Cognitive Behavioral Therapy: Cost Effective Treatment for Criminals and At-Risk Teens

In an experiment in Liberia, researchers took 999 of the most violent, high-risk criminals in their capital, and for only $535 of expenses per person (nothing to these kinds of programs or compared to the cost of crime and prisons), they bought 20-50% lower incidents of crime in that population for a year. The treatment was asking 1500 candidates if they wanted therapy – 2/3 of them said yes – and they ran a cheap cognitive behavioral therapy (CBT) course with them.

CBT was then brought to Chicago youths with similarly positive results in three separate randomized controlled trials. Graduation rates rose and crime rates fell, crucial in bringing a new generation out of poverty with access to better opportunities.

Image By Jty33 (Own work) CC BY-SA 3.0


In the two studies participation in the program reduced total arrests during the intervention period by 28–35%, reduced violent-crime arrests by 45–50%, improved school engagement, and in the first study where we have follow-up data, increased graduation rates by 12–19% […] These large behavioral responses combined with modest program costs imply benefit-cost ratios for these interventions from 5-to-1 up to 30-to-1 or more. 

If the improvements in participants’ high school graduation lead to other future benefits such as increased earnings or longer life expectancies, these estimates may understate the full value of the program’s social benefits
“Thinking, Fast and Slow?” Heller, et al

 

To investigate, we recruited 999 of the highest-risk men in Liberia’s capital, generally aged 18 to 35. Most were engaged in part-time theft and drug dealing, and regularly had violent confrontations with each other, community members, and police.

Men who received therapy reduced their antisocial behavior dramatically. Within a few weeks, for instance, drug dealing halved and thefts fell by a third, compared to controls. With therapy alone, these effects diminished after a year. When therapy was followed by cash, however, effects were lasting. For example, a year later, those who received both therapy and cash were 44% less likely to be carrying a weapon, 43% less likely to sell drugs, and reported lower aggression. In the control group, men reported stealing almost once per week on average, and with therapy and cash this fell nearly 40%—equal to 25 crimes per year, per person. 
Poverty Action Lab

Congratulations, World. We’ve Almost Eliminated Poverty

The world is dominated by negative headlines. Single horrible events, like terrorist attacks or natural disasters. But, in the background, millions of people are making slow and steady progress making our world infinitely better than the world of our ancestors. 

One striking example is the global poverty rate. As recently as the 90s, the portion of humanity that lived in extreme poverty was well over half. Now? As of 2015, it’s estimated that fewer than one in ten people suffer through the same meager existence. The biggest gains have been in India and China, but the progress is truly global. 

It’s entirely possible that someone reading this post will see a world within their lifetime where almost no person ever has to wonder where their next meal is coming from.

Image By Jonathan McIntosh (Own work) [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)%5D, via Wikimedia Commons


“In East Asia and Pacific the extreme poverty rate fell from 61 percent in 1990 to 7 percent in 2012, and in South Asia it fell from 51 percent to 19percent (figure 1a). In contrast, SubSaharan Africa’s extreme poverty rate did not fall below its 1990 level until 2002. Based on national growth rates over the past 10 years, the global extreme poverty rate is estimated to be below 10 percent in 2015, a drop of more than two-thirds since 1990.”
The World Bank

Sesame Street was, by the Numbers, a Great Investment

Education is important for reducing long-term poverty.

Sesame Street has done a great job improving test scores and education outcomes in children, which a study by the National Bureau of Economics Research was able to tell by mapping out where the show rolled out over time, and looking at statistics before and after in each school district.

While it alone can’t miraculously solve poverty, the show did have a small effect on future wages as well, and was incredibly cheap to roll out compared to other programs aimed at poverty reduction.

Image By Staff Sgt. Dijon Rolle (United States Army)
[Public domain], via Wikimedia Commons


It cost pennies on the dollar relative to other early childhood interventions. Well-designed research studies conducted at that time, reviewed in detail below, indicate that the show had a substantial and immediate impact on test scores,
[…] Our analysis takes advantage of the county-level variation in viewer’s ability to watch Sesame Street generated by these technological constraints that existed when the show was introduced in 1969
[…] The small estimated impact on wages in adulthood, though, is consistent with forecasts based on the estimated improvements in test scores and grade-for-age status brought about by the show’s introduction.
http://www.nber.org/papers/w21229.pdf (paywall) (Early Childhood Education by MOOC: Lessons from Sesame Street, Melissa S. Kearney, Phillip B. Levine, National Bureau of Economics Research)

How “Sugar Daddy Training” Saves Lives

The power imbalance and age imbalance in “sugar daddy” relationships – where a better-off older male has a sexual relationship with a young woman – are particularly bad for STD transmission rates and unplanned single-parent pregnancies.

