You are currently browsing the archives for the Disease category.


From Field to Plate...

Archive for the ‘Disease’ Category

Saturday, February 28, 2015 @ 06:02 AM
posted by admin


A preview of the unpublished book A CIVILIZATION WITHOUT A VISION WILL PERISH: AN INDEPENDENT SEARCH FOR THE TRUTH by David Willis at CHAPTER 1: INDIFFERENCE TO POVERTY (Part 63). This blog is a continuation of the review of The End of Poverty: How We Can Make it Happen in Our Life Time, by Jeffrey Sachs, published in 2005

Sauri’s Big Five development interventions
The international development community should speak of the Big Five development interventions that would spell the difference between hunger, disease, and death and health and economic development. Sauri’s Big Five, identified by the villagers as well as by the UN Millennium Project, are: agricultural inputs; investments in basic health; investments in education; power, transport, and communication services; safe drinking water and sanitation.

The costs of these services
The irony is that the costs of these services for Sauri’s 5,000 residents would be very low. Here are some quick guesses, which colleagues at the Earth Institute are refining:
Fertilizers and improved fallows for the 500 or so arable hectares would be roughly $100 per hectare per year, or $50,000 per year for the community.
A clinic staffed by a doctor and nurse, providing free malaria prevention and care and additional free basic services other than antiretrovirals, would cost around $50,000 per year.
School meals could be paid for communally out of just a small part of the incremental grain yields achieved through the application of fertilizers.
A village truck would be an annual inclusive running cost of perhaps $15,000 per year if amortized over several years (or leased from a manufacturer).
Modern cooking fuel for the primary and secondary school students (numbering about a thousand) in the entire sublocation would cost an additional $5,000 per year.
A few village cell phones and a grain storage facility would add perhaps $5,000 per year, for a total of $25,000 per year.
A combination of protected springs (with improved access), bore-wells (with pumps), and community taps connected to the large-scale storage system would provide access to water at ten convenient locations and cost around $25,000.
Electricity could be provided to the school, the nearby clinic, and five water points by a dedicated off-grid generator or by power line from Yala or Nyanminia for an initial cost of about $35,000. For another $40,000 in initial costs and recurring costs of $10,000, every household could be provided with a battery/bulb assembly to light a small bulb for a few hours every night with the battery charging station connected to the village generator. The annualized costs would be $25,000 per year.
Additional expenses would include scaling up educational activities, various costs of local management, technical advice from agricultural extension officers, and other related delivery services.

These investments would repay themselves
My Earth Institute colleagues and I estimate that the combined costs of these improvements would total around $350,000 per year, or roughly $70 per person per year in Sauri, for at least the next ten years. The benefits would be astounding: decisive malaria control (with transmission reduced by perhaps 90%, judging from recent CDC bed-net trials in a neighboring area), a doubling or tripling of food yields per hectare with a drastic reduction of chronic hunger and undernutrition, improved school attendance, a reduction of water-borne disease, a rise in incomes through the sale of surplus grains and cash crops, the growth of cash incomes via food processing, carpentry, small scale clothing manufacturing, horticulture, aquaculture, animal husbandry, and a myriad of other benefits. With anti-AIDS drugs added to the clinic’s services, the mass deaths from AIDS, as well as the deluge of newly orphaned children, could also be staunched. Sooner rather than later, these investments would repay themselves not only in lives saved, children educated, and communities preserved, but also in direct commercial returns.

Friday, February 27, 2015 @ 06:02 AM
posted by admin

A preview of the unpublished book A CIVILIZATION WITHOUT A VISION WILL PERISH: AN INDEPENDENT SEARCH FOR THE TRUTH by David Willis. CHAPTER 1: INDIFFERENCE TO POVERTY (Part 62). This blog is a continuation of the review of The End of Poverty: How We Can Make it Happen in Our Life Time, by Jeffrey Sachs, published in 2005.

