Thursday, September 06, 2007

Global Health back on track!

On 5 September history was made by 7 Ministers of Health from low-income countries together with serious politicians from West Europe and representatives from aid organisations that had learnt their lessons . The group launched the International Health Partnership.

If aid from rich countries should effectively improve health of the poor, they said, the aid must be:
1. coordinated,
2. foucsed on improving health systems as a whole instead of one disease at a time,
3. and part of good national plans.

These statements are evidance based, much needed but "un-sexy". So let me translate the 3 statements into blunt words:
1. It is mad that Ministries of Health in low-income countries each week must meet a growing number of aid delegations.
2. It is cruel to tell millions of poor mothers; "your child is dying from pneumonia for which our clinic have no drugs because Bush, Blair and rich activits did not know that pneumonia and diarrhea kill as many as do malaria, TB and HIV.
3. It is stupid to fund seprate clinics for each disease when there is not even staff and money e nough for one clinic in each village.

So, 5 September 2007, is a happy day for global health. Fragmented health aid based on what is "sexy" in the media of the rish will be replaced by health aid focusing on what is needed in the clinic of the poor.
Why is Sweden not yet part of the International Health Partnership? The Swedish Minister for Development Aid recently wisely focused Swedish bilateral aid too fewer countries. So hopefully she will soon join the Partnership of the wise. In these issues it seems more important if politicians are wise than if they come from left or right, so we can hope that Sweden will join.

Monday, June 18, 2007

GapCast #1 Health, Money & Sex in Sweden.

This vlog uses a flash presentation that Gapminder did with Trendalyzer graphics. It shows the development of Sweden during the last 300 years. It is my first attempt to use chroma key video with animated statistics as done daily with weather forcasts in TV.

Debunking Myths about the World

Monday, April 09, 2007

Save children from suffocation

Following my talk in Swedish radio news on how to avaoid child deaths in pneumonia I get requests on where to donate. What is needed is steady funding over many year so that poor families get access to diagnosis and antibiotics. I judge that UNICEF is most competent to provide long-term support for child survival. The reason is good track record, that the present Director Ann Veneman understands how health service system in low income countries need long term support and that UNICEF base their policy on best available research. To save children now donate to if not in Sweden look up UNICEF in your country. To support research for better care for infections of the poor donate to World Infections Fund . Keep donating regularly to a good cause, and learn about progress and challanges. The underfunded needs are the continious majora challanges for poor families; pneumonia, malaria and diarrhea, education and the daily bread, i.e. agriculture in rula areas and job in urban areas. Water and sanitation also get less attention than emergency relief and HIV; the two worthy causes that presently receives almost sufficient funding.

Perestroika in the Soviet Republic of Texas!

Cotton farmers in Texas earn their wealth from Soviet-like government subsidies. The annual 4 billion US dollar tax subsides to 25 000 US cotton farmers are of concern for global health! The reason being that this obstacle to free trade kill so many children.
1. Subsidies hamper economic growth in cotton producing west African countries. This keeps millions of hardworking farmers in poverty and hinder them to care well for their children.
2. If only parts of the 4 tax billions were re-directed tovAnn Venneman at UNICEF, she can avoid 600,000 child deaths from pneumonia by using 0.6 billion USD to provide care and antibiotics.
3. The soviet cotton economy of Texas is a major obstacle for successful agreements on free world trade. And a fair global trade system will save thelives of so many children’s .

The world is waiting for a US president with the guts to implement a cotton Perestroika in Texas!

Friday, February 09, 2007

Do as Bill Gates did!

On January 27 at the World Economic Forum in Davos I asked Bill Gates for help. Help to speed up provision of courses on Global Health at universities around the world. I gave him a copy of our Textbook on Global Health (see below). He rightly noted that it was the first of its kind and that fact based overviews of the global health situations are badly needed.

On February 7 I got this note from our publisher Studentlitteratur: "Här kommer lite glada nyheter om Global Health. Dessutom har Bill & Melinda Gates Foundation köpt 200 ex som deras personal ska läsa!"

Gates Foundation had bought 200 copies, one each for the staff!

Saturday, November 25, 2006

Our new book on GLOBAL HEALTH is out!!

