got to get our act together and we've got to figure out how to globalize the solutions better so that we don't simply become a species which is the victim of the globalization of problems.
Why are we so slow at achieving these advances? What's the reason for it? Well, there are, of course, a number of reasons, but perhaps the primary reason is because we're still organized as a species in the same way that we were organized 200 or 300 years ago. There's one superpower left on the planet and that is the seven billion people, the seven billion of us who cause all these problems, the same seven billion, by the way, who will resolve them all. But how are those seven billion organized? They're still organized in 200 or so nation-states, and the nations have governments that make rules and cause us to behave in certain ways. And that's a pretty efficient system, but the problem is that the way that those laws are made and the way those governments think is absolutely wrong for the solution of global problems, because it all looks inwards. The politicians that we elect and the politicians we don't elect, on the whole, have minds that microscope. They don't have minds that telescope. They look in. They pretend, they behave, as if they believed that every country was an island that existed quite happily, independently of all the others on its own little planet in its own little solar system. This is the problem: countries competing against each other, countries fighting against each other. This week, as any week you care to look at, you'll find people actually trying to kill each other from country to country, but even when that's not going on, there's competition between countries, each one trying to shaft the next.
This is clearly not a good arrangement. We clearly need to change it. We clearly need to find ways of encouraging countries to start working together a little bit better. And why won't they do that? Why is it that our leaders still persist in looking inwards?
Well, the first and most obvious reason is because that's what we ask them to do. That's what we tell them to do. When we elect governments or when we tolerate unelected governments, we're effectively telling them that what we want is for them to deliver us in our country a certain number of things. We want them to deliver prosperity, growth, competitiveness, transparency, justice and all of those things. So unless we start asking our governments to think outside a little bit, to consider the global problems that will finish us all if we don't start considering them, then we can hardly blame them if what they carry on doing is looking inwards, if they still have minds that microscope rather than minds that telescope. That's the first reason why things tend not to change.
The second reason is that these governments, just like all the rest of us, are cultural psychopaths. I don't mean to be rude, but you know what a psychopath is. A psychopath is a person who, unfortunately for him or her, lacks the ability to really empathize with other human beings. When they look around, they don't see other human beings with deep, rich, three-dimensional personal lives and aims and ambitions. What they see is cardboard cutouts, and it's very sad and it's very lonely, and it's very rare, fortunately.
But actually, aren't most of us not really so very good at empathy? Oh sure, we're very good at empathy when it's a question of dealing with people who kind of look like us and kind of walk and talk and eat and pray and wear like us, but when it comes to people who don't do that, who don't quite dress like us and don't quite pray like us and don't quite talk like us, do we not also have a tendency to see them ever so slightly as cardboard cutouts too? And this is a question we need to ask ourselves. I think constantly we have to monitor it. Are we and our politicians to a degree cultural psychopaths?
The third reason is hardly worth mentioning because it's so silly, but there's a belief amongst governments that the domestic agenda and the international agenda are incompatible and always will be. This is just nonsense. In my day job, I'm a policy adviser. I've spent the last 15 years or so advising governments around the world, and in all of that time I have never once seen a single domestic policy issue that could not be more imaginatively, effectively and rapidly resolved than by treating it as an international problem, looking at the international context, comparing what others have done, bringing in others, working externally instead of working internally.
And so you may say, well, given all of that, why then doesn't it work? Why can we not make our politicians change? Why can't we demand them? Well I, like a lot of us, spend a lot of time complaining about how hard it is to make people change, and I don't think we should fuss about it. I think we should just accept that we are an inherently conservative species. We don't like to change. It exists for very sensible evolutionary reasons. We probably wouldn't still be here today if we weren't so resistant to change. It's very simple: Many thousands of years ago, we discovered that if we carried on doing the same things, we wouldn't die, because the things that we've done before by definition didn't kill us, and therefore as long as we carry on doing them, we'll be okay, and it's very sensible not to do anything new, because it might kill you. But of course, there are exceptions to that. Otherwise, we'd never get anywhere. And one of the exceptions, the interesting exception, is when you can show to people that there might be some self-interest in them making that leap of faith and changing a little bit.
So I've spent a lot of the last 10 or 15 years trying to find out what could be that self-interest that would encourage not just politicians but also businesses and general populations, all of us, to start to think a little more outwardly, to think in a bigger picture, not always to look inwards, sometimes to look outwards. And this is where I discovered something quite important. In 2005, I launched a study called the Nation Brands Index. What it is, it's a very large-scale study that polls a very large sample of the world's population, a sample that represents about 70 percent of the planet's population, and I started asking them a series of questions about how they perceive other countries. And the Nation Brands Index over the years has grown to be a very, very large database. It's about 200 billion data points tracking what ordinary people think about other countries and why. Why did I do this? Well, because the governments that I advise are very, very keen on knowing how they are regarded. They've known, partly because I've encouraged them to realize it, that countries depend enormously on their reputations in order to survive and prosper in the world. If a country has a great, positive image, like Germany has or Sweden or Switzerland, everything is easy and everything is cheap. You get more tourists. You get more investors. You sell your products more expensively. If, on the other hand, you have a country with a very weak or a very negative image, everything is difficult and everything is expensive. So governments care desperately about the image of their country, because it makes a direct difference to how much money they can make, and that's what they've promised their populations they're going to deliver.
So a couple of years ago, I thought I would take some time out and speak to that gigantic database and ask it, why do some people prefer one country more than another? And the answer that the database gave me completely staggered me. It was 6.8. I haven't got time to explain in detail. Basically what it told me was — (Laughter) (Applause) — the kinds of countries we prefer are good countries. We don't admire countries primarily because they're rich, because they're powerful, because they're successful, because they're modern, because they're technologically advanced. We primarily admire countries that are good. What do we mean by good? We mean countries that seem to contribute something to the world in which we live, countries that actually make the world safer or better or richer or fairer. Those are the countries we like. This is a discovery of significant importance — you see where I'm going — because it squares the circle. I can now say, and often do, to any government, in order to do well, you need to do good. If you want to sell more products, if you want to get more investment, if you want to become more competitive, then you need to start behaving, because that's why people will respect you and do business with you, and therefore, the more you collaborate, the more competitive you become.
This is quite an important discovery, and as soon as I discovered this, I felt another index coming on. I swear that as I get older, my ideas become simpler and more and more childish. This one is called the Good Country Index, and it does exactly what it says on the tin. It measures, or at least it tries to measure, exactly how much each country on Earth contributes not to its own population but to the rest of humanity. Bizarrely, nobody had ever thought of measuring this before. So my colleague Dr. Robert Govers and I have spent the best part of the last two years, with the help of a large number of very serious and clever people, cramming together all the reliable data in the world we could find about what countries give to the world.
And you're waiting for me to tell you which one comes top. And I'm going to tell you, but first of all I want to tell you precisely what I mean when I say a good country. I do not mean morally good. When I say that Country X is the goodest country on Earth, and I mean goodest, I don't mean best. Best is something different. When you're talking about a good country, you can be good, gooder and goodest. It's not the same thing as good, better and best. This is a country which simply gives more to humanity than any other country. I don't talk about how they behave at home because that's measured elsewhere. And the winner is Ireland. (Applause) According to the data here, no country on Earth, per head of population, per dollar of GDP, contributes more to the world that we live in than Ireland. What does this mean? This means that as we go to sleep at night, all of us in the last 15 seconds before we drift off to sleep, our final thought should be, godammit, I'm glad that Ireland exists. (Laughter) And that — (Applause) — In the depths of a very severe economic recession, I think that there's a really important lesson there, that if you can remember your international obligations whilst you are trying to rebuild your own economy, that's really something. Finland ranks pretty much the same. The only reason why it's below Ireland is because its lowest score is lower than Ireland's lowest score.
Now the other thing you'll notice about the top 10 there is, of course, they're all, apart from New Zealand, Western European nations. They're also all rich. This depressed me, because one of the things that I did not want to discover with this index is that it's purely the province of rich countries to help poor countries. This is not what it's all about. And indeed, if you look further down the list, I don't have the slide here, you will see something that made me very happy indeed, that Kenya is in the top 30, and that demonstrates one very, very important thing. This is not about money. This is about attitude. This is about culture. This is about a government and a people that care about the rest of the world and have the imagination and the courage to think outwards instead of only thinking selfishly.
I'm going to whip through the other slides just so you can see some of the lower-lying countries. There's Germany at 13th, the U.S. comes 21st, Mexico comes 66th, and then we have some of the big developing countries, like Russia at 95th, China at 107th. Countries like China and Russia and India, which is down in the same part of the index, well, in some ways, it's not surprising. They've spent a great deal of time over the last decades building their own economy, building their own society and their own polity, but it is to be hoped that the second phase of their growth will be somewhat more outward-looking than the first phase has been so far.
And then you can break down each country in terms of the actual datasets that build into it. I'll allow you to do that. From midnight tonight it's going to be on goodcountry.org, and you can look at the country. You can look right down to the level of the individual datasets.
Now that's the Good Country Index. What's it there for? Well, it's there really because I want to try to introduce this word, or reintroduce this word, into the discourse. I've had enough hearing about competitive countries. I've had enough hearing about prosperous, wealthy, fast-growing countries. I've even had enough hearing about happy countries because in the end that's still selfish. That's still about us, and if we carry on thinking about us, we are in deep, deep trouble. I think we all know what it is that we want to hear about. We want to hear about good countries, and so I want to ask you all a favor. I'm not asking a lot. It's something that you might find easy to do and you might even find enjoyable and even helpful to do, and that's simply to start using the word "good" in this context. When you think about your own country, when you think about other people's countries, when you think about companies, when you talk about the world that we live in today, start using that word in the way that I've talked about this evening. Not good, the opposite of bad, because that's an argument that never finishes. Good, the opposite of selfish, good being a country that thinks about all of us. That's what I would like you to do, and I'd like you to use it as a stick with which to beat your politicians. When you elect them, when you reelect them, when you vote for them, when you listen to what they're offering you, use that word, "good," and ask yourself, "Is that what a good country would do?" And if the answer is no, be very suspicious. Ask yourself, is that the behavior of my country? Do I want to come from a country where the government, in my name, is doing things like that? Or do I, on the other hand, prefer the idea of walking around the world with my head held high thinking, "Yeah, I'm proud to come from a good country"? And everybody will welcome you. And everybody in the last 15 seconds before they drift off to sleep at night will say, "Gosh, I'm glad that person's country exists."
Ultimately, that, I think, is what will make the change. That word, "good," and the number 6.8 and the discovery that's behind it have changed my life. I think they can change your life, and I think we can use it to change the way that our politicians and our companies behave, and in doing so, we can change the world. I've started thinking very differently about my own country since I've been thinking about these things. I used to think that I wanted to live in a rich country, and then I started thinking I wanted to live in a happy country, but I began to realize, it's not enough. I don't want to live in a rich country. I don't want to live in a fast-growing or competitive country. I want to live in a good country, and I so, so hope that you do too.
Thank you.
(Applause)
Filmed June 2014 at TEDSalon Berlin 2014
Simon Anholt: Which country does the most good for the world?
It's an unexpected side effect of globalization: problems that once would have stayed local—say, a bank lending out too much money—now have consequences worldwide. But still, countries operate independently, as if alone on the planet. Policy advisor Simon Anholt has dreamed up an unusual scale to get governments thinking outwardly: The Good Country Index. In a riveting and funny talk, he answers the question, "Which country does the most good?" The answer may surprise you (especially if you live in the US or China).
Transcript:
I've been thinking a lot about the world recently and how it's changed over the last 20, 30, 40 years. Twenty or 30 years ago, if a chicken caught a cold and sneezed and died in a remote village in East Asia, it would have been a tragedy for the chicken and its closest relatives, but I don't think there was much possibility of us fearing a global pandemic and the deaths of millions. Twenty or 30 years ago, if a bank in North America lent too much money to some people who couldn't afford to pay it back and the bank went bust, that was bad for the lender and bad for the borrower, but we didn't imagine it would bring the global economic system to its knees for nearly a decade.
This is globalization. This is the miracle that has enabled us to transship our bodies and our minds and our words and our pictures and our ideas and our teaching and our learning around the planet ever faster and ever cheaper. It's brought a lot of bad stuff, like the stuff that I just described, but it's also brought a lot of good stuff. A lot of us are not aware of the extraordinary successes of the Millennium Development Goals, several of which have achieved their targets long before the due date. That proves that this species of humanity is capable of achieving extraordinary progress if it really acts together and it really tries hard. But if I had to put it in a nutshell these days, I sort of feel that globalization has taken us by surprise, and we've been slow to respond to it. If you look at the downside of globalization, it really does seem to be sometimes overwhelming. All of the grand challenges that we face today, like climate change and human rights and demographics and terrorism and pandemics and narco-trafficking and human slavery and species loss, I could go on, we're not making an awful lot of progress against an awful lot of those challenges.
So in a nutshell, that's the challenge that we all face today at this interesting point in history. That's clearly what we've got to do next. We've somehow got to get our act together and we've got to figure out how to globalize the solutions better so that we don't simply become a species which is the victim of the globalization of problems.
Why are we so slow at achieving these advances? What's the reason for it? Well, there are, of course, a number of reasons, but perhaps the primary reason is because we're still organized as a species in the same way that we were organized 200 or 300 years ago. There's one superpower left on the planet and that is the seven billion people, the seven billion of us who cause all these problems, the same seven billion, by the way, who will resolve them all. But how are those seven billion organized? They're still organized in 200 or so nation-states, and the nations have governments that make rules and cause us to behave in certain ways. And that's a pretty efficient system, but the problem is that the way that those laws are made and the way those governments think is absolutely wrong for the solution of global problems, because it all looks inwards. The politicians that we elect and the politicians we don't elect, on the whole, have minds that microscope. They don't have minds that telescope. They look in. They pretend, they behave, as if they believed that every country was an island that existed quite happily, independently of all the others on its own little planet in its own little solar system. This is the problem: countries competing against each other, countries fighting against each other. This week, as any week you care to look at, you'll find people actually trying to kill each other from country to country, but even when that's not going on, there's competition between countries, each one trying to shaft the next.
This is clearly not a good arrangement. We clearly need to change it. We clearly need to find ways of encouraging countries to start working together a little bit better. And why won't they do that? Why is it that our leaders still persist in looking inwards?
Well, the first and most obvious reason is because that's what we ask them to do. That's what we tell them to do. When we elect governments or when we tolerate unelected governments, we're effectively telling them that what we want is for them to deliver us in our country a certain number of things. We want them to deliver prosperity, growth, competitiveness, transparency, justice and all of those things. So unless we start asking our governments to think outside a little bit, to consider the global problems that will finish us all if we don't start considering them, then we can hardly blame them if what they carry on doing is looking inwards, if they still have minds that microscope rather than minds that telescope. That's the first reason why things tend not to change.
The second reason is that these governments, just like all the rest of us, are cultural psychopaths. I don't mean to be rude, but you know what a psychopath is. A psychopath is a person who, unfortunately for him or her, lacks the ability to really empathize with other human beings. When they look around, they don't see other human beings with deep, rich, three-dimensional personal lives and aims and ambitions. What they see is cardboard cutouts, and it's very sad and it's very lonely, and it's very rare, fortunately.
