Good morning Hank, it's Tuesday.

So few weeks ago, I had to get a tetanus shot, because I was trying to harvest some green beans and I accidentally harvested part of my abdomen. It was an easy trip to the doctor, but while I was there, I kept thinking about all the systems that had to be in place for me to get that tetanus shot. 

Like, there had to be a system of roads and highways and bridges for me to get to the clinic, and a system of gasoline distribution to fuel my car, and a electric system which is necessary to keep the lights on and refrigerate my tetanus vaccine. A sewage treatment system allows for sanitary hand-washing and there's the system that trains and license healthcare workers and a system that manufactures and distributes the astonishing number of goods associated with my tetanus vaccine. 

I don't just mean the needles and the syringe and the vaccine itself, but also a cotton ball and Band-Aid and an alcohol wipe-out and gloves for the healthcare worker. 

In the dearly grind of daily life, most of us do not talk or think much about systems, because, you know, they're boring. Like, medical breakthrough are fascinating, improving supply chains so that medical breakthroughs that need to be refrigerated can stay refrigerated? not as fascinating. Still, I would argue that healthy system are kind of the key to healthy and productive human lives. They are so central, and so interdependent, that improving them can need to this massive virtuous cycle. 

You can look at almost any country and see this, but let's consider, say, Thailand. Between 1994 and 2014, Thailand's childhood mortality rate decreased by more than 55%. So what got better? Everything. Everything got better. Transportation systems got better, healthcare delivery systems got better, water treatment systems got better, agricultural efficiency got better, because better health means more people working, which means a bigger economy, which means more tax revenue to invest things like still better health, and also, say, better roads. Better roads makes health care and food delivery and everything else cheaper and faster. Better agricultural yields and food delivery systems means better health, which means more people working, which grows the economy and so on.

So, okay, let's just improve all the systems, but, yeah, of course it's not that easy. Like, let's look at Sierra Leone for instance, about 11% similar percentage-wise to, like, the UK, Australia or France, but because Sierra Leone is so much poorer country, 11% of their GDP is equal to $54 per person per year for healthcare. I paid $75 just for that tetanus shot, which admittedly is extortion, but still $54 per person per year is not enough to fund a robust healthcare system. 

And just as healthy systems can create virtuous cycles, weak systems can create vicious ones. If a country has very little tax revenue to build systems and lacks the political and economic stability necessary to attract private enterprise, system can weaken, which means less political and economic stability.

Like imagine you are in the same situation I was in, needing a tetanus shot, but in a community with much weaker systems. You may have to travel on bad roads, because the transportation system isn't strong. The clinic might be understaffed, because the health worker training and employment system isn't strong. But even if the clinic is adequately staffed and supplied, your tetanus shot might be ineffective, because it wasn't adequately refrigerated, because there wasn't electricity. 

Investments that take a really narrow view on healthcare, like healthcare is only tetanus shots, may not improving that situation much. And that's one of the reasons I admire Partners in Health so much, which nerdfighteria has been working with for a decade now, Partners in Health is systems-focused. They do not, like, drop in with solutions. They listen to and invest in communities. And while learning about global health over the last several years, I've seen again and again that these fragile systems can get better, and that focus on health in the largest sense of the world can improve every aspect of a community's life. 

Of course, investing in fragile systems sometime fails and progress is often not simple or linear, but it is real. So let's stay excited about breakthroughs and innovations that would improve human life, but let us not forget the humble system that literally keeps the light on.

Hank, I'll see you on Friday.