Is it possible to write a book on the health of all 6.5 billion persons living on the globe? Well we did it and now it is on sale from Monday 27/11 2006. We are six authors, but it was Ann Lindstrand who got it together and Birgitta Rubensson that brought it to print. Hundreds of students read and commented various versions.

We wrote it for those that in a short text want to learn:
-how the health of the world's population has changed over time;
-how the main determinants of health varied with time and place;
-how health can be measured;
about the causes of the main diseases in the world;
-what health care that exist around the world.

Our book is a summary of the works by greater scholars on global health. The pros with our book are the overviews; the cons are the simplifications and errors that are a consequence of our broad ambitions.

Wednesday, November 22, 2006

Less sex & more condomes = stop to HIV

Yesterday UNAIDS declared: " the global AIDS epidemic continuous to grow... an estimated 40 millions are living with HIV... the number with HIV has increased from 37 millions in 2004.
But on the AIDS day in 2004 the message from UNAIDS was that "over 41 million people are living with HIV/AIDS"

Are UNAIDS lying? No, it is led by honest and good scientists, so how come? If you dig further into the data you find that the uncertainty range of UNAIDS estimates are wide: - somewhere between 32 to 44 millions lived with HIV in 2004 and today somewhere between 34 to 47 millions. So the true number may be slowly falling. A reasonable conclusion is that the number of HIV infected in the world remains the same over the last years. But telling that may put funding for much needed HIV/AIDS control at risk, so its better to conclude that the epidemic continuous to grow.

UNAIDS may be excused for drawing the scary conclusion that the epidemic is still increasing, because they simultaneously communicate that there are solid evidence that the epidemic is decreasing in more and more countries. The exclusive focus on treatment may have delayed the decrease. Best available assessment indicate that money is best used on scaling up prevention

But international support to prevention tends to focus on the moral of the donor rather than the effectiveness of the action. The present US administration likes to fund "less sex" and Sweden likes to fund "more condoms". Evidence from Zimbabwe tells that both works. Later sex debut and fewer partners may even be more important than more condom use

Tuesday, October 31, 2006

Red cross confirmes ethnic cleansing in Kagera, Tanzania

Evidance of the serious human right abuse in Kagera, Tanzania, is accumulating! But there are still no reports from independent observer inside Kagera. Lorries now pick people from their homes during nighttime. My impression is that too many "follow the situation from a distance", not realizing that there are already enough evidance for immediate observation on site! Read the words of this young women that tells Red Cross in Rwanda what happened :

Fayce Uwamwezi, a 26-year-old mother of three children and eight months pregnant, says that the local military had come around in the early evening and told everyone to get out as they were all going back to Rwanda, had no business being in Tanzania ? and that their house was to be burnt. ?I implored them to have pity on us,? she says, ?but they told me that if I didn?t leave the house with my children, they?d burn it anyway. My husband was then taken away and not allowed to talk to me.?Fayce has not seen her husband since and does not know where he is. Some people in the camp tell her that he is dead.

Saturday, October 28, 2006

Ex missionary in Kagera urge Sweden to speak

This mail came from a former Missonary in Kagera:
Sent: den 28 oktober 2006 17:58 To:
Subject: Illegal deportations in Tanzania
Dear Hans,
Thanks a lot for bringing up this humanitarian catastrophy to light. Having worked for 7 years as a missionary in Karagwe, your appeal gave me reason to investigate further on the matter of illegal deportations of Tanzanian citizens.
I feel deeply shocked by the report I obtained this afternoon about rampant abuse of of human rights in a country where I and my family spent some of our best years in life. My source of information said that the local authorities, obviously with the consent of the Government of Tanzania, fill 7 to 8 lorries a day, each lorry with around 100 people packed like cargo, people whom they leave in a camp 10 kms inside Rwanda.
There have also been reports of rape and torture against alleged "foreigners", many of whom are born and bred by parents, whose parents in turn came from Rwanda.
It is high time Sweden speaks out. If there exists sincere friendship between our countries after such a long time of co-operation, then we cannot let the suffering citizens down.
Mapambano yanaendelea,
let the struggle continue for a better world, Birgitta Farelius

Thursday, October 26, 2006

Act against illigal expling of Tanzanian citizens!

