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Today, I would like to revisit a bias I have talked about before, but which is arguably still under-discussed in the broader conversation about biases: the bias of living in the Western (for want of a better term) high-income world. Let us start with some numbers. I live in the US, a country of about 336 million people. That is about 4.23 percent of the world’s population. It is important to remember that, while the US in many ways punches about its numerical weight in its global cultural influence, the people who live here are a fairly small percentage of the global population. This reflects the comparatively small percentage, globally, of people living in the high-income world. Of the eight billion people in the world, about 16 percent are in high-income countries. This means that about 84 percent of people in the world live in middle- and low-income countries. As anyone who has traveled outside the high-income world knows, the differences between these regions are significant, perhaps nowhere more so than in their health implications.
Our health is shaped by the air we breathe, the water we drink, the food we eat, and the spaces where we live, work, and play. All these factors, and more, intersect with the economic and social resources of a given place. When these resources are abundant, a place is on its way to being optimized for generating health. When they are lacking, a region can set the health of its population up to fail. For much of the world’s population, the conditions of life are likelier to generate injury and disease than health. It is necessary to bear this in mind to establish the correct priors in creating a healthier world.
Let's add another element to our consideration of this bias—language. Although it is my second language, I speak English (I think fluently). I am comfortable with the language and assume that I can get by in it, or several other languages I have learned, anywhere in the world. Yet English is not just any language. It is the global language of science, the field where I make my living. It is also widely spoken in the Western world, allowing me to move with ease between countries and capitals which are the seats of much global influence. I can also express myself in my writing with greater ease than someone who must laboriously translate their thoughts into the lingua franca of their field. As one of approximately 1.35 billion English speakers in the world, then, (including about 241 million speaking only English in the US), I have an advantage over the rest of the global population that does not share this knowledge, it is an advantage that should inform my perspective about the privileges I enjoy and the biases they shape.
What do these biases mean for how I see and interact with the world?
First, they mean I experience far less daily hardship on the core elements of day-to-day living than most of the world’s population. I can imagine doing things efficiently, getting from A to B relatively smoothly, with working Wi-Fi, with the expectation of water in taps, clean bathrooms, and the other benefits of the reliably functioning infrastructure we tend to take for granted in the high-income world. I devote very little time to the foundations of Maslow’s hierarchy of needs—finding food and shelter—allowing me to try to contribute through my thinking and writing. It is all fine and good for me to say “I work hard to make this contribution” but I can do this because, well, I do not have to worry so much about finding fundamentals. Those of us who enjoy this luxury would do well to remember that is indeed a luxury, one that is not shared by about one in seven of the world’s adults.
Second, I have an easy path to communicating my science through language, through the unearned advantage (in my case obtained through migration, but still) of comfort in a language that is the global tongue of science. There is no good reason for this (the preeminence of English owes much to the history of colonialism), but it is still good luck for me and everyone else who speaks this useful language. One could ask: Why should global science not be communicated in, say, Mandarin principally, meaning that I would need to learn and edit my work in Mandarin? This question reflects a wish to see a fairer world and not the one we are currently living in. This reality, unfair as it may be, means English speakers in a range of fields simply have it easier than non-English speakers.
Finally, my biases mean I see the world and its problems through the lens of being able to think and express myself in a Western, high-income context. I live in a democracy, deeply flawed, but at the end of the day one with an ethos of free speech and civic engagement. While I have at times tried to push controversial ideas, I have never worried I will be arrested for what I write, yet many in the world do have this worry, lacking the protections of the First Amendment. Neither do I think as much as I perhaps should about fundamental challenges to health that many in the world face—lack of access to clean water, for example, or avenues for achievement and the development of potential. I do, of course, think about these challenges, but not to the extent that their scope demands, a scope which it is easy to lose sight of from the perspective of my biases.
What to do about this? In the context of this piece, I want to highlight a bias that informs how we operate and think. There is a growing philosophical tradition concerned with how one lives with advantages, and I leave the development of this to people who are sharper in their thinking than I am on these matters. But it seems right to remind myself, and us, how this influences the questions we ask, and what we choose to write and talk about, to support a focus on the questions that matter most for the health of the many.
A version of this post also appears on Substack.