But actually, aren't most of us not really so very good at empathy? Oh sure, we're very good at empathy when it's a question of dealing with people who kind of look like us and kind of walk and talk and eat and pray and wear like us, but when it comes to people who don't do that, who don't quite dress like us and don't quite pray like us and don't quite talk like us, do we not also have a tendency to see them ever so slightly as cardboard cutouts too? And this is a question we need to ask ourselves. I think constantly we have to monitor it. Are we and our politicians to a degree cultural psychopaths?
The third reason is hardly worth mentioning because it's so silly, but there's a belief amongst governments that the domestic agenda and the international agenda are incompatible and always will be. This is just nonsense. In my day job, I'm a policy adviser. I've spent the last 15 years or so advising governments around the world, and in all of that time I have never once seen a single domestic policy issue that could not be more imaginatively, effectively and rapidly resolved than by treating it as an international problem, looking at the international context, comparing what others have done, bringing in others, working externally instead of working internally.
And so you may say, well, given all of that, why then doesn't it work? Why can we not make our politicians change? Why can't we demand them? Well I, like a lot of us, spend a lot of time complaining about how hard it is to make people change, and I don't think we should fuss about it. I think we should just accept that we are an inherently conservative species. We don't like to change. It exists for very sensible evolutionary reasons. We probably wouldn't still be here today if we weren't so resistant to change. It's very simple: Many thousands of years ago, we discovered that if we carried on doing the same things, we wouldn't die, because the things that we've done before by definition didn't kill us, and therefore as long as we carry on doing them, we'll be okay, and it's very sensible not to do anything new, because it might kill you. But of course, there are exceptions to that. Otherwise, we'd never get anywhere. And one of the exceptions, the interesting exception, is when you can show to people that there might be some self-interest in them making that leap of faith and changing a little bit.
So I've spent a lot of the last 10 or 15 years trying to find out what could be that self-interest that would encourage not just politicians but also businesses and general populations, all of us, to start to think a little more outwardly, to think in a bigger picture, not always to look inwards, sometimes to look outwards. And this is where I discovered something quite important. In 2005, I launched a study called the Nation Brands Index. What it is, it's a very large-scale study that polls a very large sample of the world's population, a sample that represents about 70 percent of the planet's population, and I started asking them a series of questions about how they perceive other countries. And the Nation Brands Index over the years has grown to be a very, very large database. It's about 200 billion data points tracking what ordinary people think about other countries and why. Why did I do this? Well, because the governments that I advise are very, very keen on knowing how they are regarded. They've known, partly because I've encouraged them to realize it, that countries depend enormously on their reputations in order to survive and prosper in the world. If a country has a great, positive image, like Germany has or Sweden or Switzerland, everything is easy and everything is cheap. You get more tourists. You get more investors. You sell your products more expensively. If, on the other hand, you have a country with a very weak or a very negative image, everything is difficult and everything is expensive. So governments care desperately about the image of their country, because it makes a direct difference to how much money they can make, and that's what they've promised their populations they're going to deliver.
So a couple of years ago, I thought I would take some time out and speak to that gigantic database and ask it, why do some people prefer one country more than another? And the answer that the database gave me completely staggered me. It was 6.8. I haven't got time to explain in detail. Basically what it told me was — (Laughter) (Applause) — the kinds of countries we prefer are good countries. We don't admire countries primarily because they're rich, because they're powerful, because they're successful, because they're modern, because they're technologically advanced. We primarily admire countries that are good. What do we mean by good? We mean countries that seem to contribute something to the world in which we live, countries that actually make the world safer or better or richer or fairer. Those are the countries we like. This is a discovery of significant importance — you see where I'm going — because it squares the circle. I can now say, and often do, to any government, in order to do well, you need to do good. If you want to sell more products, if you want to get more investment, if you want to become more competitive, then you need to start behaving, because that's why people will respect you and do business with you, and therefore, the more you collaborate, the more competitive you become.
This is quite an important discovery, and as soon as I discovered this, I felt another index coming on. I swear that as I get older, my ideas become simpler and more and more childish. This one is called the Good Country Index, and it does exactly what it says on the tin. It measures, or at least it tries to measure, exactly how much each country on Earth contributes not to its own population but to the rest of humanity. Bizarrely, nobody had ever thought of measuring this before. So my colleague Dr. Robert Govers and I have spent the best part of the last two years, with the help of a large number of very serious and clever people, cramming together all the reliable data in the world we could find about what countries give to the world.
And you're waiting for me to tell you which one comes top. And I'm going to tell you, but first of all I want to tell you precisely what I mean when I say a good country. I do not mean morally good. When I say that Country X is the goodest country on Earth, and I mean goodest, I don't mean best. Best is something different. When you're talking about a good country, you can be good, gooder and goodest. It's not the same thing as good, better and best. This is a country which simply gives more to humanity than any other country. I don't talk about how they behave at home because that's measured elsewhere. And the winner is Ireland. (Applause) According to the data here, no country on Earth, per head of population, per dollar of GDP, contributes more to the world that we live in than Ireland. What does this mean? This means that as we go to sleep at night, all of us in the last 15 seconds before we drift off to sleep, our final thought should be, godammit, I'm glad that Ireland exists. (Laughter) And that — (Applause) — In the depths of a very severe economic recession, I think that there's a really important lesson there, that if you can remember your international obligations whilst you are trying to rebuild your own economy, that's really something. Finland ranks pretty much the same. The only reason why it's below Ireland is because its lowest score is lower than Ireland's lowest score.
Now the other thing you'll notice about the top 10 there is, of course, they're all, apart from New Zealand, Western European nations. They're also all rich. This depressed me, because one of the things that I did not want to discover with this index is that it's purely the province of rich countries to help poor countries. This is not what it's all about. And indeed, if you look further down the list, I don't have the slide here, you will see something that made me very happy indeed, that Kenya is in the top 30, and that demonstrates one very, very important thing. This is not about money. This is about attitude. This is about culture. This is about a government and a people that care about the rest of the world and have the imagination and the courage to think outwards instead of only thinking selfishly.
I'm going to whip through the other slides just so you can see some of the lower-lying countries. There's Germany at 13th, the U.S. comes 21st, Mexico comes 66th, and then we have some of the big developing countries, like Russia at 95th, China at 107th. Countries like China and Russia and India, which is down in the same part of the index, well, in some ways, it's not surprising. They've spent a great deal of time over the last decades building their own economy, building their own society and their own polity, but it is to be hoped that the second phase of their growth will be somewhat more outward-looking than the first phase has been so far.
And then you can break down each country in terms of the actual datasets that build into it. I'll allow you to do that. From midnight tonight it's going to be on goodcountry.org, and you can look at the country. You can look right down to the level of the individual datasets.
Now that's the Good Country Index. What's it there for? Well, it's there really because I want to try to introduce this word, or reintroduce this word, into the discourse. I've had enough hearing about competitive countries. I've had enough hearing about prosperous, wealthy, fast-growing countries. I've even had enough hearing about happy countries because in the end that's still selfish. That's still about us, and if we carry on thinking about us, we are in deep, deep trouble. I think we all know what it is that we want to hear about. We want to hear about good countries, and so I want to ask you all a favor. I'm not asking a lot. It's something that you might find easy to do and you might even find enjoyable and even helpful to do, and that's simply to start using the word "good" in this context. When you think about your own country, when you think about other people's countries, when you think about companies, when you talk about the world that we live in today, start using that word in the way that I've talked about this evening. Not good, the opposite of bad, because that's an argument that never finishes. Good, the opposite of selfish, good being a country that thinks about all of us. That's what I would like you to do, and I'd like you to use it as a stick with which to beat your politicians. When you elect them, when you reelect them, when you vote for them, when you listen to what they're offering you, use that word, "good," and ask yourself, "Is that what a good country would do?" And if the answer is no, be very suspicious. Ask yourself, is that the behavior of my country? Do I want to come from a country where the government, in my name, is doing things like that? Or do I, on the other hand, prefer the idea of walking around the world with my head held high thinking, "Yeah, I'm proud to come from a good country"? And everybody will welcome you. And everybody in the last 15 seconds before they drift off to sleep at night will say, "Gosh, I'm glad that person's country exists."
Ultimately, that, I think, is what will make the change. That word, "good," and the number 6.8 and the discovery that's behind it have changed my life. I think they can change your life, and I think we can use it to change the way that our politicians and our companies behave, and in doing so, we can change the world. I've started thinking very differently about my own country since I've been thinking about these things. I used to think that I wanted to live in a rich country, and then I started thinking I wanted to live in a happy country, but I began to realize, it's not enough. I don't want to live in a rich country. I don't want to live in a fast-growing or competitive country. I want to live in a good country, and I so, so hope that you do too.
Thank you.
(Applause)
POL/GINT-TED Talks-Simon Anholt: Who would the rest of the world vote for in your country's election?
The following information is used for educational purposes only.
Filmed November 2016 at TEDxFrankfurt
Simon Anholt: Who would the rest of the world vote for in your country's election?
To make the world work, we need leaders who consider the needs of every man, woman, child and animal on the planet — not just their own voters. With the Global Vote, an online platform that lets anybody, anywhere in the world vote in the election of any country on earth, policy advisor Simon Anholt hopes to fill the gap between the few people who elect the world's most powerful leaders ... and the rest of us.
Transcript:
Well, as many of you know, the results of the recent election were as follows: Hillary Clinton, the Democratic candidate won a landslide victory with 52 percent of the overall vote. Jill Stein, the Green candidate, came a distant second, with 19 percent. Donald J. Trump, the Republic candidate, was hot on her heels with 14 percent, and the remainder of the vote were shared between abstainers and Gary Johnson, the Libertarian candidate.
(Laughter)
Now, what parallel universe do you suppose I live in? Well, I don't live in a parallel universe. I live in the world, and that is how the world voted. So let me take you back and explain what I mean by that.
In June this year, I launched something called the Global Vote. And the Global Vote does exactly what it says on the tin. For the first time in history, it lets anybody, anywhere in the world, vote in the elections of other people's countries. Now, why would you do that? What's the point? Well, let me show you what it looks like. You go to a website, rather a beautiful website, and then you select an election. Here's a bunch that we've already covered. We do about one a month, or thereabouts. So you can see Bulgaria, the United States of America, Secretary-General of the United Nations, the Brexit referendum at the end there. You select the election that you're interested in, and you pick the candidates. These are the candidates from the recent presidential election in the tiny island nation of São Tomé and Príncipe, 199,000 inhabitants, off the coast of West Africa. And then you can look at the brief summary of each of those candidates which I dearly hope is very neutral, very informative and very succinct. And when you've found the one you like, you vote. These were the candidates in the recent Icelandic presidential election, and that's the way it goes.
So why on earth would you want to vote in another country's election? Well, the reason that you wouldn't want to do it, let me reassure you, is in order to interfere in the democratic processes of another country. That's not the purpose at all. In fact, you can't, because usually what I do is I release the results after the electorate in each individual country has already voted, so there's no way that we could interfere in that process. But more importantly, I'm not particularly interested in the domestic issues of individual countries. That's not what we're voting on. So what Donald J. Trump or Hillary Clinton proposed to do for the Americans is frankly none of our business. That's something that only the Americans can vote on.
No, in the global vote, you're only considering one aspect of it, which is what are those leaders going to do for the rest of us? And that's so very important because we live, as no doubt you're sick of hearing people tell you, in a globalized, hyperconnected, massively interdependent world where the political decisions of people in other countries can and will have an impact on our lives no matter who we are, no matter where we live. Like the wings of the butterfly beating on one side of the Pacific that can apparently create a hurricane on the other side, so it is with the world that we live in today and the world of politics. There is no longer a dividing line between domestic and international affairs. Any country, no matter how small, even if it's São Tomé and Príncipe, could produce the next Nelson Mandela or the next Stalin. They could pollute the atmosphere and the oceans, which belong to all of us, or they could be responsible and they could help all of us.
And yet, the system is so strange because the system hasn't caught up with this globalized reality. Only a small number of people are allowed to vote for those leaders, even though their impact is gigantic and almost universal. What number was it? 140 million Americans voted for the next president of the United States, and yet, as all of us knows, in a few weeks time, somebody is going to hand over the nuclear launch codes to Donald J. Trump. Now, if that isn't having a potential impact on all of us, I don't know what is. Similarly, the election for the referendum on the Brexit vote, a small number of millions of British people voted on that, but the outcome of the vote, whichever way it went, would have had a significant impact on the lives of tens, hundreds of millions of people around the world. And yet, only a tiny number could vote.
What kind of democracy is that? Huge decisions that affect all of us being decided by relatively very small numbers of people. And I don't know about you, but I don't think that sounds very democratic.
So I'm trying to clear it up. But as I say, we don't ask about domestic questions. In fact, I only ever ask two questions of all of the candidates. I send them the same two questions every single time. I say, one, if you get elected, what are you going to do for the rest of us, for the remainder of the seven billion who live on this planet? Second question: What is your vision for your country's future in the world? What role do you see it playing? Every candidate, I send them those questions. They don't all answer. Don't get me wrong. I reckon if you're standing to become the next president of the United States, you're probably pretty tied up most of the time, so I'm not altogether surprised that they don't all answer, but many do. More every time. And some of them do much more than answer. Some of them answer in the most enthusiastic and most exciting way you could imagine.
I just want to say a word here for Saviour Chishimba, who was one of the candidates in the recent Zambian presidential election. His answers to those two questions were basically an 18-page dissertation on his view of Zambia's potential role in the world and in the international community. I posted it on the website so anybody could read it. Now, Saviour won the global vote, but he didn't win the Zambian election.
So I found myself wondering, what am I going to do with this extraordinary group of people? I've got some wonderful people here who won the global vote. We always get it wrong, by the way. The one that we elect is never the person who's elected by the domestic electorate. That may be partly because we always seem to go for the woman. But I think it may also be a sign that the domestic electorate is still thinking very nationally. They're still thinking very inwardly. They're still asking themselves: What's in it for me? ... instead of what they should be asking today, which is, what's in it for we?
But there you go. So suggestions, please, not right now, but send me an email if you've got an idea about what we can do with this amazing team of glorious losers. (Laughter) We've got Saviour Chishimba, who I mentioned before. We've got Halla Tómasdóttir, who was the runner up in the Icelandic presidential election. Many of you may have seen her amazing talk at TEDWomen just a few weeks ago where she spoke about the need for more women to get into politics. We've got Maria das Neves from São Tomé and Príncipe. We've got Hillary Clinton. I don't know if she's available. We've got Jill Stein. And we covered also the election for the next Secretary-General of the United Nations. We've got the ex-prime minister of New Zealand, who would be a wonderful member of the team. So I think maybe those people, the glorious loser's club, could travel around the world wherever there's an election and remind people of the necessity in our modern age of thinking a little bit outwards and thinking of the international consequences.
So what comes next for the global vote? Well, obviously, the Donald and Hillary show is a bit of a difficult one to follow, but there are some other really important elections coming up. In fact, they seem to be multiplying. There's something going on, I'm sure you've noticed, in the world. And the next row of elections are all critically important. In just a few day's time we've got the rerun of the Austrian presidential election, with the prospect of Norbert Hofer becoming what is commonly described as the first far-right head of state in Europe since the Second World War. Next year we've got Germany, we've got France, we've got presidential elections in Iran and a dozen others. It doesn't get less important. It gets more and more important.
