Hans Rosling, Ola Rosling and Anna Rosling Ronnlund. Factfulness – Ten reasons we’re wrong about the world – and why things are better than you think. Sceptre Books, Hodder and Stoughton, 2018, Rs 499, 353 pgs, ISBN: 978 1 473 63748 1

Hans Rosling, the Swedish physician, statistician, epidemiologist and TED Talk celebrity has a deep and intense connection to India. He studied public health at St. John’s Medical College in Bangalore (now Bengaluru) in 1972. Factfulness is his magnum opus and his last work before his passing away at the age of 68, in February 2018. Hans Rosling was a crusader against “misinformation” and an overdramatic worldview. He was a proponent of careful review of data, updating oneself on data about the world around us and seeing the world for what it is rather than how it is portrayed. In his own words he was a “possiblist”, someone who always liked to look at the various possibilities rather than be guided by extremes.

In this book, Rosling presents 10 reasons why all our popular perceptions of the world are wrong. His argument is that the grim picture of the world that the media, activists and politicians portray with respect to population, sustainability, environment, climate, resources and health are not really that bad. Everything is much better than it was in the past. He takes readers through 10 chapters, each of which deals with an “instinct” that drives us to look at the world as a place which is worse off. Some of the important instincts which he mentions are the ‘gap instinct’ which makes us see the world in dichotomies – the developed and developing world, the rich and poor world. He argues that such a dichotomy does not exist. There are several countries which are in the middle. The instinct to classify into two groups, he argues, is dangerous and makes the world appear to be a worse-off place.

His example of a preterm new born who is very sick and admitted into the new born intensive care unit is very relatable. He says the world today is in such a situation. The sick new born is in a very critical condition. However, it is making slow and steady progress in the intensive care unit. This means there is hope, as well as anxiety. The fact that the child is very sick does not preclude the fact that there is hope and there are small improvements. He uses this anecdote to exemplify the negativity instinct and the requirement to overcome the instinct.

The other major instinct which Rosling warns the readers about is the “fear instinct”. Fear is an instinct that protected the species from destruction. Some of these fears are embedded in us. Therefore, when information is provided that incites fear, it makes us want to believe it and react to it. There is a need to stay calm and look at the data critically, especially when it is data that incites fear. The other major error in understanding the world is the error of “size instinct” says Rosling. Sometimes numbers like globally 4.2 million children die before the age of 5 years is scary. However, one needs to compare it with the fact that about 76 years ago, 14 million children were dying before the age of 5 years. This gives better perspective.

The book is enriched by very interesting graphs, bubble plots and pictograms that convey the message very clearly. It is written in a conversational style and throughout the book, we feel Hans Rosling is talking directly to us. Those who have seen his TED Talks will know his inimitable style, his energy, enthusiasm and wit. The same strengths come across in the the book

As I was reading the book, a few thoughts struck me. I started reflecting on what this book tells me as someone interested in clinical medicine, public health and bioethics. The clinician in me is excited about the optimism that is evident in the book, though Hans Rosling himself denies that he is an ‘optimist’. I am energised by the fact that medicine has made so much progress over the years and that I have the capacity to contribute to it through the practice of medicine. On the other hand, as a public health practitioner, I am a bit concerned. I read about the numerous cases of violence against women reported all over the country, I am not able to reconcile this by saying, “I am probably just noticing an increased reporting, the global trend in everything is one of improvement, so violence against women is also likely to be reducing”. I am concerned that the false sense of assurance that “everything is improving” gives me, would take away the necessary impetus that is often required to push for changes in the system. Some of the struggles in society such as those for gender equality, for abolishing caste discrimination, for protecting the environment, require sustained pressure from advocates, activists, politicians and the media, and from citizens. I am concerned that the perspective of “the world is not the scary place that you think it is” will not help in these important struggles. I am also concerned about how donors and funding agencies will react when I tell them that I need money to tackle maternal mortality in my state. It was 200 per 100,000 live births about 50 years ago and now it is 6 per 100,000. Someone who doesn’t understand numbers the way they should be understood, might feel that this is not the right investment as maternal mortality is falling anyway.

All the 10 “instincts” that Rosling talks about are very important and any reader working in health, and human sciences can understand and relate to them. But a far more primal instinct that plagues healthcare work is the “neglect instinct”. Glaring inequities in health are often ignored and brushed under the carpet. Poverty, malnutrition, poor sanitation, poor housing and other deprivations of social determinants of health hide in plain sight in our cities and towns. It is not uncommon to see large sprawling slum settlements just adjacent to high rise buildings in metropolitan cities. Such a “neglect instinct” may not augur well for the cause of universal health coverage. Without the drama and noise of data on health inequities, justice may never be achieved. This is an overwhelming concern for anyone interested in bioethics and human rights.

In the last chapter of the book, Ola Rosling and Anna Rosling Ronnlund, the son and daughter in law of Hans Rosling write about their experience of collaborating with Hans through several years crunching numbers, analysing data and presenting the statistics to people. They recall poignantly Hans’ last days, when he was struggling with pancreatic cancer, in and out of hospital, when his only ray of light was the work on this book. This book is a must read for all those interested in health, healthcare and wellbeing. Hans Rosling speaks through its pages and jolts the reader into being more discerning consumers of health data.