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Globally, we focus on health for the very same reason. We saw a terrible inequality, and we were moved by the injustice of it. A country can keep 99.8 percent of children alive during the first, most vulnerable years of their life. We know it’s possible, because Finland, which leads the world in child survival, does exactly that. But there are 10 countries in the world where a child is 50 times more likely to die than a child in Finland. Mere survival, of course, is not the goal. Thriving is. But most adults in these countries are trying to scratch a living out of already infertile soil as the climate changes. Many cannot read. Women are expected to marry young, bear children, and spend the majority of their life running the household. Thriving is very difficult under these circumstances.
Reducing inequality around the world poses different challenges than it does in the United States. The data we use to measure American economic mobility, for example, are relatively fine-grained, allowing us to look down to the level of individual zip codes. Not only can we compare our home of Seattle to one in Bettendorf, Iowa; we can compare South Seattle to North Seattle—and even the Rainier View neighborhood to Phinney Ridge.
Around the world, though, we have had to measure inequality at the level of regions or countries. We focus on driving child mortality in, say, sub-Saharan Africa or Yemen down to the level in western Europe or Finland.
Making big regional or national comparisons helps highlight the problem of inequality, but it can be a dangerous basis for formulating solutions. Such comparisons invite sweeping generalizations, treating foreign countries as undifferentiated units of analysis. China is four times the size of the United States, but it’s common to fall into the trap of regarding it as more unitary than the suburbs of Indianapolis.
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Recently, though, we received a new trove of data from the Institute for Health Metrics and Evaluation that makes it impossible to see inequality in foreign countries as any less complex than inequality in the United States.
The data are about health and education at the district level—that is, at the equivalent of the county level in the United States—in every single low- and low-middle-income country. They show with quantitative precision that every country has its South and North Seattles, its Bettendorfs, and its Indianapolis suburbs.
Consider Nigeria, which is about the size of France, Germany, and Great Britain combined. Nigeria may be a lower-middle-income country on average, but it’s not uniform. Parts of it resemble very poor countries—and parts of it are like much richer ones.
For example, in Garki, in Jigawa state, the average person never finished elementary school. (The average woman there, by the way, has more than two years less schooling than the average man.) By comparison, in Ado Ekiti, in Ekiti state, the average person is a high-school graduate. A child born in Ado Ekiti is three times more likely to survive than one born in Garki.