The women don’t have the power in the relationship to demand safe sex, and the man is more likely to have multiple partners. A simple program implemented in Kenya, and since replicated elsewhere, lowered teenage pregnancies from relationships with adult men by more than half just by replacing existing abstinence training with training that specifically pointed out the dangers of going out with older men.

This is a big deal. And all it takes is telling teenagers at risk “hey, maybe date someone your own age.”

Image Source: By Adam Jones, Ph.D. (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)%5D, via Wikimedia Commons


All these types of asymmetries are associated with nonuse of condoms. Increasing women’s power within asymmetric sexual relationships could improve their ability to negotiate safer sexual behaviors, such as condom use.
http://www.jstor.org/stable/3649496?seq=1#page_scan_tab_contents

We use a randomized experiment to test whether and what information changes teenagers’ sexual behavior in Kenya. Providing information on the relative risk of HIV infection by partner’s age led to a 28 percent decrease in teen pregnancy, an objective proxy for the incidence of unprotected sex. Self-reported sexual behavior data suggests substitution away from older (riskier) partners and toward same-age partners. In contrast, the official abstinence-only HIV curriculum had no impact on teen pregnancy.
https://www.aeaweb.org/articles?id=10.1257/app.3.1.1

An information campaign that provided Kenyan teenagers in randomly selected schools with the information that HIV prevalence was much higher among adult men and their partners than among teenage boys led to a 65% decrease in the incidence of pregnancies by adult partners among teenage girls in the treatment group relative to the comparison. This suggests a large reduction in the incidence of unprotected cross-generational sex. The information campaign did not increase pregnancies among teenage couples.
https://mpra.ub.uni-muenchen.de/248/1/MPRA_paper_248.pdf

It shows that 43 percent of men over 40 years of age in Botswana carry HIV, far higher than the 4 to 5 percent infection rate of men in their teens and early 20s.
Jaws drop. “Oh my gosh!” blurts out one girl.
http://www.npr.org/sections/goatsandsoda/2015/07/30/419565650/how-to-convince-teen-girls-to-stay-away-from-sugar-daddies

The Largest Global Cause of Death Is Being Neglected Because of Headline-Grabbing Infectious Diseases

Seven of the top 10 causes of death are from chronic diseases, like obesity, heart problems, and cancer. But chronic diseases get the lowest research funding donated out of any health conditions. Most development agencies don’t invest in it at all, and most donors choose to spend their money fighting flashy infectious diseases like Malaria and HIV, which are more engaging to the public.

As a result, some really simple concepts have gone without funding to develop them, like a universal “generic risk pill,” or cheaper heart disease pills. Because of how interconnected health, economics, and poverty are, this whole mess was recently identified by the Copenhagen Consensus as one of the top things holding back global development.


But according to a recent review of donor health funding, chronic disease receives the smallest amount of donor assistance of all health conditions, having lost ground since 1990 relative to infectious diseases. Donor assistance for health was estimated at almost $26 billion in 2009. The amount allocated to chronic disease was $270 million, or about 1% of the total. Yet cardiovascular disease in low- and middle-income countries killed over twice as many people in 2001 as did AIDS, malaria, and TB combined.
http://www.copenhagenconsensus.com/publication/chronic-disease

Ten of the sixteen most cost-effective solutions were health related; seven of these focused on R&D innovation. These included new innovations, such as the development of a ‘generic risk pill’ for vascular diseases which would avert 1.6 million deaths per year and deliver $4 worth of benefits for every dollar spent.
http://devpolicy.org/innovation-disconnect-holding-back-global-health-20160704/

Seven of the top 10 causes of death in 2010 were chronic diseases. Two of these chronic diseases—heart disease and cancer—together accounted for nearly 48% of all deaths.
http://www.cdc.gov/chronicdisease/overview/index.htm