Society

Collidoscope: Of Books, Public Health and Automation

This week’s selection from the world of social science research.

Credit: A. Charlotte Riley/Flickr CC BY-NC-ND 2.0

Credit: A. Charlotte Riley/Flickr CC BY-NC-ND 2.0

Collidoscope is The Wire‘s weekly newsletter on social science research, bringing together different views and ways of understanding and analysing society. You can subscribe to the Collidoscope newsletter here.  If you missed the previous editions and would like to catch up, you can find them here.

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Selling books in Australia

Credit: Andy Simonds/Flickr CC BY-NC-ND 2.0

Credit: Andy Simonds/Flickr CC BY-NC-ND 2.0

How do you calculate the value of a book?

That’s what Alice Grundy is talking about in this interesting article on the political economy of books in Overland. Discount sales on books are the big thing in Australia, not only through Amazon and the like but also through discount stores. Discounted books, especially through online retailers, are big in India as well – and though I think nothing can replace the joy of browsing, it is also hard to argue with a less expensive version being delivered to your door step just with a few clicks. There are numerous proponents of cheaper books. “More affordable books, the argument goes, will mean a better informed/educated/entertained public – and who could disagree with that?”

Who does money from book sales go to? In most contracts with publishing houses, the author gets 10% of the revenue from book sales, Grundy writes. The author also receives an advance, which is a percentage of the estimated royalties from the first print run. Sometimes it may be slightly more than the estimate, in order to stop competing publishers from getting the book.

Then there is the bookseller, who is sold the books at a lower price so that she can make returns on her investments. On average in Australia, Grundy says, the bookseller discount is anything between 40% and 60% of the recommended retail price. If booksellers buy books that then don’t sell for the first three months, they can be returned to the publisher to no cost to the bookseller. If a book doesn’t get early traction, it is likely that a large stock will be returned to the publisher, meaning high freight and storage costs for the publisher.

Then there’s the distribution costs – particularly high in Australia given the size of the country and dispersed population. Local distribution costs can be up to 10% of the cost of the book, according to Grundy. Production costs, including typesetting, cover design, indexing and printing, count towards another 10%, on average. Much of the remainder of the book’s price goes towards what Grundy calls ‘hidden costs’ – staff and overhead costs, including the invisibilised but all-important editing process and the commissioning of books, as well as costs of marketing and publicity, and operating costs.

All of this, Grundy says, means a lean profit margin for a book. In fact, 80% of a publisher’s income is earned from 20% of the books published.

So what does this mean about the possibility of a world where books are cheaper, like in the discount stores?

Grundy thinks a book is a lasting pleasure that well deserves the price of two movie tickets (her prices are based on the Australian market but the same would largely be true in India) – and I’m inclined to agree. While affordable access to books is something I would be a strong proponent of, the way it is happening in the market is questionable, to say the least.

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The politics of public health

Credit: Reuters/Babu/Files

Credit: Reuters/Babu/Files

How did the patient become the ‘client’, and what does this mean for the inequalities in public health?

In Development and Change, Bridget O’Laughlin sets the stage for a debate on the inequalities in public health and how to address them. Because, she says, though there is now a broad consensus among scholars and development institutions on the need to address these inequalities, there are still wide disagreements on how this should be done, why it is important and what the causes of health inequalities are.

Lakoff has argued that though global public health seems to be a unified ideal, there are two distinct methods through which interventions are carried out (with different political ideals) – health security (as practiced by organisations like the WHO) and humanitarian biomedicine (followed by NGOs like Médecins Sans Frontières). Both construct global health inequalities in different ways, O’Laughlin writes. The first arises from a threat – of spreading diseases across national boundaries. With the patterns of globalisation and the freer flow of people and goods, this is now an even bigger concern for contagious diseases. Under this public health regime, the goal of public health is to minimise these threats.

But under the humanitarian biomedicine regime, inequalities in health are a problem in themselves. The aim is then different – to alleviate people’s suffering. For some, this even makes public health part of a larger global social justice movement. Scholars have previously argued that these two regimes are complementary rather than contradictory. In Lakoff’s words, “humanitarian biomedicine could be seen as offering a philanthropic palliative to nation-states lacking public health infrastructure in exchange for the right of international health organizations to monitor their populations for outbreaks that might threaten wealthy nations”.

In recent years, there has also been a renewed interest in the structural causes of public health inequalities. This is important, according to O’Laughlin, “because structure, like inequality, is a relational concept that makes it possible to think of states of health not as the properties of individuals but as the outcome of socially defined relations of hierarchy and domination”. Even the WHO, at the turn of the century, decided to seriously look into the social causes of disease. This is reflected primarily in the report of the WHO Commission on the Social Determinants of Health, which said that “These inequities in health, avoidable health inequalities, arise because of the circumstances in which people grow, live, work, and age, and the systems put in place to deal with illness. The conditions in which people live and die are, in turn, shaped by political, social, and economic forces.”

While this report has seen many criticisms, from the political left and from health economists, it was the first time the WHO was looking at social justice and inequalities within countries as integral to the public health debate. But in this report, like in many other discussions on the social justice approach to public health, ambiguities remain – concerned mainly with the public/private divide when it come to health service provision. By this O’Laughlin meant not only the state vs market debate,

The private, and the involvement of capital in global public health, has gone far beyond even what the World Bank initially envisioned. There is increased direct corporate investment in private hospitals and clinics, in service provision and in private insurance companies. Public-private partnerships are on the rise – governments are tied to corporations or NGOs, or both. The influence of ‘philanthrocapitalism’ in global health is increasing, seen particularly in the activities of the Bill and Melinda Gates Foundation (who receive tax breaks for their philanthropic work). Commercial management of public health is becoming more common – especially through the conditionalities imposed by the World Bank and other donors, O’Laughlin, public health institutions are governed like commercial bodies. Even in public health promotion, a corporate discourse is visible – ‘patients’ becoming ‘clients’ who choose between competitive options.