Soils that are utterly exhausted of nutrients
The rest of the community is farming on tiny plots, often no more than 0.1 hectares, with soils that are utterly exhausted of nutrients, and therefore biologically unable to produce an adequate crop. The soils are so depleted of nutrients and organic matter that even if the rains are good, with yields of around one ton of maize per hectare, the households still go hungry. If the rains fail, the households face the risk of death from immunosuppression because of severe undernutrition. Stunting, meaning low height for one’s age, is widespread, a sign of the pervasive and chronic undernutrition of the children.

The price of fertilizer was now out of reach
Farmer after farmer described how the price of fertilizer was now out of reach, and how their current impoverishment left them unable to purchase what they had used in the past. Credits to buy fertilizer are neither available nor prudent for these farmers: a single failed crop season, an untimely episode of malaria, or some other calamity can push a household that has taken on debt into a spiral of unending indebtedness and destitution.

The only things coming back from the cities were coffins
I asked how many households were home to one or more orphaned children left behind by the pandemic. Virtually every hand in the room shot up. I asked how many households were receiving remittances from family members living in Nairobi and other cities. The response was that the only things coming back from the cities were coffins and orphans, not remittances.

They cannot afford the bed nets
I asked how many households had somebody currently suffering from malaria. Around three fourths of the hands shot up. The problem, many of the women explained, is that they cannot afford the bed nets, which sell for a few dollars per net, and are too expensive even when partially subsidized (socially marketed) by international donor agencies.

The villagers could not afford to pay the doctor
A year or so ago, Sauri had a small clinic. The doctor has left and the clinic is now padlocked. The villagers could not afford to pay the doctor and buy the medicines, so the doctor departed.

An increasingly erratic climate
A few years back, Sauri’s residents cooked with locally collected fuel wood, but the decline in the number of trees has left the sublocation bereft of sufficient fuel wood. The community has no money for fertilizers, medicines, school fees, or other basic needs that must be purchased from outside of the villages. This year the rains are failing again, another disaster in an increasingly erratic climate, quite possibly a climate showing the increasing effects of long-term man-made climate change emanating from the rich world.

Survival depends on addressing a series of specific challenges
This village could be rescued, and could achieve the Millennium Development Goals, but not by itself. Survival depends on addressing a series of specific challenges: nutrient-depleted soils, erratic rainfall, holoendemic malaria, pandemic HIV/AIDS, lack of adequate education opportunities, lack of access to safe drinking water and latrines, and the unmet need for basic transport, electricity, cooking fuels, and communications. All of these challenges can be met, with known, proven, reliable, and appropriate technologies and interventions.

A cost that is tiny for the world but too high for the villages
The crux of the matter for Sauri sublocation can be stated simply and directly: Sauri’s villages, and impoverished villages like them all over the world, can be saved and set on a path of development at a cost that is tiny for the world but too high for the villages themselves and for the Kenyan government on its own.

Thursday, February 26, 2015 @ 07:02 AM
posted by admin

A preview of the unpublished book A CIVILIZATION WITHOUT A VISION WILL PERISH: AN INDEPENDENT SEARCH FOR THE TRUTH by David Willis. CHAPTER 1: INDIFFERENCE TO POVERTY (Part 61). This blog is a continuation of the review of The End of Poverty: How We Can Make it Happen in Our Life Time, by Jeffrey Sachs, published in 2005

Chapter 12: On-the-Ground Solutions for Ending Poverty
The end of poverty will require a global network of cooperation among people who have never met and who do not necessarily trust each other. One part of the puzzle is relatively easy. Most people in the world, with a little bit of prodding, would accept the fact that schools, clinics, roads, electricity, ports, soil nutrients, clean drinking water, and the like are the basic necessities not only for a life of dignity and health, but also for economic productivity. They would also accept the fact that the poor may need help to meet their basic needs, but they might be skeptical that the world could pull off any effective way to give that help.