My Oct 21 post yielded frightening information from Kagera. Tanzania is in full right to correctly expell illigal imigrants. But the world community is also in their full right to protest against illigal expelling of citizen due to their ethnic belonging. The Swedish Ministry of Foreign Affaire and others that need to act now must destinguish between two separate issues in Kagera:
1. Serious humanitarian issues re expelled illigal immigrants!
2. Human rights violations re illigaly expelled citizen.

This is a part of a mail I got from a relative to one of the illigaly expelled:

.... my sister has already been expelled recently from Kagera, Tanzania, after having lived there from the early 1970s. She is around 70 years of age, of poor health. She was picked up without notice and carried off to the border. Today, nobody knows of her whereabouts. My brothers and other family, who have lived all their life in Tanzania, now live in imminent fear and anxiety, not knowing when they will be rounded up and expelled.

The origin of this tragic state of affairs for my family started in the 1930s. My father, a man of Ugandan origin .... married my mother, a Tutsi woman, in Rwanda. However, my father, together with plenty of other Rwandans, got tired of being constantly harassed, beaten and humiliated by the Belgian colonial authorities, who were infamous for their ruthlessness. They left Rwanda by foot and crossed the woodlands into Tanzania. They built up lives as farmers in Tanzania ..... Kagera region..... in the early 1970s my above-mentioned sister joined them.
The have all gotten children in Tanzania, integrated, and speak the local language kinyambo fluently. They have laboured and contributed to make a more prosperous region out of Karagwe.
When Mwalimu Julius Nyerere came to Bukoba around 1980, he responded to complaints from local citizen about problems with foreigners in the region that Tanzanians should respect and show tolerance of their African brethren, and granted citizenship to most. John Chiligati, current Minister of Home Affairs, has stated explicitly that long-term immigrants will be given time and opportunity to acquire residence permits at a nominal price of 10,000/- TSh and also apply for citizenship.
In spite of these clear statements from the highest political authorities, the members of my family ? as well as many others ?, who have resided as law-abiding and productive members of Tanzanian society for many decades, are currently put in a situation of utmost anxiety. They do not know if, whether and when they will be rounded up and expelled to a country with which most of them have no or only sparse relation to. The rumour even goes that they will not even get time to bring or sell their belongings, livestock and so forth.........

Can one get clearer documentation of imminent ethnic cleansing ? I do not think what happens is planned by the Tanzanian government, to protest against local illigal action is not directed against the country, it is paying respect to the honourable human right records of Tanzania .

Saturday, October 21, 2006

Ethnic cleansing in Kagera in NW Tanzania??

Are human rights respected during the repatriation of refugees from Kagera Region in Tanzania to Rwanda? Tanzania is highly respected for the way this low-income countries has treated refugees from nearby war-torn countries, in spite of limited support from the international community. I have in the past personally visited such refugee communities along the boarder with Mozambique and Burundi. I was deeply impressed by the respectful integration of the refugees.

In 2006 the Tanzanian president decided to repatriate the refugees from Rwanda that stay in Kagera Region. This is acceptable as conditions have improved in Rwanda and as the track-record of Tanzania suggests that refugees will be correctly treated. I was therefore disturbed when I learnt from a very reliable source in Geneva that local authorities are using the repatriation to also expulse Tanzanian citizen that are children of Rwandan immigrants that arrived several decades ago and since long have Tanzanian citizenship. My source said his relatives had been forced on to trucks and deported from their Tanzania where they owned land and houses. The acts done by the local authorities are against the law and the decision by the president. I yesterday informed the Swedish government and urges for an inquiry. Is wide-spread ethnic cleansing silently developing in Kagera as those affected are scare to tell anything because it may cause more of their relatives to be expulsed? Are their any independent observer that can give news from in Kagera? The only thing I found on the Net is this article from Tanzania:

Tuesday, April 11, 2006

HIV - begining of the end!

