I watched a great Ted Talk today by Chris Hadfield, the Canadian astronaut who spent five months on the International Space Station, three as commander. He had a line that struck me:

" There's an astronaut saying: In space, 'there is no problem so bad that you can’t make it worse.' "

I wonder if there should be a parallel for development. "In international development, there is no problem so bad that you can't make it worse." That is a nagging fear I have. We know that not everything we do in development will work as intended, but we hope, or assume, that when it doesn't work, things will just go back to how they were before, with no benefits, but no harm either.

But is that the case? In development work have we made things worse?

In nutrition, yes, sure. For example, nutrition and “nutritionism” is currently in the midst of a collective re-think as we got the whole fat versus carbohydrates thing so wrong,with the common thinking that we would be healthier with low fat diets. While it seems like a first world problem, it is also relevant in global health, as we have largely focused on micronutrient deficiencies and not given much thought to fat intakes in poor populations. This has propagated a nutritionism approach in malnourished populations, with a focus on technical solutions (micronutrient supplements and food fortification) with less attention given to food based solutions. OK, perhaps that hasn’t made things worse, but it hasn’t made them better as much as was hoped.

Another example is with the difficult case of iron deficiency anemia in malarious areas. Iron deficiency is harmful to children and dangerous to pregnant women. But iron supplementation appears to increase the risk of malaria, as iron deficiency inhibits the growth of the malaria parasite. Is this a case of making the problem worse? It may be.

Those are relatively narrow examples. A case is being forcefully made that development in general is harmful, because human rights are not placed at the centre of development planning (see The Tryanny of Experts).

So is development work doomed to making problems worse? My first answer is that in every domain the experts seem to create problems, or at least don’t get it all right the first time. Think of exercise advice and how every season brings new exercise recipes for “optimal health” as people consider different exercise regimes and different details – do you stretch before or after running? How many days between strength training? Should you exercise when you have a cold? And then consider other fields… For winter driving – the advice used to be to warm the car up before moving, but that is no longer the case. The advice used to be to pump the brakes on ice, then pumping was discouraged, and I think now it is back on again. And can’t you think of another dozen examples of how the popular understanding of “best practices” changes – from the important (should infants sleep on their back or side) to the trivial (how often to water your lawn) and everything in between?

But then how much of the fluctuation and confusion is real, and how much is simply popular science reporting getting things wrong? It seems to me that popular nutrition has jumped from fad to fad and missed the science which for at least 20 years has had ample evidence showing that good fat is part of a healthy diet (e.g., the “Mediterranean Diet” is healthy and recommended and includes lots of fat ).

So perhaps the science behind each of these domains (nutrition, exercise, car care, babies, etc) probably has not fluctuated near as much as appears in the popular press. I know that it hasn’t for nutrition, so I should give the other domains the benefit of the doubt.

But yes, there are real fluctuations in the science, as the case of our understanding of iron deficiency anemia and malaria – it is a normal process of scientific development. Ideas are proposed and refined and rejected and the field moves a little backwards and then a little more forwards.

So it probably is inevitable that in development when we apply current science there are problems that are bad, and then we make them worse. But with good monitoring, the problems are identified and rectified quickly, so that the harm is minimized. And then collectively, overall, slowly there is progress and the problems are not made worse.