The world’s remaining challenge
If the poor are poor because they are lazy or their governments are corrupt, how could global cooperation help? Fortunately, these common beliefs are misconceptions, only a small part of the explanation, if at all, of why the poor are poor. I have noted repeatedly that in all corners of the world, the poor face structural challenges that keep them from getting even their first foot on the ladder of development. Most societies with good harbors, close contacts with the rich world, favorable climates, adequate energy sources, and freedom from epidemic disease have escaped from poverty. The world’s remaining challenge is not mainly to overcome laziness and corruption, but rather to take on geographic isolation, disease, vulnerability to climate shocks, and so on, with new systems of political responsibility that can get the job done.

The tools for sustainable development
In the next chapters I lay out the strategy for ending extreme poverty by 2025. The strategy focuses on the key investments – in people and in infrastructure – that can give impoverished communities around the world, both rural and urban, the tools for sustainable development. We need plans, systems, mutual accountability, and financing mechanisms. But even before we have all of that apparatus – or economic plumbing – in place we must first understand more concretely what such a strategy means to the one billion-plus people who can be helped. It is the bravery, fortitude, realism, and sense of responsibility of the impoverished and disempowered, for themselves and especially for their children, that give us hope, and spur us on to end extreme poverty in our time.

Together with colleagues from the UN Millennium Project and the Earth Institute, I spent several days in July 2004 in a group of eight Kenyan villages known as the Sauri sublocation in the Siaya district of Nyanza Province, about 44 kilometers from Kisumu, in western Kenya. We visited farms, clinics, a subdistrict hospital, and schools in Sauri and the environs. We met with international organizations working in the region, including ICRAF (the World Agroforestry Center), the UN Development Program, and the US Centers for Disease Control and Prevention. The visit made vivid both why extreme poverty persists in rural areas and how it can be ended.

The situation is more grim than described in official documents
We found a region beset by hunger, AIDS, and malaria. The situation is far more grim than is described in official documents. The situation is also salvageable, but the international community requires a much better understanding of its severity, dynamics, and solutions if the crisis in Sauri and the rest of rural Africa is to be solved.

They are impoverished, but they are capable and resourceful
In response to an invitation from our group, more than 200 members of the community came to meet with us. Hungry, thin, and ill, they stayed for 3½ hours, speaking with dignity, eloquence, and clarity about their predicament. They are impoverished, but they are capable and resourceful. Though struggling to survive at present, they are not dispirited but determined to improve their situation. They know well how they could get back to high ground.

Leguminous (nitrogen-fixing) trees
I canvassed the group on the material conditions of the community, and received very perceptive accounts of the grim situation. Only two of the 200 or so farmers at the meeting reported using fertilizer at present. Around 25% are using improved fallows with nitrogen-fixing trees, a scientific farming approach developed and introduced into Sauri by ICRAF. With this novel technique, villagers grow trees that naturally fix nitrogen, meaning that the trees convert atmospheric nitrogen, which most food crops cannot use directly, into a nitrogen compound that food crops can use as a nutrient. The leguminous (nitrogen-fixing) trees can be planted alongside maize or other food crops. By choosing the right timing for planting and the right combination of trees and crops, the farmer gets a natural substitute for chemical nitrogen fertilizer.

The ICRAF technique could be scaled
So far, just one fourth of Sauri farmers use the new method. It costs money to introduce the technique and one planting season is lost. Farmers may also need to add some non-nitrogen fertilizers, especially potassium, which is also costly, too costly for the impoverished farmers. All of these additional complications could easily be addressed, and the ICRAF technique could be scaled up throughout the village, if only there were additional financial resources available to ICRAF and the village to jump-start the process.