Clearly, the global vote is not a stand-alone project. It's not just there on its own. It has some background. It's part of a project which I launched back in 2014, which I call the Good Country. The idea of the Good Country is basically very simple. It's my simple diagnosis of what's wrong with the world and how we can fix it. What's wrong with the world I've already hinted at. Basically, we face an enormous and growing number of gigantic, existential global challenges: climate change, human rights abuses, mass migration, terrorism, economic chaos, weapons proliferation. All of these problems which threaten to wipe us out are by their very nature globalized problems. No individual country has the capability of tackling them on its own.
And so very obviously we have to cooperate and we have to collaborate as nations if we're going to solve these problems. It's so obvious, and yet we don't. We don't do it nearly often enough. Most of the time, countries still persist in behaving as if they were warring, selfish tribes battling against each other, much as they have done since the nation-state was invented hundreds of years ago. And this has got to change. This is not a change in political systems or a change in ideology. This is a change in culture.
We, all of us, have to understand that thinking inwards is not the solution to the world's problems. We have to learn how to cooperate and collaborate a great deal more and compete just a tiny bit less. Otherwise things are going to carry on getting bad and they're going to get much worse, much sooner than we anticipate. This change will only happen if we ordinary people tell our politicians that things have changed. We have to tell them that the culture has changed. We have to tell them that they've got a new mandate. The old mandate was very simple and very single: if you're in a position of power or authority, you're responsible for your own people and your own tiny slice of territory, and that's it. And if in order to do the best thing for your own people, you screw over everybody else on the planet, that's even better. That's considered to be a bit macho. Today, I think everybody in a position of power and responsibility has got a dual mandate, which says if you're in a position of power and responsibility, you're responsible for your own people and for every single man, woman, child and animal on the planet. You're responsible for your own slice of territory and for every single square mile of the earth's surface and the atmosphere above it. And if you don't like that responsibility, you should not be in power. That for me is the rule of the modern age, and that's the message that we've got to get across to our politicians, and show them that that's the way things are done these days. Otherwise, we're all screwed.
I don't have a problem, actually, with Donald Trump's credo of "America first." It seems to me that that's a pretty banal statement of what politicians have always done and probably should always do. Of course they're elected to represent the interests of their own people. But what I find so boring and so old-fashioned and so unimaginative about his take on that is that America first means everyone else last, that making America great again means making everybody else small again, and it's just not true. In my job as a policy advisor over the last 20 years or so, I've seen so many hundreds of examples of policies that harmonize the international and the domestic needs, and they make better policy. I'm not asking nations to be altruistic or self-sacrificing. That would be ridiculous. No nation would ever do that. I'm asking them to wake up and understand that we need a new form of governance, which is possible and which harmonizes those two needs, those good for our own people and those good for everybody else. Since the US election and since Brexit it's become more and more obvious to me that those old distinctions of left wing and right wing no longer make sense. They really don't fit the pattern. What does seem to matter today is very simple, whether your view of the world is that you take comfort from looking inwards and backwards, or whether, like me, you find hope in looking forwards and outwards. That's the new politics. That's the new division that is splitting the world right down the middle. Now, that may sound judgmental, but it's not meant to be. I don't at all misunderstand why so many people find their comfort in looking inwards and backwards. When times are difficult, when you're short of money, when you're feeling insecure and vulnerable, it's almost a natural human tendency to turn inwards, to think of your own needs and to discard everybody else's, and perhaps to start to imagine that the past was somehow better than the present or the future could ever be. But I happen to believe that that's a dead end. History shows us that it's a dead end. When people turn inwards and turn backwards, human progress becomes reversed and things get worse for everybody very quickly indeed. If you're like me and you believe in forwards and outwards, and you believe that the best thing about humanity is its diversity, and the best thing about globalization is the way that it stirs up that diversity, that cultural mixture to make something more creative, more exciting, more productive than there's ever been before in human history, then, my friends, we've got a job on our hands, because the inwards and backwards brigade are uniting as never before, and that creed of inwards and backwards, that fear, that anxiety, playing on the simplest instincts, is sweeping across the world. Those of us who believe, as I believe, in forwards and outwards, we have to get ourselves organized, because time is running out very, very quickly.
Thank you.
(Applause)
Filmed November 2016 at TEDxFrankfurt
Simon Anholt: Who would the rest of the world vote for in your country's election?
To make the world work, we need leaders who consider the needs of every man, woman, child and animal on the planet — not just their own voters. With the Global Vote, an online platform that lets anybody, anywhere in the world vote in the election of any country on earth, policy advisor Simon Anholt hopes to fill the gap between the few people who elect the world's most powerful leaders ... and the rest of us.
Transcript:
Well, as many of you know, the results of the recent election were as follows: Hillary Clinton, the Democratic candidate won a landslide victory with 52 percent of the overall vote. Jill Stein, the Green candidate, came a distant second, with 19 percent. Donald J. Trump, the Republic candidate, was hot on her heels with 14 percent, and the remainder of the vote were shared between abstainers and Gary Johnson, the Libertarian candidate.
(Laughter)
Now, what parallel universe do you suppose I live in? Well, I don't live in a parallel universe. I live in the world, and that is how the world voted. So let me take you back and explain what I mean by that.
In June this year, I launched something called the Global Vote. And the Global Vote does exactly what it says on the tin. For the first time in history, it lets anybody, anywhere in the world, vote in the elections of other people's countries. Now, why would you do that? What's the point? Well, let me show you what it looks like. You go to a website, rather a beautiful website, and then you select an election. Here's a bunch that we've already covered. We do about one a month, or thereabouts. So you can see Bulgaria, the United States of America, Secretary-General of the United Nations, the Brexit referendum at the end there. You select the election that you're interested in, and you pick the candidates. These are the candidates from the recent presidential election in the tiny island nation of São Tomé and Príncipe, 199,000 inhabitants, off the coast of West Africa. And then you can look at the brief summary of each of those candidates which I dearly hope is very neutral, very informative and very succinct. And when you've found the one you like, you vote. These were the candidates in the recent Icelandic presidential election, and that's the way it goes.
So why on earth would you want to vote in another country's election? Well, the reason that you wouldn't want to do it, let me reassure you, is in order to interfere in the democratic processes of another country. That's not the purpose at all. In fact, you can't, because usually what I do is I release the results after the electorate in each individual country has already voted, so there's no way that we could interfere in that process. But more importantly, I'm not particularly interested in the domestic issues of individual countries. That's not what we're voting on. So what Donald J. Trump or Hillary Clinton proposed to do for the Americans is frankly none of our business. That's something that only the Americans can vote on.
No, in the global vote, you're only considering one aspect of it, which is what are those leaders going to do for the rest of us? And that's so very important because we live, as no doubt you're sick of hearing people tell you, in a globalized, hyperconnected, massively interdependent world where the political decisions of people in other countries can and will have an impact on our lives no matter who we are, no matter where we live. Like the wings of the butterfly beating on one side of the Pacific that can apparently create a hurricane on the other side, so it is with the world that we live in today and the world of politics. There is no longer a dividing line between domestic and international affairs. Any country, no matter how small, even if it's São Tomé and Príncipe, could produce the next Nelson Mandela or the next Stalin. They could pollute the atmosphere and the oceans, which belong to all of us, or they could be responsible and they could help all of us.
And yet, the system is so strange because the system hasn't caught up with this globalized reality. Only a small number of people are allowed to vote for those leaders, even though their impact is gigantic and almost universal. What number was it? 140 million Americans voted for the next president of the United States, and yet, as all of us knows, in a few weeks time, somebody is going to hand over the nuclear launch codes to Donald J. Trump. Now, if that isn't having a potential impact on all of us, I don't know what is. Similarly, the election for the referendum on the Brexit vote, a small number of millions of British people voted on that, but the outcome of the vote, whichever way it went, would have had a significant impact on the lives of tens, hundreds of millions of people around the world. And yet, only a tiny number could vote.
What kind of democracy is that? Huge decisions that affect all of us being decided by relatively very small numbers of people. And I don't know about you, but I don't think that sounds very democratic.
So I'm trying to clear it up. But as I say, we don't ask about domestic questions. In fact, I only ever ask two questions of all of the candidates. I send them the same two questions every single time. I say, one, if you get elected, what are you going to do for the rest of us, for the remainder of the seven billion who live on this planet? Second question: What is your vision for your country's future in the world? What role do you see it playing? Every candidate, I send them those questions. They don't all answer. Don't get me wrong. I reckon if you're standing to become the next president of the United States, you're probably pretty tied up most of the time, so I'm not altogether surprised that they don't all answer, but many do. More every time. And some of them do much more than answer. Some of them answer in the most enthusiastic and most exciting way you could imagine.
I just want to say a word here for Saviour Chishimba, who was one of the candidates in the recent Zambian presidential election. His answers to those two questions were basically an 18-page dissertation on his view of Zambia's potential role in the world and in the international community. I posted it on the website so anybody could read it. Now, Saviour won the global vote, but he didn't win the Zambian election.
So I found myself wondering, what am I going to do with this extraordinary group of people? I've got some wonderful people here who won the global vote. We always get it wrong, by the way. The one that we elect is never the person who's elected by the domestic electorate. That may be partly because we always seem to go for the woman. But I think it may also be a sign that the domestic electorate is still thinking very nationally. They're still thinking very inwardly. They're still asking themselves: What's in it for me? ... instead of what they should be asking today, which is, what's in it for we?
But there you go. So suggestions, please, not right now, but send me an email if you've got an idea about what we can do with this amazing team of glorious losers. (Laughter) We've got Saviour Chishimba, who I mentioned before. We've got Halla Tómasdóttir, who was the runner up in the Icelandic presidential election. Many of you may have seen her amazing talk at TEDWomen just a few weeks ago where she spoke about the need for more women to get into politics. We've got Maria das Neves from São Tomé and Príncipe. We've got Hillary Clinton. I don't know if she's available. We've got Jill Stein. And we covered also the election for the next Secretary-General of the United Nations. We've got the ex-prime minister of New Zealand, who would be a wonderful member of the team. So I think maybe those people, the glorious loser's club, could travel around the world wherever there's an election and remind people of the necessity in our modern age of thinking a little bit outwards and thinking of the international consequences.
So what comes next for the global vote? Well, obviously, the Donald and Hillary show is a bit of a difficult one to follow, but there are some other really important elections coming up. In fact, they seem to be multiplying. There's something going on, I'm sure you've noticed, in the world. And the next row of elections are all critically important. In just a few day's time we've got the rerun of the Austrian presidential election, with the prospect of Norbert Hofer becoming what is commonly described as the first far-right head of state in Europe since the Second World War. Next year we've got Germany, we've got France, we've got presidential elections in Iran and a dozen others. It doesn't get less important. It gets more and more important.
Clearly, the global vote is not a stand-alone project. It's not just there on its own. It has some background. It's part of a project which I launched back in 2014, which I call the Good Country. The idea of the Good Country is basically very simple. It's my simple diagnosis of what's wrong with the world and how we can fix it. What's wrong with the world I've already hinted at. Basically, we face an enormous and growing number of gigantic, existential global challenges: climate change, human rights abuses, mass migration, terrorism, economic chaos, weapons proliferation. All of these problems which threaten to wipe us out are by their very nature globalized problems. No individual country has the capability of tackling them on its own.
And so very obviously we have to cooperate and we have to collaborate as nations if we're going to solve these problems. It's so obvious, and yet we don't. We don't do it nearly often enough. Most of the time, countries still persist in behaving as if they were warring, selfish tribes battling against each other, much as they have done since the nation-state was invented hundreds of years ago. And this has got to change. This is not a change in political systems or a change in ideology. This is a change in culture.
We, all of us, have to understand that thinking inwards is not the solution to the world's problems. We have to learn how to cooperate and collaborate a great deal more and compete just a tiny bit less. Otherwise things are going to carry on getting bad and they're going to get much worse, much sooner than we anticipate. This change will only happen if we ordinary people tell our politicians that things have changed. We have to tell them that the culture has changed. We have to tell them that they've got a new mandate. The old mandate was very simple and very single: if you're in a position of power or authority, you're responsible for your own people and your own tiny slice of territory, and that's it. And if in order to do the best thing for your own people, you screw over everybody else on the planet, that's even better. That's considered to be a bit macho. Today, I think everybody in a position of power and responsibility has got a dual mandate, which says if you're in a position of power and responsibility, you're responsible for your own people and for every single man, woman, child and animal on the planet. You're responsible for your own slice of territory and for every single square mile of the earth's surface and the atmosphere above it. And if you don't like that responsibility, you should not be in power. That for me is the rule of the modern age, and that's the message that we've got to get across to our politicians, and show them that that's the way things are done these days. Otherwise, we're all screwed.
I don't have a problem, actually, with Donald Trump's credo of "America first." It seems to me that that's a pretty banal statement of what politicians have always done and probably should always do. Of course they're elected to represent the interests of their own people. But what I find so boring and so old-fashioned and so unimaginative about his take on that is that America first means everyone else last, that making America great again means making everybody else small again, and it's just not true. In my job as a policy advisor over the last 20 years or so, I've seen so many hundreds of examples of policies that harmonize the international and the domestic needs, and they make better policy. I'm not asking nations to be altruistic or self-sacrificing. That would be ridiculous. No nation would ever do that. I'm asking them to wake up and understand that we need a new form of governance, which is possible and which harmonizes those two needs, those good for our own people and those good for everybody else. Since the US election and since Brexit it's become more and more obvious to me that those old distinctions of left wing and right wing no longer make sense. They really don't fit the pattern. What does seem to matter today is very simple, whether your view of the world is that you take comfort from looking inwards and backwards, or whether, like me, you find hope in looking forwards and outwards. That's the new politics. That's the new division that is splitting the world right down the middle. Now, that may sound judgmental, but it's not meant to be. I don't at all misunderstand why so many people find their comfort in looking inwards and backwards. When times are difficult, when you're short of money, when you're feeling insecure and vulnerable, it's almost a natural human tendency to turn inwards, to think of your own needs and to discard everybody else's, and perhaps to start to imagine that the past was somehow better than the present or the future could ever be. But I happen to believe that that's a dead end. History shows us that it's a dead end. When people turn inwards and turn backwards, human progress becomes reversed and things get worse for everybody very quickly indeed. If you're like me and you believe in forwards and outwards, and you believe that the best thing about humanity is its diversity, and the best thing about globalization is the way that it stirs up that diversity, that cultural mixture to make something more creative, more exciting, more productive than there's ever been before in human history, then, my friends, we've got a job on our hands, because the inwards and backwards brigade are uniting as never before, and that creed of inwards and backwards, that fear, that anxiety, playing on the simplest instincts, is sweeping across the world. Those of us who believe, as I believe, in forwards and outwards, we have to get ourselves organized, because time is running out very, very quickly.
Thank you.
(Applause)
STS/BUS/FIN/ECON/GINT-TED Talks-Mona Chalabi: 3 ways to spot a bad statistic
The following information is used for educational purposes only.