Once more lack of good statistics has kept us sadder than needed. Accumulating data indicate that the global HIV epidemic has passed the peak. A new study form India shows that HIV infection rates remains low in the north and DECRESES IN THE SOUTH (Lancet April 08,
This years data from China also show stable rate of new infections. It seems as there will be a limited HIV epidemic in Asia. And HIV infection rates fall in most countries in Africa. The best data source for the global HIV epidemic is still the US Census Bureau.
Although the percentage of HIV infected adults started to fall only in recent years new analysis indicate that the proportion of newly infected started to fall many years ago. Even in South Africa the proportion newly infected decreased several years ago, BUT has now reached a plateau on a very high level. This is interpreted as a sign that major changes in sexual behavior is yet to occur in South Africa. The head of Sida´s regional HIV office in Africa, Anita Sandström, notes in the newsletter EyesoAIDS that HIV occurrence varies widely within Africa.
From a fraction of a percent in Arabic North Africa, to 1-5 % in West Africa and above 30% in Southern Africa. With frustration she states that research has done little to tell why. World Health Organization failed to put 3 million on HIV drugs by the end of 2005, but in spite of its focus on medical treatment, the prevention has worked in silence. The horrendous HIV epidemic has reached the end of its beginning, and maybe even the beginning of the end..

Monday, March 27, 2006

Health in Vietnam and Shoes in EU

In the Swedish Daily, Svenska Dagbladet, international health researcher Mattias Larsson defend the right for Vietnam to free shoe trade.
Sweden contributes to a yearly 1.8 billion USD of development aid to Vietnam that exports shoes worth 2.6 billion USD per year, most of it to the European Union. Larsson remainds that Vietnam still has large part of the population in poverty and lots of children malnourished even if child mortality is relatively low. Vietnam badly needs fast economic growth to continue. Larsson rightly asks the Swedish government to work for solidarity beyond the borders of EU. Free shoe trade for Vietnam is a good task for Swedens new well qualified Minister of Foreign Affaires, Jan Eliasson. he has always linked global and local politics, will he take a lead re coherent aid and trade policy in EU?

Wednesday, December 07, 2005

Why did Sweden miss the Tsunami risk?

On 1 Dec the Swedish National Tsunami commission reported that Swedish government and authorities were late to rescue 20 000 Swedish tourists in Thailand. the repot rightly concludes that swifter Swedish actions would have reduced the sufferings inflicted on Swedes on the Thai beaches. The debate that followed miss, as debates on sudden impact emergencies often do, what prevention could have done.
Sweden is safe due to costly but evidence based preventions in all spheres of life: Lowest rates of child deaths due to injuries and lowest rates of traffic deaths. However, today about 5% of Swedes stay abroad in each moment. Annually 400 die abroad. Estimates indicate that up to 150 die from injuries, mainly in traffic, i.e. about 20% of Swedes dying in traffic abroad. Sverel folds higher risks than at home. Yet no Swedish preventive resources are geared toward lowering these traffic deaths. Such resources could be spent in collaboration with countries where many Swedes reside. Sweden now wisely co finances Tsunami warning systems in Indian Ocean and the tsunami tragedy should make us think beyond national limits in preventing deaths and suffering among Swedish citizen. Today there is not even yearly routine statistics available for the cause of deaths of Swedes abroad.
Not one Swedish Tsunami death would have been avoided by swift rescue from Sweden. But had just a minimum of Tsunami awareness existed among Swedes on the Thai beaches many of the 500 deaths could have been avoided.
The difficult question is: Why did Sweden?s immense resources for prevention not identify that Swedes spent a lot of time on Tsunami prone beaches? Is this too much to ask for? No not in a country that has reduced domestic risks to extremely low levels. It is not even good use of resourcs for Swedes to continue to only reduce risks in Sweden. Sweden should use more resources for reducing human risks outside Swedish boarders. This will be cost-effective for both Swedes and other nationalities. This is not said to reduce the critics on slow rescue, on the contrary, it is to increase the critics against the slowness of Sweden in adapting to the changes of how Swedes themself live in the world.

Wednesday, November 30, 2005

Five thoughts at the same time

Carl Hamilton in Studio 8/TV8 claimed this evening that I am too optimistic about world development. Well, his program showed how majority of Swedes think that the world is getting worse. In this context it is difficult to avoid the impression of optimism when conveying that family size and child mortality has decreased considerably in Bangladesh and elsewhere in Asia and the Arab world. ( and click "Has the world become a better place?").

An evidence base world view requires five thoughts at the same time:
1. World is getting better and better,
2. but at the cost of climate change,
3. and billions still live miserable lives in poverty
4. and in the last decade life got worse for 100 of millions,
5. but as the world is stupidly managed, we have many opportunities to fix the world for the grandkids!

