Reporting of artificial intelligence prediction models.

www.thelancet.com Vol 393 April 20, 2019 1577 shortcut, investing in magic bullets such as vaccines, antiretrovirals, and bednets that could be distributed without a well functioning health­care system, and even in war zones. These programmes saved millions of lives, but failed to launch the anticipated virtuous cycle of development, poverty reduction, and improved health systems. Many African countries remain deeply impoverished, and although child mortality has plummeted, weak health systems remain ill­ equipped to address soaring numbers of deaths and disability from heart disease, cancer, and other non­ communicable diseases. Bollyky and colleagues’ findings suggest a possible reason for this dispiriting reality: many of the countries with the worst health systems are governed by corrupt autocrats who retain power by force and can ignore the welfare of their people without repercussions. To date, the global development community has skirted the complications of politics, instead emphasising medical programmes and the empower ment of women, the LGBT+ (lesbian, gay, bisexual, transgender, and all other identities) community, and people with disabilities—ie, people who do not directly challenge government power. This emphasis is sometimes justified by the longstanding assumption that in poor countries, especially, dictators are better at getting things done because they can ignore the demands of petty, competing constituencies. However, Bollyky’s findings support the theory that dictators might themselves be a cause of poverty and illness, and that democrats, however befuddled and disorganised, better serve their people. Unfortunately, the rights of pro­democracy activists are routinely violated with impunity, especially in those African countries most beset by poverty and ill health. Recent elections in Kenya, Uganda, Ethiopia, Rwanda, the Democratic Republic of the Congo, Gabon, Cameroon, and Zimbabwe were all marred by credible rigging allegations, which donors, in most cases, dismissed. When two opposition members of parliament in donor darling Uganda were beaten and crippled by security forces inside parliament in September, 2017, not one international donor or human rights organisation spoke out. Global health advocacy groups need to do more than clamour for more funding and occasionally bemoan corruption. They need to call on Washington (USA), Brussels (Belgium), London (UK), and other donors to impose sanctions on dictators, including those who cooperate with western military aims. As Rudolf Vichow, one of the pioneers of modern public health, wrote after witnessing the ravages of typhus on the oppressed peasants of Silesia, “politics is nothing but medicine at a larger scale”.