Filmed February 2017 at TEDNYC
Mona Chalabi: 3 ways to spot a bad statistic
Polls that predict political candidates' chances to two decimal places are a problem. But we shouldn't count out stats altogether ... instead, we should learn to look behind them. In this delightful, hilarious talk, data journalist Mona Chalabi shares handy tips to help question, interpret and truly understand what the numbers are saying.
Transcript:
Now, I'm going to be talking about statistics today. If that makes you immediately feel a little bit wary, that's OK, that doesn't make you some kind of crazy conspiracy theorist, it makes you skeptical. And when it comes to numbers, especially now, you should be skeptical. But you should also be able to tell which numbers are reliable and which ones aren't. So today I want to try to give you some tools to be able to do that. But before I do, I just want to clarify which numbers I'm talking about here. I'm not talking about claims like, "9 out of 10 women recommend this anti-aging cream." I think a lot of us always roll our eyes at numbers like that. What's different now is people are questioning statistics like, "The US unemployment rate is five percent." What makes this claim different is it doesn't come from a private company, it comes from the government.
About 4 out of 10 Americans distrust the economic data that gets reported by government. Among supporters of President Trump it's even higher; it's about 7 out of 10. I don't need to tell anyone here that there are a lot of dividing lines in our society right now, and a lot of them start to make sense, once you understand people's relationships with these government numbers. On the one hand, there are those who say these statistics are crucial, that we need them to make sense of society as a whole in order to move beyond emotional anecdotes and measure progress in a subjective way. And then there are the others, who say that these statistics are elitist, maybe even rigged; they don't make sense and they don't really reflect what's happening in people's everyday lives.
It kind of feels like that second group is winning the argument right now. We're living in a world of alternative facts, where people don't find statistics this kind of common ground, this starting point for debate. This is a problem. There are actually moves in the US right now to get rid of some government statistics altogether. Right now there's a bill in congress about measuring racial inequality. The draft law says that government money should not be used to collect data on racial segregation. This is a total disaster. If we don't have this data, how can we observe discrimination, let alone fix it? In other words: How can a government create fair policies if they can't measure current levels of unfairness? This isn't just about discrimination, it's everything — think about it. How can we legislate on health care if we don't have good data on health or poverty? How can we have public debate about immigration if we can't at least agree on how many people are entering and leaving the country? Statistics come from the state; that's where they got their name. The point was to better measure the population in order to better serve it. So we need these government numbers, but we also have to move beyond either blindly accepting or blindly rejecting them. We need to learn the skills to be able to spot bad statistics.
I started to learn some of these when I was working in a statistical department that's part of the United Nations. Our job was to find out how many Iraqis had been forced from their homes as a result of the war, and what they needed. It was really important work, but it was also incredibly difficult. Every single day, we were making decisions that affected the accuracy of our numbers — decisions like which parts of the country we should go to, who we should speak to, which questions we should ask. And I started to feel really disillusioned with our work, because we thought we were doing a really good job, but the one group of people who could really tell us were the Iraqis, and they rarely got the chance to find our analysis, let alone question it. So I started to feel really determined that the one way to make numbers more accurate is to have as many people as possible be able to question them.
So I became a data journalist. My job is finding these data sets and sharing them with the public. Anyone can do this, you don't have to be a geek or a nerd. You can ignore those words; they're used by people trying to say they're smart while pretending they're humble. Absolutely anyone can do this.
I want to give you guys three questions that will help you be able to spot some bad statistics. So, question number one is: Can you see uncertainty? One of things that's really changed people's relationship with numbers, and even their trust in the media, has been the use of political polls. I personally have a lot of issues with political polls because I think the role of journalists is actually to report the facts and not attempt to predict them, especially when those predictions can actually damage democracy by signaling to people: don't bother to vote for that guy, he doesn't have a chance. Let's set that aside for now and talk about the accuracy of this endeavor.
Based on national elections in the UK, Italy, Israel and of course, the most recent US presidential election, using polls to predict electoral outcomes is about as accurate as using the moon to predict hospital admissions. No, seriously, I used actual data from an academic study to draw this. There are a lot of reasons why polling has become so inaccurate. Our societies have become really diverse, which makes it difficult for pollsters to get a really nice representative sample of the population for their polls. People are really reluctant to answer their phones to pollsters, and also, shockingly enough, people might lie. But you wouldn't necessarily know that to look at the media. For one thing, the probability of a Hillary Clinton win was communicated with decimal places. We don't use decimal places to describe the temperature. How on earth can predicting the behavior of 230 million voters in this country be that precise? And then there were those sleek charts. See, a lot of data visualizations will overstate certainty, and it works — these charts can numb our brains to criticism. When you hear a statistic, you might feel skeptical. As soon as it's buried in a chart, it feels like some kind of objective science, and it's not.
So I was trying to find ways to better communicate this to people, to show people the uncertainty in our numbers. What I did was I started taking real data sets, and turning them into hand-drawn visualizations, so that people can see how imprecise the data is; so people can see that a human did this, a human found the data and visualized it. For example, instead of finding out the probability of getting the flu in any given month, you can see the rough distribution of flu season. This is —
(Laughter)
a bad shot to show in February. But it's also more responsible data visualization, because if you were to show the exact probabilities, maybe that would encourage people to get their flu jabs at the wrong time.
The point of these shaky lines is so that people remember these imprecisions, but also so they don't necessarily walk away with a specific number, but they can remember important facts. Facts like injustice and inequality leave a huge mark on our lives. Facts like Black Americans and Native Americans have shorter life expectancies than those of other races, and that isn't changing anytime soon. Facts like prisoners in the US can be kept in solitary confinement cells that are smaller than the size of an average parking space.
The point of these visualizations is also to remind people of some really important statistical concepts, concepts like averages. So let's say you hear a claim like, "The average swimming pool in the US contains 6.23 fecal accidents." That doesn't mean every single swimming pool in the country contains exactly 6.23 turds. So in order to show that, I went back to the original data, which comes from the CDC, who surveyed 47 swimming facilities. And I just spent one evening redistributing poop. So you can kind of see how misleading averages can be.
(Laughter)
OK, so the second question that you guys should be asking yourselves to spot bad numbers is: Can I see myself in the data? This question is also about averages in a way, because part of the reason why people are so frustrated with these national statistics, is they don't really tell the story of who's winning and who's losing from national policy. It's easy to understand why people are frustrated with global averages when they don't match up with their personal experiences. I wanted to show people the way data relates to their everyday lives. I started this advice column called "Dear Mona," where people would write to me with questions and concerns and I'd try to answer them with data. People asked me anything. questions like, "Is it normal to sleep in a separate bed to my wife?" "Do people regret their tattoos?" "What does it mean to die of natural causes?
All of these questions are great, because they make you think about ways to find and communicate these numbers. If someone asks you, "How much pee is a lot of pee?" which is a question that I got asked, you really want to make sure that the visualization makes sense to as many people as possible. These numbers aren't unavailable. Sometimes they're just buried in the appendix of an academic study. And they're certainly not inscrutable; if you really wanted to test these numbers on urination volume, you could grab a bottle and try it for yourself.
(Laughter)
The point of this isn't necessarily that every single data set has to relate specifically to you. I'm interested in how many women were issued fines in France for wearing the face veil, or the niqab, even if I don't live in France or wear the face veil. The point of asking where you fit in is to get as much context as possible. So it's about zooming out from one data point, like the unemployment rate is five percent, and seeing how it changes over time, or seeing how it changes by educational status — this is why your parents always wanted you to go to college — or seeing how it varies by gender. Nowadays, male unemployment rate is higher than the female unemployment rate. Up until the early '80s, it was the other way around. This is a story of one of the biggest changes that's happened in American society, and it's all there in that chart, once you look beyond the averages. The axes are everything; once you change the scale, you can change the story.
OK, so the third and final question that I want you guys to think about when you're looking at statistics is: How was the data collected? So far, I've only talked about the way data is communicated, but the way it's collected matters just as much. I know this is tough, because methodologies can be opaque and actually kind of boring, but there are some simple steps you can take to check this.
I'll use one last example here. One poll found that 41 percent of Muslims in this country support jihad, which is obviously pretty scary, and it was reported everywhere in 2015. When I want to check a number like that, I'll start off by finding the original questionnaire. It turns out that journalists who reported on that statistic ignored a question lower down on the survey that asked respondents how they defined "jihad." And most of them defined it as, "Muslims' personal, peaceful struggle to be more religious." Only 16 percent defined it as, "violent holy war against unbelievers." This is the really important point: based on those numbers, it's totally possible that no one in the survey who defined it as violent holy war also said they support it. Those two groups might not overlap at all.
It's also worth asking how the survey was carried out. This was something called an opt-in poll, which means anyone could have found it on the internet and completed it. There's no way of knowing if those people even identified as Muslim. And finally, there were 600 respondents in that poll. There are roughly three million Muslims in this country, according to Pew Research Center. That means the poll spoke to roughly one in every 5,000 Muslims in this country.
This is one of the reasons why government statistics are often better than private statistics. A poll might speak to a couple hundred people, maybe a thousand, or if you're L'Oreal, trying to sell skin care products in 2005, then you spoke to 48 women to claim that they work.
(Laughter)
Private companies don't have a huge interest in getting the numbers right, they just need the right numbers. Government statisticians aren't like that. In theory, at least, they're totally impartial, not least because most of them do their jobs regardless of who's in power. They're civil servants. And to do their jobs properly, they don't just speak to a couple hundred people. Those unemployment numbers I keep on referencing come from the Bureau of Labor Statistics, and to make their estimates, they speak to over 140,000 businesses in this country.
I get it, it's frustrating. If you want to test a statistic that comes from a private company, you can buy the face cream for you and a bunch of friends, test it out, if it doesn't work, you can say the numbers were wrong. But how do you question government statistics? You just keep checking everything. Find out how they collected the numbers. Find out if you're seeing everything on the chart you need to see. But don't give up on the numbers altogether, because if you do, we'll be making public policy decisions in the dark, using nothing but private interests to guide us.
Thank you.
(Applause)
Filmed February 2017 at TEDNYC
Mona Chalabi: 3 ways to spot a bad statistic
Polls that predict political candidates' chances to two decimal places are a problem. But we shouldn't count out stats altogether ... instead, we should learn to look behind them. In this delightful, hilarious talk, data journalist Mona Chalabi shares handy tips to help question, interpret and truly understand what the numbers are saying.
Transcript:
Now, I'm going to be talking about statistics today. If that makes you immediately feel a little bit wary, that's OK, that doesn't make you some kind of crazy conspiracy theorist, it makes you skeptical. And when it comes to numbers, especially now, you should be skeptical. But you should also be able to tell which numbers are reliable and which ones aren't. So today I want to try to give you some tools to be able to do that. But before I do, I just want to clarify which numbers I'm talking about here. I'm not talking about claims like, "9 out of 10 women recommend this anti-aging cream." I think a lot of us always roll our eyes at numbers like that. What's different now is people are questioning statistics like, "The US unemployment rate is five percent." What makes this claim different is it doesn't come from a private company, it comes from the government.
About 4 out of 10 Americans distrust the economic data that gets reported by government. Among supporters of President Trump it's even higher; it's about 7 out of 10. I don't need to tell anyone here that there are a lot of dividing lines in our society right now, and a lot of them start to make sense, once you understand people's relationships with these government numbers. On the one hand, there are those who say these statistics are crucial, that we need them to make sense of society as a whole in order to move beyond emotional anecdotes and measure progress in a subjective way. And then there are the others, who say that these statistics are elitist, maybe even rigged; they don't make sense and they don't really reflect what's happening in people's everyday lives.
It kind of feels like that second group is winning the argument right now. We're living in a world of alternative facts, where people don't find statistics this kind of common ground, this starting point for debate. This is a problem. There are actually moves in the US right now to get rid of some government statistics altogether. Right now there's a bill in congress about measuring racial inequality. The draft law says that government money should not be used to collect data on racial segregation. This is a total disaster. If we don't have this data, how can we observe discrimination, let alone fix it? In other words: How can a government create fair policies if they can't measure current levels of unfairness? This isn't just about discrimination, it's everything — think about it. How can we legislate on health care if we don't have good data on health or poverty? How can we have public debate about immigration if we can't at least agree on how many people are entering and leaving the country? Statistics come from the state; that's where they got their name. The point was to better measure the population in order to better serve it. So we need these government numbers, but we also have to move beyond either blindly accepting or blindly rejecting them. We need to learn the skills to be able to spot bad statistics.
I started to learn some of these when I was working in a statistical department that's part of the United Nations. Our job was to find out how many Iraqis had been forced from their homes as a result of the war, and what they needed. It was really important work, but it was also incredibly difficult. Every single day, we were making decisions that affected the accuracy of our numbers — decisions like which parts of the country we should go to, who we should speak to, which questions we should ask. And I started to feel really disillusioned with our work, because we thought we were doing a really good job, but the one group of people who could really tell us were the Iraqis, and they rarely got the chance to find our analysis, let alone question it. So I started to feel really determined that the one way to make numbers more accurate is to have as many people as possible be able to question them.
So I became a data journalist. My job is finding these data sets and sharing them with the public. Anyone can do this, you don't have to be a geek or a nerd. You can ignore those words; they're used by people trying to say they're smart while pretending they're humble. Absolutely anyone can do this.
I want to give you guys three questions that will help you be able to spot some bad statistics. So, question number one is: Can you see uncertainty? One of things that's really changed people's relationship with numbers, and even their trust in the media, has been the use of political polls. I personally have a lot of issues with political polls because I think the role of journalists is actually to report the facts and not attempt to predict them, especially when those predictions can actually damage democracy by signaling to people: don't bother to vote for that guy, he doesn't have a chance. Let's set that aside for now and talk about the accuracy of this endeavor.
Based on national elections in the UK, Italy, Israel and of course, the most recent US presidential election, using polls to predict electoral outcomes is about as accurate as using the moon to predict hospital admissions. No, seriously, I used actual data from an academic study to draw this. There are a lot of reasons why polling has become so inaccurate. Our societies have become really diverse, which makes it difficult for pollsters to get a really nice representative sample of the population for their polls. People are really reluctant to answer their phones to pollsters, and also, shockingly enough, people might lie. But you wouldn't necessarily know that to look at the media. For one thing, the probability of a Hillary Clinton win was communicated with decimal places. We don't use decimal places to describe the temperature. How on earth can predicting the behavior of 230 million voters in this country be that precise? And then there were those sleek charts. See, a lot of data visualizations will overstate certainty, and it works — these charts can numb our brains to criticism. When you hear a statistic, you might feel skeptical. As soon as it's buried in a chart, it feels like some kind of objective science, and it's not.
So I was trying to find ways to better communicate this to people, to show people the uncertainty in our numbers. What I did was I started taking real data sets, and turning them into hand-drawn visualizations, so that people can see how imprecise the data is; so people can see that a human did this, a human found the data and visualized it. For example, instead of finding out the probability of getting the flu in any given month, you can see the rough distribution of flu season. This is —
(Laughter)
a bad shot to show in February. But it's also more responsible data visualization, because if you were to show the exact probabilities, maybe that would encourage people to get their flu jabs at the wrong time.