It is not optimistic to see that 350 billion USD in agricultural subsidies in the richest countries is stupid, that fighting wars for oil instead of investing in energy research is suboptimal, that improved governance can do a lot for progress in low income countries, and that if Senegal has less than 1% HIV and South Africa has 28% among adults it is in human reach to change sex behavior and stop the epidemic. It is just to realize that there are plenty of opportunities at hand to make the world continue to improve. Reaming poverty, climate change, and ethnic wars are major threats.

Tuesday, November 29, 2005

When to speak about sex!

On 23 Nov in Stockholm I spoke on the Global HIV epidemic to an audience dominated by young African professionals in Enterprise and Labor organizations. The host was Labour Market Dialogue formed by Confederation of Enterprise and Trade Unions in Sweden and funded by Sida to run international development activities. My speech coincided with the release of AIDS epidemic update 2005. It indicates declining HIV rates in some hardly hit countries in Africa, but still increasing rates in South Africa.

When challenging the meeting with 28% infected adults in South Africa and less than 0,3% in Egypt (100 fold difference!) a good discussion emerged about the sexual pattern that drive the severe HIV epidemic in parts of Southern Africa. The HIV rates vary greatly in Africa, and so must the sexual patterns do! There are 20 fold higher HIV rate in Zambia compared to Senegal!
But the discussions in the cofee break were even better. Young professionals from Southern Africa stated ??The male culture in highly affected areas of Southern Africa is that of many small houses, i.e simultaneous sexual relations with several young women. Most men in my country used to have as many sex partners as their economy could allow. That must and will stop, because these people are now dying!?
Discussions on HIV in southern Africa should have short sessions and long coffee breaks! It remains too delicate to discuss the sexual patterns that are driving the epidemic in formel settings. That is to talk about what in academic jargon is ?inter-generational transactional sex? in stright language is rarely done in international meetings. But I was quite impressed by the insights and understanding expressed by the young African professionals in the break. They will find ways to stop this epidemic, although they still do not speak with laud voices.

Monday, November 21, 2005

Who wants to be rich and sick?

At a meeting on the future of WHO I met Philip Stevens that authored "The Real Determinants of Health". Philip think tanks at international policy network that is described at His booklet tells that economic growth is the main underlying determinant of health. I agree! But the cover photo, a Vietnamese woman on a bike, illustrates major side effects of growth that is not mentioned in the text. The photo shows:
1. She drives in flip-flop without helmet reflecting the extremely high rate of traffic accidents in Vietnam.
2. She transports live birds to market illustrating the challenge to prevent avian flue in a fast growing Asian poultry economy. Avian flue is mainly a threat to the economy in Asia.
3. The women look sad illustrating the female epidemic of depression and suicide in Vietnam and China in the midst of fast economic growth. Money does not buy gender equity.

The cover illustrate the side effects of economic growth that are not found in the text. Is it not in corporate interest with mutually reinforcing economic growth and improved health? Many government regulatrions that are needed both to attain optimal health and to secure continued growth are left out. The corporate view on health and growth is one sided, even if it argues well on some issues. One wonders if analysts in corprate tanks are ignorant or if they are forced to close an eye?

Monday, November 14, 2005

Media worse than WWF on dam reporting

Swedish radio news this morning said that World Wildlife Fund (WWF) in a report (no referance and report not found on web) tells about 400 dams under construction. The news was that WWF´s view is that, especially in East Asia, these dams destroys the environment. As usual the reporter did not ask critical questions about environmental impact of alternative sources of electricity (coal or nuclear) , nor did he tell listners that electricity promote child survival as shown by L. Wang L in Health Policy. 2003 Sep;65(3):277-99. His study on 60 poor countries conclude: "The analysis on mortality determination shows that at the national level access to electricity, incomes, vaccination in the first year of birth, and public health expenditure significantly reduce child mortality. The electricity effect is large and independent of the income effect."

I note with interest that WWF lately carefuly state that they are not against dams as such, but this moderation is jet to reach the Swedish Public Service Radio. One wonders what turns good reporters into unprofessional promotion as soon as they repore about environmental impacts of dams. I thought the dam "myth bubble" had burst already.

African farmers need inorganic fertilizers!

