Slim, Malaria, and the Marginal Value of Attention

The story

In October 1943 William Slim took command of the new Fourteenth Army, the British and Indian army that would fight the Japanese in Burma. That year, for every man evacuated from the front with wounds, 120 were evacuated sick. Malaria was the main cause.

Two of the army’s measures against malaria matter here. The first was medical. The army formed Malaria Forward Treatment Units near the front, so that a man with malaria could be treated close to his unit instead of being sent back to the rear.

The second was a daily tablet. The army issued mepacrine, a drug that suppressed malaria if a man took it every day. Many soldiers did not trust it. A rumor spread among them that the drug made men impotent, and often the tablets were not swallowed.

Slim ordered surprise checks of units, in which a medical test showed whether the men had been taking mepacrine. He later wrote what he did with the results:

If the overall result was less than ninety-five per cent positive I sacked the commanding officer. I only had to sack three; by then the rest had got my meaning.

How we see it through leadership economics

A commander has more problems than he has time for, so an hour Slim spent on malaria was an hour he could not spend on planning or defenses. The useful question for him was what one more hour of his attention would add in each place. Economists call this the marginal value of his attention.

With 120 men evacuated sick for every one evacuated wounded, one more hour spent getting soldiers to take their tablets could keep more men at the front than one more hour on the battle plan. Slim spent his attention on malaria, and he made his commanders spend theirs on it too. Once a commanding officer’s job depended on his men’s test results, each commander had a reason to see that his men took the tablets.

The value of Slim’s next hour on malaria also fell as more of his men took the drug. He had to sack only three commanding officers before the rest enforced the rule, and after that an hour of his attention was likely worth more on other problems.

A leader can set priorities by giving each problem attention in proportion to what the next hour spent on it would add. By that test, malaria was one of Slim’s highest priorities in his first months in command.

A quote we’re thinking about

“The cost of a thing is the amount of what I will call life which is required to be exchanged for it, immediately or in the long run.”

Henry David Thoreau, Walden (1854)