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Dicing with death New prescriptions

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The Economist April 12th 2014 International 1 2 The odds of being murdered Dicing with death C ONGRATULATIONS: ifyou are reading this then you are not one of the 437,000 people whose lives ended as statistics in a grisly report on murder published on April 10th by the UN Office on Drugs and Crime. The unfortunate half-million were all those around the world who were slain in 2012. The aver- age person thus had roughly a one in 16,000 chance ofbeing bumped offthat year. But as the UN’s figures make clear, there is no such thing as an average per- son. How can you shorten your odds of making it through 2014? First, don’t live in the Americas or Africa, where murder rates (one in 6,100 and one in 8,000 respectively) are more than four times as high as the rest ofthe world. Western Europe and East Asia are the safest regions. And the safest coun- tries? Liechtenstein recorded no murders at all in 2012, but its population could fit in a football stadium. Amongthose coun- tries whose populations number in millions, the safest is Singapore, which clocked up just11murders in 2012, or one killing per 480,000 people. In Honduras, the world’s most violent country, one in every1,100 residents was killed. Next, be a woman. Your chance of being murdered will be barely a quarter what it would be were you a man. In fact, steer clear ofmen altogether: nearly half ofall female murder-victimsare killed by their partner or another (usually male) family member. But note that the gender imbalance is less pronounced in the rich world, probably because there is less banditry, a mainly male pursuit. In Japan and South Korea slightly over halfof all murder victims are female. Then, sit back and grow older. From the age of30 onwards, murder rates fall steadily in most places. But not every- where. Europeans are more at risk in middle age than in youth. European women cannot let their guard down even in retirement: those aged over 60 are more likely to be murdered than those aged 15-29. The UN speculates that this may be because they are more likely to have partners, and those partners are more likely to drink. Other studies have found that alcohol featured in half of murders in Australia, Finland and Swe- den, making it a more common factor than any weapon. And ifyou are killed? The chances are no one will be convicted. Worldwide only 43% ofmurders result in someone being put behind bars. This, too, varies hugely: whereas Europe’s police solve eight out of ten murders and those in Asia clear up nearly half, three-quarters of killers in the Americas escape justice (a smallershare in North America; a higher one elsewhere in the region). As long as that continues, there is little reason to thinkthat the region’s fearsome murder rate will be tamed. The UN offers some hints on howto avoid being bumped off Blood on the page South Africa 1/1,908 Brazil 1/2,473 United States 1/13,450 Singapore 1/256,100 Honduras 1/599 In Honduras, the world’s most violent country, one man in every 599 was murdered in 2012. To help readers visualise this statistic, we have created a (rare) print-only interactive chart. Stick this page of The Economist on the wall, don a blindfold, and throw a dart in its general direction. The chance of it hitting the large red square (assuming it lands somewhere on the page; if it doesn’t, try again) is the same as a Honduran man’s annual chance of being murdered. The chance for a man in Singapore, the world’s safest country with a population in the millions, is the same as your dart’s chance of hitting the tiny red speck to the left. Over a lifetime (assuming a life expectancy of 71 years and a stable murder rate), a Honduran man’s risk of being killed accumulates to a horrifying one in nine. That is equivalent to the chances of your dart landing anywhere in this red-outlined box. Odds of being murdered in one year Men, 2012 or latest heaval in Egypt to Jumia.com, an online re- tailer. Internet penetration rose as people sought reliable news. And because the streets were rowdy, explains Mattia Per- roni, Jumia’s boss in Egypt, people were less keen to shop on the street. Online re- tailers prospered. Sometimes the path from trouble to op- portunity is more direct. During the inter- necine violence in Colombia in the 1990s, Miguel Caballero knew a politician’s daughter who was tired of wearing heavy body armour. His firm developed a light- weight, haute couture alternative that is now available in Harrods, a high-end Lon- don department store. It has since branched out into bulletproof backpacks for American schoolchildren. “In every- thing bad,” observes that Syrian banker, “there is something good.” 7 I N 2000 policy wonks from governments and aid organisations agreed on what would become the Millennium Develop- ment Goals, an ambitious set of develop- ment targets for 2015. Surprisingly, the fine words prompted concerted action. From 2001 to 2010 the aid devoted to health care grew by more than 10% a year, compared with 7% a year in the 1990s. Most of the new money went on fighting the scourges on the list: HIV/AIDS, malaria, tuberculo- sis, and maternal and infantmortality. The growth in health-care aid has now slowed to less than halfthe rate ofthe early 2000s. And as 2015 approaches, donors are mulling new health-care goals. Ideas will be discussed at a big meeting of the World Bank and IMF in Washington, DC, on April 11th-13th. One is to make aid money go fur- ther by increasing the use of cash incen- tives for patients or health-care providers. Rather than merely buy inputs such as vac- cines, donors would pay for results, such as each child who is immunised. Such schemes can improve outcomes: one in Rwanda that offered cash rewards for clinics increased the share of women giving birth in the clinic, rather than at home, by 23%. But the design and imple- mentation need thought, says Tim Evans of the World Bank: another in the Demo- cratic Republic of Congo that paid clinics for offering more services—more prenatal consultations and childhood immunisa- tions, for example—made little difference, perhaps because the bonus payments were too small. Since 2008 the World Bankhasdevoted $2.5 billion to programmes that pay at least partly by results. It, and other donors, are thinking of shifting more of their spending to such schemes. But even ifthe outcome is greaterefficiency, itwill notdeal with a big- ger problem: the growing burden of chron- ic diseases in the developing world. Research by Christopher Murray of the University of Washington published on April 8th in the journal Health Affairs shows a growing mismatch between the ailments donors spend most on tackling, and those that are taking the heaviest toll. About 55% of all aid for health care in 2011, the most recent year for which global fig- ures were available, went to areas identi- fied by the Millennium Development Goals. Just 1% went to chronic ailments such as diabetes and heart disease, though Aid for health care New prescriptions Chronicdiseases and a cash squeeze are prompting donors to rethinkspending
Transcript