Has any of this increased access to healthcare? There are abundant case studies, O’Laughlin writes, showing that shrinking public health systems are increasing health inequalities. With redistributive healthcare reform linked closely to the market forces, the regulatory responsibilities of the state are shrinking. But why has this happened? O’Laughlin highlights certain convincing possibilities. First if the disillusionment with what states have achieved so far when it comes to public health goals. Another is that countries in the developing world that are former colonies inherited health structures that breed inequalities of race, class and region.

Looking into all of this background (and more) is what led O’Laughlin to formulate her final question on the subject – “How could wide concern with global inequalities in health be reconciled with assigning such an important role in addressing them to corporate and financial capital, the dominating pole of one of the core global inequalities of our times — namely class? How it is that capital has come to appropriate the right of critique and to dominate the space of reform?”

While contributors to Development and Change tried to answer these questions in their articles, O’Laughlin feels that this debate provided more in critique than as a transformational alternative. But, she argues, a possible conclusion comes through.

“Contributions to this Debate have shown that addressing the social causes of health requires broadening the political basis of coalitions beyond health professionals to find common ground with groups working against gender and racial discrimination or for migrant rights, land rights, better working conditions and wages and accountable government. Collective power built through struggles waged by local and national coalitions pushing for change in national health policies can affect the public health agenda of multilateral institutions such as the WHO.

The politics of social justice should not, therefore, be limited to narrow comparison of equity in individual outcomes. They must challenge the structural premises of the current health consensus. If corporate capital and social justice activists sit down in common fora and pragmatically agree, then there is something terribly wrong since structural struggle should always displace the boundaries of the possible.”

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How computers are setting us up for disaster

A Baxter robot of Rethink Robotics picks up a business card as it performs during a display at the World Economic Forum (WEF), in China's port city Dalian, Liaoning province, China, September 9, 2015. REUTERS/Jason Lee

Credit: Reuters/Jason Lee

Is our reliance on automation dangerously diminishing our skills?

That’s what Tim Harford is looking at in his Guardian article, adapted from his book Messy. And his answer is a clear yes.

Harford opens with the example of Air France flight 447 that crashed in May 2009 – only to highlight just how avoidable the crash was, if only the pilots were less dependent on the aeroplane’s sophisticated automation system. When the system went off without warning, the crew was left feeling completely helpless – even though they were, in fact, in control. In their panic, they did the opposite of what they should have done, led by their inexperience of handling a plane that had to be driven manually. The entire crew and all passengers – 228 people – died in the crash.

This is an extreme and hard-hitting example of what is otherwise an everyday phenomena – we no longer remember phone numbers because our cellphones will do it for us, calculators have replaced mental math even for easy calculations, Google Maps means you never really have to learn all the ways you can get from Point A to B. This is the paradox of automation, Harford writes. The more adept a technological system is, the more it will take away from human practice and skill. While on an everyday basis it may be hard to see the danger in this, what it does do is make humans much less able to handle extreme situations. It also means that it is easy to mask incompetence or the lack of skill. He quotes psychologist James Reason, writing in Human Error:

“Manual control is a highly skilled activity, and skills need to be practised continuously in order to maintain them. Yet an automatic control system that fails only rarely denies operators the opportunity for practising these basic control skills … when manual takeover is necessary something has usually gone wrong; this means that operators need to be more rather than less skilled in order to cope with these atypical conditions.”

And this danger, Harford writes, is only exacerbated by our complete trust and faith in automation. “We fail to see that a computer that is a hundred times more accurate than a human, and a million times faster, will make 10,000 times as many mistakes.”

Why do we see humans as watching and helping machines when they fail (which is usually in extreme circumstances that they then no longer have the skill to handle), rather than the other way round? This is an alternative solution Harford suggests – rather than humans, who need skill and practice, taking over in extreme circumstances, what if computers were to do so? If the bulk of the work was done by humans, thereby continuously honing their skills, and computers only take over if something is amiss?

“When humans are asked to babysit computers, for example, in the operation of drones, the computers themselves should be programmed to serve up occasional brief diversions. Even better might be an automated system that demanded more input, more often, from the human – even when that input is not strictly needed. If you occasionally need human skill at short notice to navigate a hugely messy situation, it may make sense to artificially create smaller messes, just to keep people on their toes.”

Harford then brings up the example of Dutch traffic engineer Hans Monderman, who did something of what he suggests computers do – create a messy situation to bring out the best in people. He pushed against the trend of tidy-trafficand created the “squareabout” instead of traffic light.

“…he built a square with fountains, a small grassy roundabout in one corner, pinch points where cyclists and pedestrians might try to cross the flow of traffic, and very little signposting of any kind. … Pedestrians and cyclists must cross the traffic as before, but now they have no traffic lights to protect them. It sounds dangerous – and surveys show that locals think it is dangerous. It is certainly unnerving to watch the squareabout in operation – drivers, cyclists and pedestrians weave in and out of one another in an apparently chaotic fashion.”

And yet, somehow, it works. People are careful, aware of their surroundings, and according to Harford, see each other as humans rather than threats. The clean world of automation, it looks like Harford is trying to argue, is missing one major element – when they’re used to it or prepared, a mess can bring out the best in people. And when they’re not, but find themselves in a mess anyway, it can mean disaster.


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If you have any comments or suggestions on what could be carried in this column, write to me at jahnavi@thewire.in