The point of these shaky lines is so that people remember these imprecisions, but also so they don't necessarily walk away with a specific number, but they can remember important facts. Facts like injustice and inequality leave a huge mark on our lives. Facts like Black Americans and Native Americans have shorter life expectancies than those of other races, and that isn't changing anytime soon. Facts like prisoners in the US can be kept in solitary confinement cells that are smaller than the size of an average parking space.
The point of these visualizations is also to remind people of some really important statistical concepts, concepts like averages. So let's say you hear a claim like, "The average swimming pool in the US contains 6.23 fecal accidents." That doesn't mean every single swimming pool in the country contains exactly 6.23 turds. So in order to show that, I went back to the original data, which comes from the CDC, who surveyed 47 swimming facilities. And I just spent one evening redistributing poop. So you can kind of see how misleading averages can be.
(Laughter)
OK, so the second question that you guys should be asking yourselves to spot bad numbers is: Can I see myself in the data? This question is also about averages in a way, because part of the reason why people are so frustrated with these national statistics, is they don't really tell the story of who's winning and who's losing from national policy. It's easy to understand why people are frustrated with global averages when they don't match up with their personal experiences. I wanted to show people the way data relates to their everyday lives. I started this advice column called "Dear Mona," where people would write to me with questions and concerns and I'd try to answer them with data. People asked me anything. questions like, "Is it normal to sleep in a separate bed to my wife?" "Do people regret their tattoos?" "What does it mean to die of natural causes?
All of these questions are great, because they make you think about ways to find and communicate these numbers. If someone asks you, "How much pee is a lot of pee?" which is a question that I got asked, you really want to make sure that the visualization makes sense to as many people as possible. These numbers aren't unavailable. Sometimes they're just buried in the appendix of an academic study. And they're certainly not inscrutable; if you really wanted to test these numbers on urination volume, you could grab a bottle and try it for yourself.
(Laughter)
The point of this isn't necessarily that every single data set has to relate specifically to you. I'm interested in how many women were issued fines in France for wearing the face veil, or the niqab, even if I don't live in France or wear the face veil. The point of asking where you fit in is to get as much context as possible. So it's about zooming out from one data point, like the unemployment rate is five percent, and seeing how it changes over time, or seeing how it changes by educational status — this is why your parents always wanted you to go to college — or seeing how it varies by gender. Nowadays, male unemployment rate is higher than the female unemployment rate. Up until the early '80s, it was the other way around. This is a story of one of the biggest changes that's happened in American society, and it's all there in that chart, once you look beyond the averages. The axes are everything; once you change the scale, you can change the story.
OK, so the third and final question that I want you guys to think about when you're looking at statistics is: How was the data collected? So far, I've only talked about the way data is communicated, but the way it's collected matters just as much. I know this is tough, because methodologies can be opaque and actually kind of boring, but there are some simple steps you can take to check this.
I'll use one last example here. One poll found that 41 percent of Muslims in this country support jihad, which is obviously pretty scary, and it was reported everywhere in 2015. When I want to check a number like that, I'll start off by finding the original questionnaire. It turns out that journalists who reported on that statistic ignored a question lower down on the survey that asked respondents how they defined "jihad." And most of them defined it as, "Muslims' personal, peaceful struggle to be more religious." Only 16 percent defined it as, "violent holy war against unbelievers." This is the really important point: based on those numbers, it's totally possible that no one in the survey who defined it as violent holy war also said they support it. Those two groups might not overlap at all.
It's also worth asking how the survey was carried out. This was something called an opt-in poll, which means anyone could have found it on the internet and completed it. There's no way of knowing if those people even identified as Muslim. And finally, there were 600 respondents in that poll. There are roughly three million Muslims in this country, according to Pew Research Center. That means the poll spoke to roughly one in every 5,000 Muslims in this country.
This is one of the reasons why government statistics are often better than private statistics. A poll might speak to a couple hundred people, maybe a thousand, or if you're L'Oreal, trying to sell skin care products in 2005, then you spoke to 48 women to claim that they work.
(Laughter)
Private companies don't have a huge interest in getting the numbers right, they just need the right numbers. Government statisticians aren't like that. In theory, at least, they're totally impartial, not least because most of them do their jobs regardless of who's in power. They're civil servants. And to do their jobs properly, they don't just speak to a couple hundred people. Those unemployment numbers I keep on referencing come from the Bureau of Labor Statistics, and to make their estimates, they speak to over 140,000 businesses in this country.
I get it, it's frustrating. If you want to test a statistic that comes from a private company, you can buy the face cream for you and a bunch of friends, test it out, if it doesn't work, you can say the numbers were wrong. But how do you question government statistics? You just keep checking everything. Find out how they collected the numbers. Find out if you're seeing everything on the chart you need to see. But don't give up on the numbers altogether, because if you do, we'll be making public policy decisions in the dark, using nothing but private interests to guide us.
Thank you.
(Applause)
POL/SOC/GINT-TED Talks-Margaret Bourdeaux: Why civilians suffer more once a war is over
The following information is used for educational purposes only.
Filmed November 2015 at TEDxBeaconStreet
Margaret Bourdeaux: Why civilians suffer more once a war is over
War doesn't just kill people; it destroys the institutions that keep society running, like utilities, banks and hospitals. Physician and global health policy analyst Margaret Bourdeaux proposes a bold approach to post-conflict recovery that focuses on building strong, resilient health systems that protect vulnerable populations.
Transcript:
So have you ever wondered what it would be like to live in a place with no rules? That sounds pretty cool.
(Laughter)
You wake up one morning, however, and you discover that the reason there are no rules is because there's no government, and there are no laws. In fact, all social institutions have disappeared. So there's no schools, there's no hospitals, there's no police, there's no banks, there's no athletic clubs, there's no utilities.
Well, I know a little bit about what this is like, because when I was a medical student in 1999, I worked in a refugee camp in the Balkans during the Kosovo War. When the war was over, I got permission — unbelievably — from my medical school to take some time off and follow some of the families that I had befriended in the camp back to their village in Kosovo, and understand how they navigated life in this postwar setting.
Postwar Kosovo was a very interesting place because NATO troops were there, mostly to make sure the war didn't break out again. But other than that, it was actually a lawless place, and almost every social institution, both public and private, had been destroyed. So I can tell you that when you go into one of these situations and settings, it is absolutely thrilling ... for about 30 minutes, because that's about how long it takes before you run into a situation where you realize how incredibly vulnerable you are.
For me, that moment came when I had to cross the first checkpoint, and I realized as I drove up that I would be negotiating passage through this checkpoint with a heavily armed individual who, if he decided to shoot me right then and there, actually wouldn't be doing anything illegal. But the sense of vulnerability that I had was absolutely nothing in comparison to the vulnerability of the families that I got to know over that year.
You see, life in a society where there are no social institutions is riddled with danger and uncertainty, and simple questions like, "What are we going to eat tonight?" are very complicated to answer. Questions about security, when you don't have any security systems, are terrifying. Is that altercation I had with the neighbor down the block going to turn into a violent episode that will end my life or my family's life?
Health concerns when there is no health system are also terrifying. I listened as many families had to sort through questions like, "My infant has a fever. What am I going to do?" "My sister, who is pregnant, is bleeding. What should I do? Who should I turn to?" "Where are the doctors, where are the nurses? If I could find one, are they trustworthy? How will I pay them? In what currency will I pay them?" "If I need medications, where will I find them? If I take those medications, are they actually counterfeits?" And on and on. So for life in these settings, the dominant theme, the dominant feature of life, is the incredible vulnerability that people have to manage day in and day out, because of the lack of social systems.
And it actually turns out that this feature of life is incredibly difficult to explain and be understood by people who are living outside of it. I discovered this when I left Kosovo. I came back to Boston, I became a physician, I became a global public health policy researcher. I joined the Harvard Medical School and Brigham and Women's Hospital Division of Global Health. And I, as a researcher, really wanted to get started on this problem right away. I was like, "How do we reduce the crushing vulnerability of people living in these types of fragile settings? Is there any way we can start to think about how to protect and quickly recover the institutions that are critical to survival, like the health system?" And I have to say, I had amazing colleagues. But one interesting thing about it was, this was sort of an unusual question for them. They were kind of like, "Oh, if you work in war, doesn't that mean you work on refugee camps, and you work on documenting mass atrocities?" — which is, by the way, very, very, very important.
So it took me a while to explain why I was so passionate about this issue, until about six years ago. That's when this landmark study that looked at and described the public health consequences of war was published. They came to an incredible, provocative conclusion. These researchers concluded that the vast majority of death and disability from war happens after the cessation of conflict. So the most dangerous time to be a person living in a conflict-affected state is after the cessation of hostilities; it's after the peace deal has been signed. It's when that political solution has been achieved. That seems so puzzling, but of course it's not, because war kills people by robbing them of their clinics, of their hospitals, of their supply chains. Their doctors are targeted, are killed; they're on the run. And more invisible and yet more deadly is the destruction of the health governance institutions and their finances.
So this is really not surprising at all to me. But what is surprising and somewhat dismaying, is how little impact this insight has had, in terms of how we think about human suffering and war. Let me give you a couple examples.
Last year, you may remember, Ebola hit the West African country of Liberia. There was a lot of reporting about this group, Doctors Without Borders, sounding the alarm and calling for aid and assistance. But not a lot of that reporting answered the question: Why is Doctors Without Borders even in Liberia? Doctors Without Borders is an amazing organization, dedicated and designed to provide emergency care in war zones. Liberia's civil war had ended in 2003 — that was 11 years before Ebola even struck. When Ebola struck Liberia, there were less than 50 doctors in the entire country of 4.5 million people. Doctors Without Borders is in Liberia because Liberia still doesn't really have a functioning health system, 11 years later.
When the earthquake hit Haiti in 2010, the outpouring of international aid was phenomenal. But did you know that only two percent of that funding went to rebuild Haitian public institutions, including its health sector? From that perspective, Haitians continue to die from the earthquake even today.
I recently met this gentleman. This is Dr. Nezar Ismet. He's the Minister of Health in the northern autonomous region of Iraq, in Kurdistan. Here he is announcing that in the last nine months, his country, his region, has increased from four million people to five million people. That's a 25 percent increase. Thousands of these new arrivals have experienced incredible trauma. His doctors are working 16-hour days without pay. His budget has not increased by 25 percent; it has decreased by 20 percent, as funding has flowed to security concerns and to short-term relief efforts. When his health sector fails — and if history is any guide, it will — how do you think that's going to influence the decision making of the five million people in his region as they think about whether they should flee that type of vulnerable living situation?
So as you can see, this is a frustrating topic for me, and I really try to understand: Why the reluctance to protect and support indigenous health systems and security systems? I usually tier two concerns, two arguments. The first concern is about corruption, and the concern that people in these settings are corrupt and they are untrustworthy. And I will admit that I have met unsavory characters working in health sectors in these situations. But I will tell you that the opposite is absolutely true in every case I have worked on, from Afghanistan to Libya, to Kosovo, to Haiti, to Liberia — I have met inspiring people, who, when the chips were down for their country, they risked everything to save their health institutions. The trick for the outsider who wants to help is identifying who those individuals are, and building a pathway for them to lead.
That is exactly what happened in Afghanistan. One of the unsung and untold success stories of our nation-building effort in Afghanistan involved the World Bank in 2002 investing heavily in identifying, training and promoting Afghani health sector leaders. These health sector leaders have pulled off an incredible feat in Afghanistan. They have aggressively increased access to health care for the majority of the population. They are rapidly improving the health status of the Afghan population, which used to be the worst in the world. In fact, the Afghan Ministry of Health does things that I wish we would do in America. They use things like data to make policy. It's incredible.
(Laughter)
The other concern I hear a lot about is: "We just can't afford it, we just don't have the money. It's just unsustainable." I would submit to you that the current situation and the current system we have is the most expensive, inefficient system we could possibly conceive of. The current situation is that when governments like the US — or, let's say, the collection of governments that make up the European Commission — every year, they spend 15 billion dollars on just humanitarian and emergency and disaster relief worldwide. That's nothing about foreign aid, that's just disaster relief. Ninety-five percent of it goes to international relief agencies, that then have to import resources into these areas, and knit together some type of temporary health system, let's say, which they then dismantle and send away when they run out of money.
So our job, it turns out, is very clear.
We, as the global health community policy experts, our first job is to become experts in how to monitor the strengths and vulnerabilities of health systems in threatened situations. And that's when we see doctors fleeing, when we see health resources drying up, when we see institutions crumbling — that's the emergency. That's when we need to sound the alarm and wave our arms. OK? Not now. Everyone can see that's an emergency, they don't need us to tell them that.
Number two: places like where I work at Harvard need to take their cue from the World Bank experience in Afghanistan, and we need to — and we will — build robust platforms to support health sector leaders like these. These people risk their lives. I think we can match their courage with some support.
Number three: we need to reach out and make new partnerships. At our global health center, we have launched a new initiative with NATO and other security policy makers to explore with them what they can do to protect health system institutions during deployments. We want them to see that protecting health systems and other critical social institutions is an integral part of their mission. It's not just about avoiding collateral damage; it's about winning the peace.
But the most important partner we need to engage is you, the American public, and indeed, the world public. Because unless you understand the value of social institutions, like health systems in these fragile settings, you won't support efforts to save them. You won't click on that article that talks about "Hey, all those doctors are on the run in country X. I wonder what that means. I wonder what that means for that health system's ability to, let's say, detect influenza." "Hmm, it's probably not good." That's what I'd tell you.
Up on the screen, I've put up my three favorite American institution defenders and builders. Over here is George C. Marshall, he was the guy that proposed the Marshall Plan to save all of Europe's economic institutions after World War II. And this Eleanor Roosevelt. Her work on human rights really serves as the foundation for all of our international human rights organizations. Then my big favorite is Ben Franklin, who did many things in terms of creating institutions, but was the midwife of our constitution.
And I would say to you that these are folks who, when our country was threatened, or our world was threatened, they didn't retreat. They didn't talk about building walls. They talked about building institutions to protect human security, for their generation and also for ours. And I think our generation should do the same.
Thank you.
(Applause)
Filmed November 2015 at TEDxBeaconStreet
Margaret Bourdeaux: Why civilians suffer more once a war is over
War doesn't just kill people; it destroys the institutions that keep society running, like utilities, banks and hospitals. Physician and global health policy analyst Margaret Bourdeaux proposes a bold approach to post-conflict recovery that focuses on building strong, resilient health systems that protect vulnerable populations.
Transcript:
So have you ever wondered what it would be like to live in a place with no rules? That sounds pretty cool.
(Laughter)
You wake up one morning, however, and you discover that the reason there are no rules is because there's no government, and there are no laws. In fact, all social institutions have disappeared. So there's no schools, there's no hospitals, there's no police, there's no banks, there's no athletic clubs, there's no utilities.
Well, I know a little bit about what this is like, because when I was a medical student in 1999, I worked in a refugee camp in the Balkans during the Kosovo War. When the war was over, I got permission — unbelievably — from my medical school to take some time off and follow some of the families that I had befriended in the camp back to their village in Kosovo, and understand how they navigated life in this postwar setting.
Postwar Kosovo was a very interesting place because NATO troops were there, mostly to make sure the war didn't break out again. But other than that, it was actually a lawless place, and almost every social institution, both public and private, had been destroyed. So I can tell you that when you go into one of these situations and settings, it is absolutely thrilling ... for about 30 minutes, because that's about how long it takes before you run into a situation where you realize how incredibly vulnerable you are.