The Economist April 12th 2014 International

1

2 The odds of being murdered

Dicing with death

CONGRATULATIONS: ifyou arereading this then you are not one of

the 437,000 people whose lives ended asstatistics in a grisly report on murderpublished on April 10th by the UN Officeon Drugs and Crime. The unfortunatehalf-million were all those around theworld who were slain in 2012. The aver-age person thus had roughly a one in16,000 chance ofbeing bumped offthatyear. But as the UN’s figures make clear,there is no such thing as an average per-son. How can you shorten your odds ofmaking it through 2014?

First, don’t live in the Americas orAfrica, where murder rates (one in 6,100and one in 8,000 respectively) are morethan four times as high as the rest of theworld. Western Europe and East Asia arethe safest regions. And the safest coun-tries? Liechtenstein recorded no murdersat all in 2012, but its population could fitin a football stadium. Among those coun-tries whose populations number inmillions, the safest is Singapore, whichclocked up just11murders in 2012, or onekilling per 480,000 people. In Honduras,the world’s most violent country, one inevery1,100 residents was killed.

Next, be a woman. Your chance ofbeing murdered will be barely a quarterwhat it would be were you a man. In fact,steer clear ofmen altogether: nearly halfofall female murder-victims are killed bytheir partner or another (usually male)

family member. But note that the genderimbalance is less pronounced in the richworld, probably because there is lessbanditry, a mainly male pursuit. In Japanand South Korea slightly over halfof allmurder victims are female.

Then, sit backand grow older. Fromthe age of30 onwards, murder rates fallsteadily in most places. But not every-where. Europeans are more at risk inmiddle age than in youth. Europeanwomen cannot let their guard down evenin retirement: those aged over 60 aremore likely to be murdered than thoseaged 15-29. The UN speculates that thismay be because they are more likely tohave partners, and those partners aremore likely to drink. Other studies havefound that alcohol featured in half ofmurders in Australia, Finland and Swe-den, making it a more common factorthan any weapon.

