Results (Don't) Speak For Themselves: A Case For Documentation
In 1847, Hungarian doctor Ignaz Semmelweis made a groundbreaking discovery: handwashing could dramatically reduce maternal mortality rates. By implementing a simple chlorine solution wash between morgue visits and deliveries, he slashed death rates from 18% to 1% in his Vienna hospital ward. Yet, his findings were largely ignored by the medical establishment of the time, and countless women were condemned to death because of it.
Fast-forward to the Crimean War (1853-1856), when Florence Nightingale, influenced by Semmelweis's published work, implemented rigorous hygiene practices in British army hospitals. The result? A staggering reduction in mortality rates from 42% to 2%.
Today, the Semmelweis-Nightingale example remains painfully relevant. It prompts us to ask: How many tragedies, lesser or greater, are being played out similarly? What practices and procedures are being overlooked in boardrooms, laboratories, and government offices worldwide until decades later? We don't know, but the only thing we can do, first and foremost, is to document what we can and make it easy for others to find that documentation, no matter how long it takes for the policy or practice to be implemented by a future Nightingale.
Housing
Look at housing, where massive housing production after World War II significantly cut the Home Price to Median Household Income Ratio from a high of 6 in the 1950s to a record low of 3.75 in 1968. However, a few cities implemented exclusionary zoning practices, and they began to spread from city to city and then from country to country. In a long process that cut housing production, and now in the U.S., that ratio has reached an all-time high of 7.74 times the median income. These policies, often cloaked in the guise of environmental protection or "local control," have created a massive storm of unaffordability, made even worse after the Fed jacked up rates after the COVID Crisis. Yet, glimmers of hope emerge from unexpected quarters.
The YIMBY (Yes In My Back Yard) movement, born from frustration with housing scarcity, advocates for supply-side reforms globally. Their efforts yield results: Minneapolis made headlines by eliminating single-family zoning citywide, a bold move challenging the status quo. From 2017 to 2022, Minneapolis increased its housing stock by 12% while rents grew by just 1%. Over the same period, the rest of Minnesota added only 4% to its housing stock while rents increased by 14%.
Once one of the most unaffordable cities in the 1990s, Tokyo demonstrates the long-term benefits of flexible zoning laws prioritizing supply. Housing costs there have remained stable for decades, starkly contrasting with other global cities. To showcase how affordable Tokyo has become, Tokyo has plummeted 30 places in global unaffordability rankings, while London—hamstrung by restrictive zoning—has climbed nine spots.
Yet, despite clear evidence of success, progress elsewhere remains slow. Local opposition and a lack of understanding of successful models impede reform in many cities, leaving millions in housing precarity.
Education
The education sector tells a similar tale of forgotten victories. While we all talk about making universities affordable or paying for themselves, both objectives were achieved before Reagan became Governor of California.
The University of California system was once a beacon of free higher education and one of the engines that helped turn California into one of the wealthiest states, with research producing results such as helping birth the Internet. Across the Atlantic, the Netherlands' Wageningen University & Research integrated research with practical application, boosting global food security and one of the pillars of turning the Netherlands into an agricultural powerhouse. But not all good things are left untargeted. When Reagan became governor of California, he started a process that turned the UC system, which was once tuition-free, into more expensive for in-state residents than an out-of-state university. WUR has faced decades of uncertain funding and budget cuts since the 90s, with the new Dutch collation demanding WUR must cut back on spending by 80 million euros this year alone.
Health
GLP-1 agonists (such as Novo's Ozempic) are another example in healthcare. Despite their effectiveness, Pfizer rejected GLP-1s in the 1990s because they would eat into their other product lines. It took over a decade before another company, Novo, commercialized them. Not only that, with GLP-1s out of focus during that time, obesity and diabetes that could have been prevented skyrocketed, and we are only now figuring out how GLP-1s work. Â
Then we have another tragedy brewing: During the pandemic, we developed significant expertise in vaccine development and distribution thanks to the massive success of Operation Warp Speed. We easily could have leveraged into maintaining the capacity for rapid vaccine development to prevent the next pandemic. We didn't. The kicker? The groundbreaking Warp Speed program is now politically unpopular. The right has fallen into an Antivax hysteria, while centrists and the left seem to abandon the model. If another pandemic struck, the United States may never attempt something like Warp Speed again, regardless of the cost of lives.
Bottomline
The imperative of comprehensive documentation becomes more evident with each failure. We need robust systems for recording policies, practices, and procedures that are standardized for easy comparison and accessible to all. Open-access platforms and efforts to translate academic findings for public consumption are crucial steps. But beyond mere recording, we need to enable people to discover them in the first place. After all, what good is documenting everything if people can't find the answers they need from the documentation?
Critics may argue that effective policies naturally prevail—that cream rises to the top. But the evidence suggests otherwise. We've seen the decline in life expectancy in the U.K. and U.S., wage stagnation in Southern and parts of Western Europe, and growing despair among younger generations. These are stark reminders that progress is not inevitable. The cost of inaction—in human lives and economic impact—is immeasurable. It often seems that some critics downplay the sacrifices of those who drive real progress, instead attributing success to those responsible for blocking it in the first place. I think such critics themselves are a reason we need to document as much as we can when we can. Â
Semmelweis himself suffered a cruel fate, dying of sepsis in an asylum. Yet, thanks to his paper, Florence Nightingale was able to use his work to help save countless lives. Though progress is often bittersweet, it's through documentation that we can ensure today's efforts benefit tomorrow's generations—even if we don't see the results in our lifetime. That said, one can't help but cry because of the tragedy.
On that note, feel free to email Dave at ddeek@population.news if you have:
A research paper on housing/employment/family policy you'd like us to summarize
A case study on some policy you would like us to document
Any other suggestions or feedback
Your engagement helps us continue our work. We look forward to hearing from you!