For me, that moment came when I had to cross the first checkpoint, and I realized as I drove up that I would be negotiating passage through this checkpoint with a heavily armed individual who, if he decided to shoot me right then and there, actually wouldn't be doing anything illegal. But the sense of vulnerability that I had was absolutely nothing in comparison to the vulnerability of the families that I got to know over that year.
You see, life in a society where there are no social institutions is riddled with danger and uncertainty, and simple questions like, "What are we going to eat tonight?" are very complicated to answer. Questions about security, when you don't have any security systems, are terrifying. Is that altercation I had with the neighbor down the block going to turn into a violent episode that will end my life or my family's life?
Health concerns when there is no health system are also terrifying. I listened as many families had to sort through questions like, "My infant has a fever. What am I going to do?" "My sister, who is pregnant, is bleeding. What should I do? Who should I turn to?" "Where are the doctors, where are the nurses? If I could find one, are they trustworthy? How will I pay them? In what currency will I pay them?" "If I need medications, where will I find them? If I take those medications, are they actually counterfeits?" And on and on. So for life in these settings, the dominant theme, the dominant feature of life, is the incredible vulnerability that people have to manage day in and day out, because of the lack of social systems.
And it actually turns out that this feature of life is incredibly difficult to explain and be understood by people who are living outside of it. I discovered this when I left Kosovo. I came back to Boston, I became a physician, I became a global public health policy researcher. I joined the Harvard Medical School and Brigham and Women's Hospital Division of Global Health. And I, as a researcher, really wanted to get started on this problem right away. I was like, "How do we reduce the crushing vulnerability of people living in these types of fragile settings? Is there any way we can start to think about how to protect and quickly recover the institutions that are critical to survival, like the health system?" And I have to say, I had amazing colleagues. But one interesting thing about it was, this was sort of an unusual question for them. They were kind of like, "Oh, if you work in war, doesn't that mean you work on refugee camps, and you work on documenting mass atrocities?" — which is, by the way, very, very, very important.
So it took me a while to explain why I was so passionate about this issue, until about six years ago. That's when this landmark study that looked at and described the public health consequences of war was published. They came to an incredible, provocative conclusion. These researchers concluded that the vast majority of death and disability from war happens after the cessation of conflict. So the most dangerous time to be a person living in a conflict-affected state is after the cessation of hostilities; it's after the peace deal has been signed. It's when that political solution has been achieved. That seems so puzzling, but of course it's not, because war kills people by robbing them of their clinics, of their hospitals, of their supply chains. Their doctors are targeted, are killed; they're on the run. And more invisible and yet more deadly is the destruction of the health governance institutions and their finances.
So this is really not surprising at all to me. But what is surprising and somewhat dismaying, is how little impact this insight has had, in terms of how we think about human suffering and war. Let me give you a couple examples.
Last year, you may remember, Ebola hit the West African country of Liberia. There was a lot of reporting about this group, Doctors Without Borders, sounding the alarm and calling for aid and assistance. But not a lot of that reporting answered the question: Why is Doctors Without Borders even in Liberia? Doctors Without Borders is an amazing organization, dedicated and designed to provide emergency care in war zones. Liberia's civil war had ended in 2003 — that was 11 years before Ebola even struck. When Ebola struck Liberia, there were less than 50 doctors in the entire country of 4.5 million people. Doctors Without Borders is in Liberia because Liberia still doesn't really have a functioning health system, 11 years later.
When the earthquake hit Haiti in 2010, the outpouring of international aid was phenomenal. But did you know that only two percent of that funding went to rebuild Haitian public institutions, including its health sector? From that perspective, Haitians continue to die from the earthquake even today.
I recently met this gentleman. This is Dr. Nezar Ismet. He's the Minister of Health in the northern autonomous region of Iraq, in Kurdistan. Here he is announcing that in the last nine months, his country, his region, has increased from four million people to five million people. That's a 25 percent increase. Thousands of these new arrivals have experienced incredible trauma. His doctors are working 16-hour days without pay. His budget has not increased by 25 percent; it has decreased by 20 percent, as funding has flowed to security concerns and to short-term relief efforts. When his health sector fails — and if history is any guide, it will — how do you think that's going to influence the decision making of the five million people in his region as they think about whether they should flee that type of vulnerable living situation?
So as you can see, this is a frustrating topic for me, and I really try to understand: Why the reluctance to protect and support indigenous health systems and security systems? I usually tier two concerns, two arguments. The first concern is about corruption, and the concern that people in these settings are corrupt and they are untrustworthy. And I will admit that I have met unsavory characters working in health sectors in these situations. But I will tell you that the opposite is absolutely true in every case I have worked on, from Afghanistan to Libya, to Kosovo, to Haiti, to Liberia — I have met inspiring people, who, when the chips were down for their country, they risked everything to save their health institutions. The trick for the outsider who wants to help is identifying who those individuals are, and building a pathway for them to lead.
That is exactly what happened in Afghanistan. One of the unsung and untold success stories of our nation-building effort in Afghanistan involved the World Bank in 2002 investing heavily in identifying, training and promoting Afghani health sector leaders. These health sector leaders have pulled off an incredible feat in Afghanistan. They have aggressively increased access to health care for the majority of the population. They are rapidly improving the health status of the Afghan population, which used to be the worst in the world. In fact, the Afghan Ministry of Health does things that I wish we would do in America. They use things like data to make policy. It's incredible.
(Laughter)
The other concern I hear a lot about is: "We just can't afford it, we just don't have the money. It's just unsustainable." I would submit to you that the current situation and the current system we have is the most expensive, inefficient system we could possibly conceive of. The current situation is that when governments like the US — or, let's say, the collection of governments that make up the European Commission — every year, they spend 15 billion dollars on just humanitarian and emergency and disaster relief worldwide. That's nothing about foreign aid, that's just disaster relief. Ninety-five percent of it goes to international relief agencies, that then have to import resources into these areas, and knit together some type of temporary health system, let's say, which they then dismantle and send away when they run out of money.
So our job, it turns out, is very clear.
We, as the global health community policy experts, our first job is to become experts in how to monitor the strengths and vulnerabilities of health systems in threatened situations. And that's when we see doctors fleeing, when we see health resources drying up, when we see institutions crumbling — that's the emergency. That's when we need to sound the alarm and wave our arms. OK? Not now. Everyone can see that's an emergency, they don't need us to tell them that.
Number two: places like where I work at Harvard need to take their cue from the World Bank experience in Afghanistan, and we need to — and we will — build robust platforms to support health sector leaders like these. These people risk their lives. I think we can match their courage with some support.
Number three: we need to reach out and make new partnerships. At our global health center, we have launched a new initiative with NATO and other security policy makers to explore with them what they can do to protect health system institutions during deployments. We want them to see that protecting health systems and other critical social institutions is an integral part of their mission. It's not just about avoiding collateral damage; it's about winning the peace.
But the most important partner we need to engage is you, the American public, and indeed, the world public. Because unless you understand the value of social institutions, like health systems in these fragile settings, you won't support efforts to save them. You won't click on that article that talks about "Hey, all those doctors are on the run in country X. I wonder what that means. I wonder what that means for that health system's ability to, let's say, detect influenza." "Hmm, it's probably not good." That's what I'd tell you.
Up on the screen, I've put up my three favorite American institution defenders and builders. Over here is George C. Marshall, he was the guy that proposed the Marshall Plan to save all of Europe's economic institutions after World War II. And this Eleanor Roosevelt. Her work on human rights really serves as the foundation for all of our international human rights organizations. Then my big favorite is Ben Franklin, who did many things in terms of creating institutions, but was the midwife of our constitution.
And I would say to you that these are folks who, when our country was threatened, or our world was threatened, they didn't retreat. They didn't talk about building walls. They talked about building institutions to protect human security, for their generation and also for ours. And I think our generation should do the same.
Thank you.
(Applause)
MED/HEALTH/GINT-TED Talks-Catherine Mohr: Surgery's past, present and robotic future
The following information is used for educational purposes only.
Filmed February 2009 at TED2009
Catherine Mohr: Surgery's past, present and robotic future
Surgeon and inventor Catherine Mohr tours the history of surgery (and its pre-painkiller, pre-antiseptic past), then demos some of the newest tools for surgery through tiny incisions, performed using nimble robot hands. Fascinating — but not for the squeamish.
Transcript:
A talk about surgical robots is also a talk about surgery. And while I've tried to make my images not too graphic, keep in mind that surgeons have a different relationship with blood than normal people do, because, after all, what a surgeon does to a patient, if it were done without consent, would be a felony. Surgeons are the tailors, the plumbers, the carpenters — some would say the butchers — of the medical world: cutting, reshaping, reforming, bypassing, fixing. But you need to talk about surgical instruments and the evolution of surgical technology together.
So in order to give you some kind of a perspective of where we are right now with surgical robots, and where we're going to be going in the future, I want to give you a little bit of perspective of how we got to this point, how we even came to believe that surgery was OK, that this was something that was possible to do, that this kind of cutting and reforming was OK.
So, a little bit of perspective — about 10,000 years of perspective. This is a trephinated skull. And trephination is simply just cutting a hole in the skull. And many, many hundreds of skulls like this have been found in archaeological sites all over the world, dating back five to 10 thousand years. Five to 10 thousand years! Now imagine this. You are a healer in a Stone Age village. And you have some guy that you're not quite sure what's wrong with him — Oliver Sacks is going to be born way in the future. He's got some seizure disorder. And you don't understand this. But you think to yourself, "I'm not quite sure what's wrong with this guy. But maybe if I cut a hole in his head I can fix it." (Laughter) Now that is surgical thinking.
Now we've got the dawn of interventional surgery here. What is astonishing about this is, even though we don't know really how much of this was intended to be religious, or how much of it was intended to be therapeutic, what we can tell is that these patients lived! Judging by the healing on the borders of these holes, they lived days, months, years following trephination. And so what we are seeing is evidence of a refined technique that was being handed down over thousands and thousands of years, all over the world. This arose independently at sites everywhere that had no communication to one another. We really are seeing the dawn of interventional surgery.
Now we can fast forward many thousands of years into the Bronze Age and beyond. And we see new refined tools coming out. But surgeons in these eras are a little bit more conservative than their bold, trephinating ancestors. These guys confined their surgery to fairly superficial injuries. And surgeons were tradesmen, rather than physicians. This persisted all the way into and through the Renaissance.
That may have saved the writers, but it didn't really save the surgeons terribly much. They were still a mistrusted lot. Surgeons still had a bit of a PR problem, because the landscape was dominated by the itinerant barber surgeon. These were folks that traveled from village to village, town to town, doing surgery sort of as a form of performance art. Because we were in the age before anesthesia, the agony of the patient is really as much of the public spectacle as the surgery itself. One of the most famous of these guys, Frere Jacques, shown here doing a lithotomy — which is the removal of the bladder stone, one of the most invasive surgeries they did at the time — had to take less than two minutes. You had to have quite a flair for the dramatic, and be really, really quick.
And so here you see him doing a lithotomy. And he is credited with doing over 4,000 of these public surgeries, wandering around in Europe, which is an astonishing number, when you think that surgery must have been a last resort. I mean who would put themselves through that? Until anesthesia, the absence of sensation. With the demonstration of the Morton Ether Inhaler at the Mass. General in 1847, a whole new era of surgery was ushered in. Anesthesia gave surgeons the freedom to operate. Anesthesia gave them the freedom to experiment, to start to delve deeper into the body. This was truly a revolution in surgery.
But there was a pretty big problem with this. After these very long, painstaking operations, attempting to cure things they'd never been able to touch before, the patients died. They died of massive infection. Surgery didn't hurt anymore, but it killed you pretty quickly. And infection would continue to claim a majority of surgical patients until the next big revolution in surgery, which was aseptic technique.
Joseph Lister was aepsis's, or sterility's, biggest advocate, to a very very skeptical bunch of surgeons. But eventually they did come around. The Mayo brothers came out to visit Lister in Europe. And they came back to their American clinic and they said they had learned it was as important to wash your hands before doing surgery as it was to wash up afterwards. (Laughter) Something so simple. And yet, operative mortality dropped profoundly.
These surgeries were actually now being effective. With the patient insensitive to pain, and a sterile operating field all bets were off, the sky was the limit. You could now start doing surgery everywhere, on the gut, on the liver, on the heart, on the brain. Transplantation: you could take an organ out of one person, you could put it in another person, and it would work. Surgeons didn't have a problem with respectability anymore; they had become gods.
The era of the "big surgeon, big incision" had arrived, but at quite a cost, because they are saving lives, but not necessarily quality of life, because healthy people don't usually need surgery, and unhealthy people have a very hard time recovering from a cut like that. The question had to be asked, "Well, can we do these same surgeries but through little incisions?" Laparoscopy is doing this kind of surgery: surgery with long instruments through small incisions. And it really changed the landscape of surgery. Some of the tools for this had been around for a hundred years, but it had only been used as a diagnostic technique until the 1980s, when there was changes in camera technologies and things like that, that allowed this to be done for real operations.
So what you see — this is now the first surgical image — as we're coming down the tube, this is a new entry into the body. It looks very different from what you're expecting surgery to look like. We bring instruments in, from two separate cuts in the side, and then you can start manipulating tissue. Within 10 years of the first gallbladder surgeries being done laparoscopically, a majority of gallbladder surgeries were being done laparoscopically — truly a pretty big revolution.
But there were casualties of this revolution. These techniques were a lot harder to learn than people had anticipated. The learning curve was very long. And during that learning curve the complications went quite a bit higher. Surgeons had to give up their 3D vision. They had to give up their wrists. They had to give up intuitive motion in the instruments. This surgeon has over 3,000 hours of laparoscopic experience. Now this is a particularly frustrating placement of the needle. But this is hard. And one of the reasons why it is so hard is because the external ergonomics are terrible. You've got these long instruments, and you're working off your centerline. And the instruments are essentially working backwards.
So what you need to do, to take the capability of your hand, and put it on the other side of that small incision, is you need to put a wrist on that instrument. And so — I get to talk about robots — the da Vinci robot put just that wrist on the other side of that incision. And so here you're seeing the operation of this wrist. And now, in contrast to the laparoscopy, you can precisely place the needle in your instruments, and you can pass it all the way through and follow it in a trajectory. And the reason why this becomes so much easier is — you can see on the bottom — the hands are making the motions, and the instruments are following those motions exactly. Now, what you put between those instruments and those hands, is a large, fairly complicated robot. The surgeon is sitting at a console, and controlling the robot with these controllers. And the robot is moving these instruments around, and powering them, down inside the body. You have a 3D camera, so you get a 3D view.
And since this was introduced in 1999, a lot of these robots have been out and being used for surgical procedures like a prostatectomy, which is a prostate deep in the pelvis, and it requires fine dissection and delicate manipulation to be able to get a good surgical outcome. You can also sew bypass vessels directly onto a beating heart without cracking the chest. This is all done in between the ribs. And you can go inside the heart itself and repair the valves from the inside. You've got these technologies — thank you — (Applause) And so you might say, "Wow this is really cool! So, smartypants, why isn't all surgery being done this way?" And there are some reasons, some good reasons. And cost is one of them.