And ifyou are killed? The chances areno one will be convicted. Worldwideonly 43% ofmurders result in someonebeing put behind bars. This, too, varieshugely: whereas Europe’s police solveeight out of ten murders and those in Asiaclear up nearly half, three-quarters ofkillers in the Americas escape justice (asmaller share in North America; a higherone elsewhere in the region). As long asthat continues, there is little reason tothink that the region’s fearsome murderrate will be tamed.

The UN offers some hints on howto avoid being bumped off

Blood on the page

SouthAfrica

1/1,908Brazil

1/2,473UnitedStates

1/13,450Singapore1/256,100

Honduras1/599

In Honduras, the world’s most violent country, one man in every 599 was murdered in 2012. To help readers visualise this statistic, we have created a (rare) print-only interactive chart. Stick this page of The Economist on the wall, don a blindfold, and throw a dart in its general direction. The chance of it hitting the large red

square (assuming it lands somewhere on the page; if it doesn’t, try again) is the same as a Honduran man’s annual chance of being murdered. The chance for a man in Singapore, the world’s safest country with a population in the millions, is the same as your dart’s chance of hitting the tiny red speck to the left. Over a lifetime (assuming a life expectancy of 71 years and a stable murder rate), a Honduran man’s risk of being killed accumulates to a horrifying one in nine. That is equivalent to the chances of your dart landing anywhere in this red-outlined box.

Odds of being murdered in one yearMen, 2012 or latest

heaval in Egypt to Jumia.com, an online re-tailer. Internet penetration rose as peoplesought reliable news. And because thestreets were rowdy, explains Mattia Per-roni, Jumia’s boss in Egypt, people wereless keen to shop on the street. Online re-tailers prospered.

Sometimes the path from trouble to op-portunity is more direct. During the inter-necine violence in Colombia in the 1990s,Miguel Caballero knew a politician’sdaughter who was tired of wearing heavybody armour. His firm developed a light-weight, haute couture alternative that isnow available in Harrods, a high-end Lon-don department store. It has sincebranched out into bulletproof backpacksfor American schoolchildren. “In every-thing bad,” observes that Syrian banker,“there is something good.” 7

IN 2000 policy wonks from governmentsand aid organisations agreed on what

would become the Millennium Develop-ment Goals, an ambitious set of develop-ment targets for 2015. Surprisingly, the finewords prompted concerted action. From2001 to 2010 the aid devoted to health caregrew by more than 10% a year, comparedwith 7% a year in the 1990s. Most of thenew money went on fighting the scourgeson the list: HIV/AIDS, malaria, tuberculo-sis, and maternal and infant mortality.

The growth in health-care aid has nowslowed to less than halfthe rate ofthe early2000s. And as 2015 approaches, donors aremulling new health-care goals. Ideas willbe discussed at a big meeting of the WorldBank and IMF in Washington, DC, on April11th-13th. One is to make aid money go fur-ther by increasing the use of cash incen-tives for patients or health-care providers.Rather than merely buy inputs such as vac-cines, donors would pay for results, suchas each child who is immunised.

Such schemes can improve outcomes:one in Rwanda that offered cash rewardsfor clinics increased the share of womengiving birth in the clinic, rather than athome, by 23%. But the design and imple-mentation need thought, says Tim Evansof the World Bank: another in the Demo-cratic Republic of Congo that paid clinicsfor offering more services—more prenatalconsultations and childhood immunisa-tions, for example—made little difference,perhaps because the bonus paymentswere too small.

Since 2008 the World Bankhas devoted$2.5 billion to programmes that pay at leastpartly by results. It, and other donors, arethinking of shifting more of their spendingto such schemes. But even if the outcome isgreaterefficiency, itwill notdeal with a big-ger problem: the growing burden of chron-ic diseases in the developing world.

Research by Christopher Murray of theUniversity of Washington published on

April 8th in the journal Health Affairsshows a growing mismatch between theailments donors spend most on tackling,and those that are taking the heaviest toll.About 55% of all aid for health care in 2011,the most recent year for which global fig-ures were available, went to areas identi-fied by the Millennium DevelopmentGoals. Just 1% went to chronic ailmentssuch as diabetes and heart disease, though

Aid for health care

New prescriptions

Chronicdiseases and a cash squeeze areprompting donors to rethinkspending

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