[scott_ci]

I've heard public health people talk about the problem of giving away nets for free before, and that charging some amount of money seems to improve usage. It may be more than just the decision between starving and malaria, but also some psychology involved with getting free things.

[schiffern]

How about… address the food insecurity first?

The symptom is that people are misusing nets. The problem is that they have no sustainable food system.

[vinceguidry]

That turns out to be surprisingly hard to do as well. You can't just ship free food in, strongmen will capture it and put it to their own use. Nets, being less fungible in their value, are ultimately less likely to be misused.

[schiffern]

>You can't just ship free food in

Agreed, that doesn't qualify as a sustainable food system.

[vinceguidry]

We need easy solutions because hard solutions won't scale. We can't create modern economies in places that don't have the infrastructure. We tried doing that once, it's called colonialism and it generally sucked. Your "sustainable food system" is something we can't give to people.

[schiffern]

>Your "sustainable food system" is something we can't give to people.

No argument there. They need their own sustainable food system.

We all do, if humanity is to continue (which is all "sustainable" means — able to continue).

How could humanity possibly continue without a sustainable food system? Am I missing something? This seems pretty uncontroversial.

[vinceguidry]

I'm having trouble understanding what you're hoping to bring to the conversation. The basic problem is this. There are a great deal of resources that can be brought to bear on solving problems in the world. There are lots of philanthropists in the world, with lots of money.

The problem is picking the right problem. There are big problems, like hunger. No matter how many resources you have, you're never going to make a dent in world hunger.

There are smaller problems, like dam building. One could, conceivably, build all the dams in the world that need to be built. But just like the big problems, there's never going to be any shortage of these smaller problems to solve, and each effort needs to be managed and championed.

So you can't just solve all of them. You have to pick one at a time and throw everything you have at it. The problem is not resources, but ideas. We need really good ideas for how best to go about making the world a better place. A good idea needs to be simple, because it has to be scaled.

HN is a forum where one good idea could inspire someone to make a Kickstarter campaign, that could attract the attention of someone like Bill Gates, and could improve the lives of potentially millions of people. I wish more people took that seriously.

Malaria nets have their problems. But they've also helped eradicate malaria in many places. People look at stories like this and they think, "aww that was a stupid idea anyway! Silly billionaires." It's not a stupid idea. It's a great one that we need more of.

[autokad]

and then they have more people and need more food, need more support for their ecosystem because of the exploding population is destroying it, and now you have uneducated people so they need education assistance, schools etc, etc etc. it seems like it would never end

[schiffern]

Any truly sustainable solution must address all these issues.

You've hit on the fundamental challenge of complex systems — it's the interactions between components that determines the behavior, not the components themselves. I would strongly recommend the video I linked elsewhere in this thread, if only as a "crash course" in systems thinking.

https://www.youtube.com/watch?v=HMmChiLZZHg#t=27m53s

[greeneggs]

Do you have any links? For example, Dupas writes,

"The third finding from recent pricing studies is that people need not have paid for something to value it. Households are as likely to use their bednet when they get it for free as when they have to pay for it (4, 7–9). People are as likely to use their water filter if they paid a lower price for it (2). This is surprising for two reasons. First, standard economic theory suggests that charging nontrivial user fees should help target products to those who need them the most—and thus those most likely to put them to appropriate use. But this reasoning breaks down when people face credit constraints and their ability to pay is lower than their willingness to pay. When those who could use a product the most are too poor to pay cash for it, higher prices screen out the poor, not just those with lower health returns from using the product (9). Second, it is often thought that the act of paying itself makes people value a product or service more; the feeling of “guilt” from having spent money on something that is left unused would make people more diligent users. However, experimental studies designed to test the importance of this psychological phenomenon suggest that this consideration is not important when it comes to essential health (2, 7, 10). The cost of poor health seems a good enough incentive to put products to good use."

Pascaline Dupas, "Getting essential health products to their end users: Subsidize, but how much?" Science 345:1279-1281, 2014. http://www.sciencemag.org/content/345/6202/1279.full.pdf?key...

[swatow]

There's another side to that, which is that charging a tiny amount has a disproportionate effect on usage (e.g. $0.00 to $0.01 has a bigger effect than $0.01 to $1.00). This shows that charging a fee has the negative impact of preventing people from buying them, even though the benefit outwieghs the cost.

[greeneggs]

Yes.

"It is often argued that cost-sharing—charging a subsidized, positive price—for a health product is necessary to avoid wasting resources on those who will not use or do not need the product. We explore this argument through a field experiment in Kenya, in which we randomized the price at which prenatal clinics could sell long-lasting antimalarial insecticide-treated bed nets (ITNs) to pregnant women. We find no evidence that cost-sharing reduces wastage on those who will not use the product: women who received free ITNs are not less likely to use them than those who paid subsidized positive prices. We also find no evidence that costsharing induces selection of women who need the net more: those who pay higher prices appear no sicker than the average prenatal client in the area in terms of measured anemia (an important indicator of malaria). Cost-sharing does, however, considerably dampen demand. We find that uptake drops by sixty percentage points when the price of ITNs increases from zero to $0.60 (i.e., from 100% to 90% subsidy), a price still $0.15 below the price at which ITNs are currently sold to pregnant women in Kenya. We combine our estimates in a cost-effectiveness analysis of the impact of ITN prices on child mortality that incorporates both private and social returns to ITN usage. Overall, our results suggest that free distribution of ITNs could save many more lives than cost-sharing programs have achieved so far, and, given the large positive externality associated with widespread usage of ITNs, would likely do so at a lesser cost per life saved."

Jessica Cohen & Pascaline Dupas, "Free Distribution or Cost-Sharing? Evidence from a Randomized Malaria Prevention Experiment", 2010 http://www.stanford.edu/~pdupas/CohenDupas.pdf

[jsnathan]

It might improve usage per household which agrees to pay for the nets, but what about the people who refuse to buy them?

Couldn't giving them out for free increase coverage even if the average usage is lower?

[patrickg_zill]

My brother runs a medical mission in Guatemala and this is precisely his experience - charging a small amount leads to better usage.