I talked about the large, complicated robot. With all its bells and whistles, one of those robots will cost you about as much as a solid gold surgeon. More useful than a solid gold surgeon, but, still, it's a fairly big capital investment. But once you've got it, your procedure costs do come down. But there are other barriers. So something like a prostatectomy — the prostate is small, and it's in one spot, and you can set your robot up very precisely to work in that one spot. And so it's perfect for something like that. And in fact if you, or anyone you know, had their prostate taken out in the last couple of years, chances are it was done with one of these systems. But if you need to reach more places than just one, you need to move the robot. And you need to put some new incisions in there. And you need to re-set it up. And then you need to add some more ports, and more. And the problem is it gets time-consuming, and cumbersome.
And for that reason there are many surgeries that just aren't being done with the da Vinci. So we had to ask the question, "Well how do we fix that?" What if we could change it so that we didn't have to re-set up each time we wanted to move somewhere different? What if we could bring all the instruments in together in one place? How would that change the capabilities of the surgeon? And how would that change the experience for the patient? Now, to do that, we need to be able to bring a camera and instruments in together through one small tube, like that tube you saw in the laparoscopy video. Or, not so coincidentally, like a tube like this.
So what's going to come out of that tube is the debut of this new technology, this new robot that is going to be able to reach anywhere. Ready? So here it comes. This is the camera, and three instruments. And as you see it come out, in order to actually be able to do anything useful, it can't all stay clustered up like this. It has to be able to come off of the centerline and then be able to work back toward that centerline. He's a cheeky little devil. But what this lets you do is gives you that all-important traction, and counter-traction, so that you can dissect, so that you can sew, so that you can do all the things that you need to do, all the surgical tasks. But it's all coming in through one incision. It's not so simple. But it's worth it for the freedom that this gives us as we're going around. For the patient, however, it's transparent. This is all they're going to see.
It's very exciting to think where we get to go with this. We get to write the script of the next revolution in surgery. As we take these capabilities, and we get to go to the next places, we get to decide what our new surgeries are going to be. And I think to really get the rest of the way in that revolution, we need to not just take our hands in in new ways, we also need to take our eyes in in new ways. We need to see beyond the surface. We need to be able to guide what we're cutting in a much better way.
This is a cancer surgery. One of the problems with this, even for surgeons who've been looking at this a lot, is you can't see the cancer, especially when it's hidden below the surface. And so what we're starting to do is we're starting to inject specially designed markers into the bloodstream that will target the cancer. It will go, bind to the cancer. And we can make those markers glow. And we can take special cameras, and we can look at it. Now we know where we need to cut, even when it's below the surface. We can take these markers and we can inject them in a tumor site. And we can follow where they flow out from that tumor site, so we can see the first places where that cancer might travel. We can inject these dyes into the bloodstream, so that when we do a new vessel and we bypass a blockage on the heart, we can see if we actually made the connection, before we close that patient back up again — something that we haven't been able to do without radiation before. We can light up tumors like this kidney tumor, so that you can exactly see where the boundary is between the kidney tumor and the kidney you want to leave behind, or the liver tumor and the liver you want to leave behind.
And we don't even need to confine ourselves to this macro vision. We have flexible microscopic probes that we can bring down into the body. And we can look at cells directly. I'm looking at nerves here. So these are nerves you see, down on the bottom, and the microscope probe that's being held by the robotic hand, up at the top. So this is all very prototypey at this point. But you care about nerves, if you are a surgical patient. Because they let you keep continence, bladder control, and sexual function after surgery, all of which is generally fairly important to the patient.
So, with the combination of these technologies we can reach it all, and we can see it all. We can heal the disease. And we can leave the patient whole and intact and functional afterwards. Now, I've talked about the patient as if the patient is, somehow, someone abstract outside this room. And that is not the case. Many of you, all of you maybe, will at some point, or have already, faced a diagnosis of cancer, or heart disease, or some organ dysfunction that's going to buy you a date with a surgeon. And when you get to that point — I mean, these maladies don't care how many books you've written, how many companies you've started, that Nobel Prize you have yet to win, how much time you planned to spend with your children. These maladies come for us all.
And the prospect I'm offering you, of an easier surgery ... is that going to make that diagnosis any less terrifying? I'm not sure I really even want it to. Because facing your own mortality causes a re-evaluation of priorities, and a realignment of what your goals are in life, unlike anything else. And I would never want to deprive you of that epiphany. What I want instead, is for you to be whole, intact, and functional enough to go out and save the world, after you've decided you need to do it. And that is my vision for your future. Thank you. (Applause)
Filmed February 2009 at TED2009
Catherine Mohr: Surgery's past, present and robotic future
Surgeon and inventor Catherine Mohr tours the history of surgery (and its pre-painkiller, pre-antiseptic past), then demos some of the newest tools for surgery through tiny incisions, performed using nimble robot hands. Fascinating — but not for the squeamish.
Transcript:
A talk about surgical robots is also a talk about surgery. And while I've tried to make my images not too graphic, keep in mind that surgeons have a different relationship with blood than normal people do, because, after all, what a surgeon does to a patient, if it were done without consent, would be a felony. Surgeons are the tailors, the plumbers, the carpenters — some would say the butchers — of the medical world: cutting, reshaping, reforming, bypassing, fixing. But you need to talk about surgical instruments and the evolution of surgical technology together.
So in order to give you some kind of a perspective of where we are right now with surgical robots, and where we're going to be going in the future, I want to give you a little bit of perspective of how we got to this point, how we even came to believe that surgery was OK, that this was something that was possible to do, that this kind of cutting and reforming was OK.
So, a little bit of perspective — about 10,000 years of perspective. This is a trephinated skull. And trephination is simply just cutting a hole in the skull. And many, many hundreds of skulls like this have been found in archaeological sites all over the world, dating back five to 10 thousand years. Five to 10 thousand years! Now imagine this. You are a healer in a Stone Age village. And you have some guy that you're not quite sure what's wrong with him — Oliver Sacks is going to be born way in the future. He's got some seizure disorder. And you don't understand this. But you think to yourself, "I'm not quite sure what's wrong with this guy. But maybe if I cut a hole in his head I can fix it." (Laughter) Now that is surgical thinking.
Now we've got the dawn of interventional surgery here. What is astonishing about this is, even though we don't know really how much of this was intended to be religious, or how much of it was intended to be therapeutic, what we can tell is that these patients lived! Judging by the healing on the borders of these holes, they lived days, months, years following trephination. And so what we are seeing is evidence of a refined technique that was being handed down over thousands and thousands of years, all over the world. This arose independently at sites everywhere that had no communication to one another. We really are seeing the dawn of interventional surgery.
Now we can fast forward many thousands of years into the Bronze Age and beyond. And we see new refined tools coming out. But surgeons in these eras are a little bit more conservative than their bold, trephinating ancestors. These guys confined their surgery to fairly superficial injuries. And surgeons were tradesmen, rather than physicians. This persisted all the way into and through the Renaissance.
That may have saved the writers, but it didn't really save the surgeons terribly much. They were still a mistrusted lot. Surgeons still had a bit of a PR problem, because the landscape was dominated by the itinerant barber surgeon. These were folks that traveled from village to village, town to town, doing surgery sort of as a form of performance art. Because we were in the age before anesthesia, the agony of the patient is really as much of the public spectacle as the surgery itself. One of the most famous of these guys, Frere Jacques, shown here doing a lithotomy — which is the removal of the bladder stone, one of the most invasive surgeries they did at the time — had to take less than two minutes. You had to have quite a flair for the dramatic, and be really, really quick.
And so here you see him doing a lithotomy. And he is credited with doing over 4,000 of these public surgeries, wandering around in Europe, which is an astonishing number, when you think that surgery must have been a last resort. I mean who would put themselves through that? Until anesthesia, the absence of sensation. With the demonstration of the Morton Ether Inhaler at the Mass. General in 1847, a whole new era of surgery was ushered in. Anesthesia gave surgeons the freedom to operate. Anesthesia gave them the freedom to experiment, to start to delve deeper into the body. This was truly a revolution in surgery.
But there was a pretty big problem with this. After these very long, painstaking operations, attempting to cure things they'd never been able to touch before, the patients died. They died of massive infection. Surgery didn't hurt anymore, but it killed you pretty quickly. And infection would continue to claim a majority of surgical patients until the next big revolution in surgery, which was aseptic technique.
Joseph Lister was aepsis's, or sterility's, biggest advocate, to a very very skeptical bunch of surgeons. But eventually they did come around. The Mayo brothers came out to visit Lister in Europe. And they came back to their American clinic and they said they had learned it was as important to wash your hands before doing surgery as it was to wash up afterwards. (Laughter) Something so simple. And yet, operative mortality dropped profoundly.
These surgeries were actually now being effective. With the patient insensitive to pain, and a sterile operating field all bets were off, the sky was the limit. You could now start doing surgery everywhere, on the gut, on the liver, on the heart, on the brain. Transplantation: you could take an organ out of one person, you could put it in another person, and it would work. Surgeons didn't have a problem with respectability anymore; they had become gods.
The era of the "big surgeon, big incision" had arrived, but at quite a cost, because they are saving lives, but not necessarily quality of life, because healthy people don't usually need surgery, and unhealthy people have a very hard time recovering from a cut like that. The question had to be asked, "Well, can we do these same surgeries but through little incisions?" Laparoscopy is doing this kind of surgery: surgery with long instruments through small incisions. And it really changed the landscape of surgery. Some of the tools for this had been around for a hundred years, but it had only been used as a diagnostic technique until the 1980s, when there was changes in camera technologies and things like that, that allowed this to be done for real operations.
So what you see — this is now the first surgical image — as we're coming down the tube, this is a new entry into the body. It looks very different from what you're expecting surgery to look like. We bring instruments in, from two separate cuts in the side, and then you can start manipulating tissue. Within 10 years of the first gallbladder surgeries being done laparoscopically, a majority of gallbladder surgeries were being done laparoscopically — truly a pretty big revolution.
But there were casualties of this revolution. These techniques were a lot harder to learn than people had anticipated. The learning curve was very long. And during that learning curve the complications went quite a bit higher. Surgeons had to give up their 3D vision. They had to give up their wrists. They had to give up intuitive motion in the instruments. This surgeon has over 3,000 hours of laparoscopic experience. Now this is a particularly frustrating placement of the needle. But this is hard. And one of the reasons why it is so hard is because the external ergonomics are terrible. You've got these long instruments, and you're working off your centerline. And the instruments are essentially working backwards.
So what you need to do, to take the capability of your hand, and put it on the other side of that small incision, is you need to put a wrist on that instrument. And so — I get to talk about robots — the da Vinci robot put just that wrist on the other side of that incision. And so here you're seeing the operation of this wrist. And now, in contrast to the laparoscopy, you can precisely place the needle in your instruments, and you can pass it all the way through and follow it in a trajectory. And the reason why this becomes so much easier is — you can see on the bottom — the hands are making the motions, and the instruments are following those motions exactly. Now, what you put between those instruments and those hands, is a large, fairly complicated robot. The surgeon is sitting at a console, and controlling the robot with these controllers. And the robot is moving these instruments around, and powering them, down inside the body. You have a 3D camera, so you get a 3D view.
And since this was introduced in 1999, a lot of these robots have been out and being used for surgical procedures like a prostatectomy, which is a prostate deep in the pelvis, and it requires fine dissection and delicate manipulation to be able to get a good surgical outcome. You can also sew bypass vessels directly onto a beating heart without cracking the chest. This is all done in between the ribs. And you can go inside the heart itself and repair the valves from the inside. You've got these technologies — thank you — (Applause) And so you might say, "Wow this is really cool! So, smartypants, why isn't all surgery being done this way?" And there are some reasons, some good reasons. And cost is one of them.
I talked about the large, complicated robot. With all its bells and whistles, one of those robots will cost you about as much as a solid gold surgeon. More useful than a solid gold surgeon, but, still, it's a fairly big capital investment. But once you've got it, your procedure costs do come down. But there are other barriers. So something like a prostatectomy — the prostate is small, and it's in one spot, and you can set your robot up very precisely to work in that one spot. And so it's perfect for something like that. And in fact if you, or anyone you know, had their prostate taken out in the last couple of years, chances are it was done with one of these systems. But if you need to reach more places than just one, you need to move the robot. And you need to put some new incisions in there. And you need to re-set it up. And then you need to add some more ports, and more. And the problem is it gets time-consuming, and cumbersome.
And for that reason there are many surgeries that just aren't being done with the da Vinci. So we had to ask the question, "Well how do we fix that?" What if we could change it so that we didn't have to re-set up each time we wanted to move somewhere different? What if we could bring all the instruments in together in one place? How would that change the capabilities of the surgeon? And how would that change the experience for the patient? Now, to do that, we need to be able to bring a camera and instruments in together through one small tube, like that tube you saw in the laparoscopy video. Or, not so coincidentally, like a tube like this.
So what's going to come out of that tube is the debut of this new technology, this new robot that is going to be able to reach anywhere. Ready? So here it comes. This is the camera, and three instruments. And as you see it come out, in order to actually be able to do anything useful, it can't all stay clustered up like this. It has to be able to come off of the centerline and then be able to work back toward that centerline. He's a cheeky little devil. But what this lets you do is gives you that all-important traction, and counter-traction, so that you can dissect, so that you can sew, so that you can do all the things that you need to do, all the surgical tasks. But it's all coming in through one incision. It's not so simple. But it's worth it for the freedom that this gives us as we're going around. For the patient, however, it's transparent. This is all they're going to see.
It's very exciting to think where we get to go with this. We get to write the script of the next revolution in surgery. As we take these capabilities, and we get to go to the next places, we get to decide what our new surgeries are going to be. And I think to really get the rest of the way in that revolution, we need to not just take our hands in in new ways, we also need to take our eyes in in new ways. We need to see beyond the surface. We need to be able to guide what we're cutting in a much better way.
This is a cancer surgery. One of the problems with this, even for surgeons who've been looking at this a lot, is you can't see the cancer, especially when it's hidden below the surface. And so what we're starting to do is we're starting to inject specially designed markers into the bloodstream that will target the cancer. It will go, bind to the cancer. And we can make those markers glow. And we can take special cameras, and we can look at it. Now we know where we need to cut, even when it's below the surface. We can take these markers and we can inject them in a tumor site. And we can follow where they flow out from that tumor site, so we can see the first places where that cancer might travel. We can inject these dyes into the bloodstream, so that when we do a new vessel and we bypass a blockage on the heart, we can see if we actually made the connection, before we close that patient back up again — something that we haven't been able to do without radiation before. We can light up tumors like this kidney tumor, so that you can exactly see where the boundary is between the kidney tumor and the kidney you want to leave behind, or the liver tumor and the liver you want to leave behind.
And we don't even need to confine ourselves to this macro vision. We have flexible microscopic probes that we can bring down into the body. And we can look at cells directly. I'm looking at nerves here. So these are nerves you see, down on the bottom, and the microscope probe that's being held by the robotic hand, up at the top. So this is all very prototypey at this point. But you care about nerves, if you are a surgical patient. Because they let you keep continence, bladder control, and sexual function after surgery, all of which is generally fairly important to the patient.