On 10 November the Swedish Agricultural University boldly hosted a seminar on Livelihoods, Food Security and HIV & Aids in Africa, with the participation of ambassadors from Southern and eastern Africa.
Magnus Jirström from Lund University gave a key presentation. With colleagues he had recently researched the straight forward question: ?If green revolution worked in Asia, why not in Africa.? The study design was pragmatic, but well thought through, using macro and micro level studies in both continents. In Africa 3000 farm households in 8 countries were interviewed.
Results were that global and national agricultural policies must promote higher productivity at farm level by adequate input of planting material and fertilizer and that farmers market access is key to poverty alleviation. I got convinced that this research is worth reading in detail. It is now available as a book that I have ordered:
The African Food Crisis: Lessons from the Asian Green Revolution. Edited by Göran Djurfeldt, Hans Holmen, Magnus Jirstrom and Rolf Larsson.
That inorganic fertilizers were superior to organic in African small scale farming is not surprising. In spite of widely held ideas in post-industrialized societies that African farmers can do without inorganic fertilizers I have never read convincing studies that supporte these ideas, and therefore regard them as a promonent global myth.

Thursday, November 03, 2005

Do more than fundrising

UNICEF-Sweden did not comment, but the secretary general mailed me. She reviewed the ad before publishing and states:
"to me it was obvious that the ad was not about family size in Bangladesh, but about factors underlying trafficking of children. To me it was also obvious that we did not base the ad on statistics about the number of children per family in Bangladesh, but on a rather representative example (of trafficking).

Problem is that no one pay for a full page in Sweden?s main daily that says:

Progress in Bangladesh! Number of children per women has fallen from six to three in the last generation.
But for good humanitarian reason Swedish public is remanded about remaining problems. The result is a wide spread perception that the world is not improving. Is it contra productive for fundraising to share good news from Bangladesh ? provides a free pdf-report of a good study of child mortality in Bangladesh. Due to fast reduction of deaths from infections and malnutrition the main cause of death in children above one year is now drowning, i.e. progress but remaining problems. Why not in a full page put a small textbox with facts and links so that the public in the post-industrialized countries learn about the progress in Bangladesh and large parts of Asia.

Sunday, October 30, 2005

UNICEF wrong on family size in Bangladesh

UNICEF had on Sunday Oct 30, 2005, a full page advertisement with text in mega fonts in the leading Swedish daily newspaper, Dagens Nyheter. It reads: "You and your six children live in rural Bangladesh. If you and your children work ten hours per day you get enough to eat. If you send your ten year daughter to India to work as domestic servant, you can afford to let her two younger brothers go to school. What do you do?" The end, in smaller fonts, rightly states that people should not have to do such choices and readers are asked to contribute money to UNICEF for their work to improve the life for children. Knowing UNICEF I am convinced the organization will effectively convert collected money to a better life for disadvantaged children in Bangladesh and elsewhere. So please donate money!

My problem is that the advertisement gives the impression that women in rural Bangladesh have 6 children. The latest UN sources state between 2.9 and 3.4 children born per women in Bangladesh in 2003. Even when the 10 year old girl mentioned in the advertisement was born in 1995 all sources give a number of less than 4 children per woman.

But what about inequity? A study published 2000 by Dave Gwatkin is available on:

Based on a survey done in 1996 the poorest 20 % had 3.8 children and the richest 20% 2.2 children per woman.

The first line in the advertisement is not evidence based! It conveys an impression that nothing has changed to the better. There are of course today many poor women with six children or more in rural Bangladesh, but they are a small proportion of all rural women, only some few percent! Even if these poorest women are the ones that UNICEF will help, I do think it matters that UNICEF conveys an incorrect image of rural Bangladesh. This is especially sad as Bangladesh is a success story regarding lowering of fertility and child mortality.

Please look at the animated statistics at where you scroll down to "Has the world become a better place?" The Gapminder animation shows that Bangladesh had 6 children per women in 1982.

Why is UNICEF conveying a 20 year old image?
1. Lack of knowledge.
2. Conscious judgment that the image of no change in Bangladesh is good for fund rising.
3. Unawareness about negative impacts of the image that nothing changed in Bangladesh.

I hope the reason is number 3 and suggest UNICEF to consider the following start of further adds. "You are one of the women that still has not benefited form the ongoing improvements in rural Bangladesh. If you and your six children ....... " or simply : "You and your four children live in rural Bangladesh. "

Saturday, October 29, 2005

Fact based worldview

This blogg will be used to comment on how world development is presented in relation to the best available "facts", as well as to the uncertainty of these "facts".