Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Just the Facts: A Book Review of “Factfulness”


This book is full of examples showing that we are actually doing well as a species, despite constant pronouncements to the contrary. It also reminds us that we need to be mindful of our own instincts and the biases that can influence our decisions.

Still think that majority of the world’s population lives in poverty? “Factfulness” will show you how wrong we can be regarding common misconceptions, and that we live in better times than we might think.


We’re subjected to a deluge of information every day. Much of it is sensational, and negative events predominate the news. Coupled with an instinctive human brain wired to arrive at swift conclusions in a milieu of unconscious biases, our perception of the world can be skewed. “Factfulness – Ten Reasons We’re Wrong About the World and Why Things Are Better Than You Think,” by Hans Rosling, shows us how our comprehension of the world may not be as precise as we think it is.


Hans Rosling, a Swedish physician and eminent public health researcher (one of TIME ‘s 100 most influential people, 2012), has studied global trends such as poverty, health, and education, and highlights how dramatically they have changed for the better. He has also explored various biases that afflict our current understanding of these trends and how to be mindful of them.


These biases are in every way applicable to our practice of medicine. Here are a few discussed in the book:


1.) The Gap Instinct

While examining a difference or a ‘gap’ between two groups, we tend to categorize them as polar opposites. As a result, we end up ignoring the vast majority in between these two entities. Rosling cites one of the most fundamental examples of this phenomenon – the developing and the developed world. Turns out that these concepts are a thing of the past, and that the world population now lives in 4 levels (1-4). What is even more startling is that poverty levels are at an all time low – only 9% live below the poverty line (Level 1). Therefore, a vast majority of low-income countries are much more developed than most people may think.


2.) The Negativity Instinct: Positive trends don’t get the coverage they deserve. This builds an expectation that the world around us is going from bad to worse. This, however, is not true, and Rosling has actually included a number of graphs dedicated to showing progressive improvements from incidence of HIV infections, to oil spills, and nuclear arms. He advises us to be cognizant of the fact that sometimes more bad news is a result of better surveillance of suffering, rather than a worsening world.


3.) The Straight Line Instinct

Whenever we see a graph we automatically assume the line is going to follow a straight path without meandering. For example, the mega misconception that “The world population is just increasing and increasing,” as Rosling puts it. We presume that it must be following the trajectory of a straight line, when in fact population growth has already slowed down and will do so over the decades to come.


4.) The Fear Instinct

This instinct can be traced back to evolution and how it helped our ancestors survive. We tend to pay the most attention to things that evoke the most fear – such as physical harm, captivity, and contamination. But even in the face of our worst fears, there have been major improvements. We have become so good at disaster management that the average annual deaths from natural disasters has shrunk over the years, with the biggest reductions in the most impoverished populations.


5.) The Single Perspective Instinct

When a problem erupts, we tend to immediately implicate a single cause and gravitate towards a single solution. Often, this approach does not solve problems and instead exacerbates it. In the 1950s, Halfan Mahler, a Danish public health doctor, embarked on an ambitious effort to eradicate tuberculosis, by sending buses with x-ray machines to villages all around India to screen and then treat the entire population. This project did not work, since the main problem, adequate primary health care, was not addressed.


This book is full of examples that rouse a sense of faith that we are doing well as a species, despite constant speculation to the contrary. However, our journey is not over yet – we are constantly confronted with many problems that afflict different subsets of our patient populations. We still need to constantly seek the right information and be mindful of our instincts and biases that influence us.