So, with the combination of these technologies we can reach it all, and we can see it all. We can heal the disease. And we can leave the patient whole and intact and functional afterwards. Now, I've talked about the patient as if the patient is, somehow, someone abstract outside this room. And that is not the case. Many of you, all of you maybe, will at some point, or have already, faced a diagnosis of cancer, or heart disease, or some organ dysfunction that's going to buy you a date with a surgeon. And when you get to that point — I mean, these maladies don't care how many books you've written, how many companies you've started, that Nobel Prize you have yet to win, how much time you planned to spend with your children. These maladies come for us all.
And the prospect I'm offering you, of an easier surgery ... is that going to make that diagnosis any less terrifying? I'm not sure I really even want it to. Because facing your own mortality causes a re-evaluation of priorities, and a realignment of what your goals are in life, unlike anything else. And I would never want to deprive you of that epiphany. What I want instead, is for you to be whole, intact, and functional enough to go out and save the world, after you've decided you need to do it. And that is my vision for your future. Thank you. (Applause)
MED/HEALTH/GINT-TED Talks-Nikolai Begg: A tool to fix one of the most dangerous moments in surgery
The following information is used for educational purposes only.
Filmed November 2013 at TEDxBeaconStreet
Nikolai Begg: A tool to fix one of the most dangerous moments in surgery
Surgeons are required every day to puncture human skin before procedures — with the risk of damaging what's on the other side. In a fascinating talk, find out how mechanical engineer Nikolai Begg is using physics to update an important medical device, called the trocar, and improve one of the most dangerous moments in many common surgeries.
Transcript:
The first time I stood in the operating room and watched a real surgery, I had no idea what to expect. I was a college student in engineering. I thought it was going to be like on TV. Ominous music playing in the background, beads of sweat pouring down the surgeon's face. But it wasn't like that at all. There was music playing on this day, I think it was Madonna's greatest hits. (Laughter) And there was plenty of conversation, not just about the patient's heart rate, but about sports and weekend plans. And since then, the more surgeries I watched, the more I realized this is how it is. In some weird way, it's just another day at the office. But every so often the music gets turned down, everyone stops talking, and stares at exactly the same thing. And that's when you know that something absolutely critical and dangerous is happening.
The first time I saw that I was watching a type of surgery called laparoscopic surgery And for those of you who are unfamiliar, laparoscopic surgery, instead of the large open incision you might be used to with surgery, a laparoscopic surgery is where the surgeon creates these three or more small incisions in the patient. And then inserts these long, thin instruments and a camera, and actually does the procedure inside the patient. This is great because there's much less risk of infection, much less pain, shorter recovery time. But there is a trade-off, because these incisions are created with a long, pointed device called a trocar. And the way the surgeon uses this device is that he takes it and he presses it into the abdomen until it punctures through. And now the reason why everyone in the operating room was staring at that device on that day was because he had to be absolutely careful not to plunge it through and puncture it into the organs and blood vessels below. But this problem should seem pretty familiar to all of you because I'm pretty sure you've seen it somewhere else. (Laughter) Remember this? (Applause) You knew that at any second that straw was going to plunge through, and you didn't know if it was going to go out the other side and straight into your hand, or if you were going to get juice everywhere, but you were terrified. Right? Every single time you did this, you experienced the same fundamental physics that I was watching in the operating room that day. And it turns out it really is a problem. In 2003, the FDA actually came out and said that trocar incisions might be the most dangerous step in minimally invasive surgery. Again in 2009, we see a paper that says that trocars account for over half of all major complications in laparoscopic surgery. And, oh by the way, this hasn't changed for 25 years.
So when I got to graduate school, this is what I wanted to work on. I was trying to explain to a friend of mine what exactly I was spending my time doing, and I said, "It's like when you're drilling through a wall to hang something in your apartment. There's that moment when the drill first punctures through the wall and there's this plunge. Right? And he looked at me and he said, "You mean like when they drill into people's brains?" And I said, "Excuse me?" (Laughter) And then I looked it up and they do drill into people's brains. A lot of neurosurgical procedures actually start with a drill incision through the skull. And if the surgeon isn't careful, he can plunge directly into the brain. So this is the moment when I started thinking, okay, cranial drilling, laparoscopic surgery, why not other areas of medicine? Because think about it, when was the last time you went to the doctor and you didn't get stuck with something? Right? So the truth is in medicine puncture is everywhere. And here are just a couple of the procedures that I've found that involve some tissue puncture step. And if we take just three of them — laparoscopic surgery, epidurals, and cranial drilling — these procedures account for over 30,000 complications every year in this country alone. I call that a problem worth solving.
So let's take a look at some of the devices that are used in these types of procedures. I mentioned epidurals. This is an epidural needle. It's used to puncture through the ligaments in the spine and deliver anesthesia during childbirth. Here's a set of bone marrow biopsy tools. These are actually used to burrow into the bone and collect bone marrow or sample bone lesions. Here's a bayonette from the Civil War. (Laughter) If I had told you it was a medical puncture device you probably would have believed me. Because what's the difference? So, the more I did this research the more I thought there has to be a better way to do this. And for me the key to this problem is that all these different puncture devices share a common set of fundamental physics.
So what are those physics? Let's go back to drilling through a wall. So you're applying a force on a drill towards the wall. And Newton says the wall is going to apply force back, equal and opposite. So, as you drill through the wall, those forces balance. But then there's that moment when the drill first punctures through the other side of the wall, and right at that moment the wall can't push back anymore. But your brain hasn't reacted to that change in force. So for that millisecond, or however long it takes you to react, you're still pushing, and that unbalanced force causes an acceleration, and that is the plunge. But what if right at the moment of puncture you could pull that tip back, actually oppose the forward acceleration? That's what I set out to do.
So imagine you have a device and it's got some kind of sharp tip to cut through tissue. What's the simplest way you could pull that tip back? I chose a spring. So when you extend that spring, you extend that tip out so it's ready to puncture tissue, the spring wants to pull the tip back. How do you keep the tip in place until the moment of puncture? I used this mechanism. When the tip of the device is pressed against tissue, the mechanism expands outwards and wedges in place against the wall. And the friction that's generated locks it in place and prevents the spring from retracting the tip. But right at the moment of puncture, the tissue can't push back on the tip anymore. So the mechanism unlocks and the spring retracts the tip. Let me show you that happening in slow motion. This is about 2,000 frames a second, and I'd like you to notice the tip that's right there on the bottom, about to puncture through tissue. And you'll see that right at the moment of puncture, right there, the mechanism unlocks and retracts that tip back. I want to show it to you again, a little closer up. You're going to see the sharp bladed tip, and right when it punctures that rubber membrane it's going to disappear into this white blunt sheath. Right there. That happens within four 100ths of a second after puncture. And because this device is designed to address the physics of puncture and not the specifics of cranial drilling or laparoscopic surgery, or another procedure, it's applicable across these different medical disciplines and across different length scales.
But it didn't always look like this. This was my first prototype. Yes, those are popsicle sticks, and there's a rubber band at the top. It took about 30 minutes to do this, but it worked. And it proved to me that my idea worked and it justified the next couple years of work on this project. I worked on this because this problem really fascinated me. It kept me up at night. But I think it should fascinate you too, because I said puncture is everywhere. That means at some point it's going to be your problem too. That first day in the operating room I never expected to find myself on the other end of a trocar. But last year, I got appendicitis when I was visiting Greece. So I was in the hospital in Athens, and the surgeon was telling me he was going to perform a laparoscopic surgery. He was going to remove my appendix through these tiny incisions, and he was talking about what I could expect for the recovery, and what was going to happen. He said, "Do you have any questions?" And I said, "Just one, doc. What kind of trocar do you use?"
So my favorite quote about laparoscopic surgery comes from a Doctor H. C. Jacobaeus: "It is puncture itself that causes risk." That's my favorite quote because H.C. Jacobaeus was the first person to ever perform laparoscopic surgery on humans, and he wrote that in 1912. This is a problem that's been injuring and even killing people for over 100 years.
So it's easy to think that for every major problem out there there's some team of experts working around the clock to solve it. The truth is that's not always the case. We have to be better at finding those problems and finding ways to solve them. So if you come across a problem that grabs you, let it keep you up at night. Allow yourself to be fascinated, because there are so many lives to save.
(Applause)
Filmed November 2013 at TEDxBeaconStreet
Nikolai Begg: A tool to fix one of the most dangerous moments in surgery
Surgeons are required every day to puncture human skin before procedures — with the risk of damaging what's on the other side. In a fascinating talk, find out how mechanical engineer Nikolai Begg is using physics to update an important medical device, called the trocar, and improve one of the most dangerous moments in many common surgeries.
Transcript:
The first time I stood in the operating room and watched a real surgery, I had no idea what to expect. I was a college student in engineering. I thought it was going to be like on TV. Ominous music playing in the background, beads of sweat pouring down the surgeon's face. But it wasn't like that at all. There was music playing on this day, I think it was Madonna's greatest hits. (Laughter) And there was plenty of conversation, not just about the patient's heart rate, but about sports and weekend plans. And since then, the more surgeries I watched, the more I realized this is how it is. In some weird way, it's just another day at the office. But every so often the music gets turned down, everyone stops talking, and stares at exactly the same thing. And that's when you know that something absolutely critical and dangerous is happening.
The first time I saw that I was watching a type of surgery called laparoscopic surgery And for those of you who are unfamiliar, laparoscopic surgery, instead of the large open incision you might be used to with surgery, a laparoscopic surgery is where the surgeon creates these three or more small incisions in the patient. And then inserts these long, thin instruments and a camera, and actually does the procedure inside the patient. This is great because there's much less risk of infection, much less pain, shorter recovery time. But there is a trade-off, because these incisions are created with a long, pointed device called a trocar. And the way the surgeon uses this device is that he takes it and he presses it into the abdomen until it punctures through. And now the reason why everyone in the operating room was staring at that device on that day was because he had to be absolutely careful not to plunge it through and puncture it into the organs and blood vessels below. But this problem should seem pretty familiar to all of you because I'm pretty sure you've seen it somewhere else. (Laughter) Remember this? (Applause) You knew that at any second that straw was going to plunge through, and you didn't know if it was going to go out the other side and straight into your hand, or if you were going to get juice everywhere, but you were terrified. Right? Every single time you did this, you experienced the same fundamental physics that I was watching in the operating room that day. And it turns out it really is a problem. In 2003, the FDA actually came out and said that trocar incisions might be the most dangerous step in minimally invasive surgery. Again in 2009, we see a paper that says that trocars account for over half of all major complications in laparoscopic surgery. And, oh by the way, this hasn't changed for 25 years.
So when I got to graduate school, this is what I wanted to work on. I was trying to explain to a friend of mine what exactly I was spending my time doing, and I said, "It's like when you're drilling through a wall to hang something in your apartment. There's that moment when the drill first punctures through the wall and there's this plunge. Right? And he looked at me and he said, "You mean like when they drill into people's brains?" And I said, "Excuse me?" (Laughter) And then I looked it up and they do drill into people's brains. A lot of neurosurgical procedures actually start with a drill incision through the skull. And if the surgeon isn't careful, he can plunge directly into the brain. So this is the moment when I started thinking, okay, cranial drilling, laparoscopic surgery, why not other areas of medicine? Because think about it, when was the last time you went to the doctor and you didn't get stuck with something? Right? So the truth is in medicine puncture is everywhere. And here are just a couple of the procedures that I've found that involve some tissue puncture step. And if we take just three of them — laparoscopic surgery, epidurals, and cranial drilling — these procedures account for over 30,000 complications every year in this country alone. I call that a problem worth solving.
So let's take a look at some of the devices that are used in these types of procedures. I mentioned epidurals. This is an epidural needle. It's used to puncture through the ligaments in the spine and deliver anesthesia during childbirth. Here's a set of bone marrow biopsy tools. These are actually used to burrow into the bone and collect bone marrow or sample bone lesions. Here's a bayonette from the Civil War. (Laughter) If I had told you it was a medical puncture device you probably would have believed me. Because what's the difference? So, the more I did this research the more I thought there has to be a better way to do this. And for me the key to this problem is that all these different puncture devices share a common set of fundamental physics.
So what are those physics? Let's go back to drilling through a wall. So you're applying a force on a drill towards the wall. And Newton says the wall is going to apply force back, equal and opposite. So, as you drill through the wall, those forces balance. But then there's that moment when the drill first punctures through the other side of the wall, and right at that moment the wall can't push back anymore. But your brain hasn't reacted to that change in force. So for that millisecond, or however long it takes you to react, you're still pushing, and that unbalanced force causes an acceleration, and that is the plunge. But what if right at the moment of puncture you could pull that tip back, actually oppose the forward acceleration? That's what I set out to do.
So imagine you have a device and it's got some kind of sharp tip to cut through tissue. What's the simplest way you could pull that tip back? I chose a spring. So when you extend that spring, you extend that tip out so it's ready to puncture tissue, the spring wants to pull the tip back. How do you keep the tip in place until the moment of puncture? I used this mechanism. When the tip of the device is pressed against tissue, the mechanism expands outwards and wedges in place against the wall. And the friction that's generated locks it in place and prevents the spring from retracting the tip. But right at the moment of puncture, the tissue can't push back on the tip anymore. So the mechanism unlocks and the spring retracts the tip. Let me show you that happening in slow motion. This is about 2,000 frames a second, and I'd like you to notice the tip that's right there on the bottom, about to puncture through tissue. And you'll see that right at the moment of puncture, right there, the mechanism unlocks and retracts that tip back. I want to show it to you again, a little closer up. You're going to see the sharp bladed tip, and right when it punctures that rubber membrane it's going to disappear into this white blunt sheath. Right there. That happens within four 100ths of a second after puncture. And because this device is designed to address the physics of puncture and not the specifics of cranial drilling or laparoscopic surgery, or another procedure, it's applicable across these different medical disciplines and across different length scales.
But it didn't always look like this. This was my first prototype. Yes, those are popsicle sticks, and there's a rubber band at the top. It took about 30 minutes to do this, but it worked. And it proved to me that my idea worked and it justified the next couple years of work on this project. I worked on this because this problem really fascinated me. It kept me up at night. But I think it should fascinate you too, because I said puncture is everywhere. That means at some point it's going to be your problem too. That first day in the operating room I never expected to find myself on the other end of a trocar. But last year, I got appendicitis when I was visiting Greece. So I was in the hospital in Athens, and the surgeon was telling me he was going to perform a laparoscopic surgery. He was going to remove my appendix through these tiny incisions, and he was talking about what I could expect for the recovery, and what was going to happen. He said, "Do you have any questions?" And I said, "Just one, doc. What kind of trocar do you use?"
So my favorite quote about laparoscopic surgery comes from a Doctor H. C. Jacobaeus: "It is puncture itself that causes risk." That's my favorite quote because H.C. Jacobaeus was the first person to ever perform laparoscopic surgery on humans, and he wrote that in 1912. This is a problem that's been injuring and even killing people for over 100 years.
So it's easy to think that for every major problem out there there's some team of experts working around the clock to solve it. The truth is that's not always the case. We have to be better at finding those problems and finding ways to solve them. So if you come across a problem that grabs you, let it keep you up at night. Allow yourself to be fascinated, because there are so many lives to save.
(Applause)
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