Monday, February 23, 2015 @ 05:02 AM
posted by admin

A preview of the unpublished book A CIVILIZATION WITHOUT A VISION WILL PERISH: AN INDEPENDENT SEARCH FOR THE TRUTH by David Willis. CHAPTER 1: INDIFFERENCE TO POVERTY (Part 58). This blog is a continuation of the review of The End of Poverty: How We Can Make it Happen in Our Life Time, by Jeffrey Sachs, published in 2005

Table 1: The Millennium Development Goals
Eradicate extreme poverty and hunger
Halve, between 1990 and 2015, the proportion of people whose income is less than one dollar a day
Halve, between 1990 and 2015, the proportion of people who suffer from hunger

Achieve universal primary education
Ensure that by 2015 children everywhere, boys and girls alike, will be able to complete a full course of primary schooling

Promote gender equality and empower women
Eliminate gender disparity in primary and secondary education, preferably by 2005, and to all levels of education no later than 2015

Reduce child mortality
Reduce by two thirds, between 1990 and 2015, the under-five mortality rate

Improve maternal health
Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio

Combat HIV/AIDS, malaria and other diseases
Have halted by 2015 and begun to reverse the spread of HIV/AIDS
Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases

Ensure environmental sustainability
Integrate the principles of sustainable development into country policies and programs and reverse the loss of environmental resources
Halve by 2015 the proportion of people without sustainable access to safe drinking water and basic sanitation
By 2020 to have achieved a significant improvement in lives of at least 100 million slum dwellers

Develop a global partnership for development
Develop further an open, rule-based, predictable, nondiscriminatory trading and financial system. Includes a commitment to good governance, development, and poverty reduction – both nationally and internationally
Address the special needs of the least developed countries. This includes: tariff- and quota-free access for least developed countries’ exports; an enhanced program of debt relief for HIPC and cancellation of official bilateral debt; and more generous ODA for countries committed to poverty reduction
Address the special needs of landlocked countries and small island developing states (through the Program of Action for the Sustainable Development of Small Island Developing States and the outcome of the twenty-second special session of the General Assembly)
Deal comprehensively with the debt problems of developing countries through national and international measures in order to make debt sustainable in the long term
In cooperation with developing countries, develop and implement strategies for decent and productive work for youth
In cooperation with pharmaceutical companies, provide access to affordable, essential drugs in developing countries
In cooperation with the private sector, make available the benefits of new technologies, especially information and communication

The 1978 pledge of “Health for All by the Year 2000.”
The MDGs could, no doubt, engender some cynicism as well as hope. In many cases, the goals repeated long-held commitments of the international community that had not been fulfilled in the past. After all, one of the famous commitments of the past century was the international community’s 1978 pledge of “Health for All by the Year 2000.” Yet the world arrived in 2000 with the AIDS pandemic, resurgent TB and malaria, and billions of the world’s poor without reliable, or sometimes any, access to essential health services.

Universal access to primary education by the year 2000
At the World Summit for Children in 1990, the world pledged universal access to primary education by the year 2000, yet 130 million or more primary-aged children were not in school by then. The rich world had famously committed to the target of 0.7% of GNP devoted to official development assistance (ODA), direct financial aid to poor countries, yet the share of financial aid as a proportion of rich-world GNP had actually declined from 0.3% to 0.2% during the 1990s.

A palpable sense that they might be fulfilled.
Still, when the world leaders adopted the Millennium Declaration, and the MDGs within the Declaration, there was a palpable sense that this time – yes, this time – they just might be fulfilled. The world felt that with the strength of the ongoing economic boom, the vast new power of modern technologies, and the uniqueness of our global interconnectedness, this time we would follow through.

Sunday, February 22, 2015 @ 07:02 AM
posted by admin

A preview of the unpublished book A CIVILIZATION WITHOUT A VISION WILL PERISH: AN INDEPENDENT SEARCH FOR THE TRUTH by David Willis. CHAPTER 1: INDIFFERENCE TO POVERTY (Part 57). This blog is a continuation of the review of The End of Poverty: How We Can Make it Happen in Our Life Time, by Jeffrey Sachs, published in 2005

Chapter 11: The Millennium, 9/11, and the United Nations
The new millennium opened on a hopeful note. The world survived the widely feared Y2K computer crisis without incident. Celebrations the world over went off without a hitch. The US economy continued to surge ahead. Economic progress in China, India, and finally even Russia gave the sense that globalization might yet fulfill its promise. The IT boom was still in its full glory. We marveled at the dizzying progress of the new Internet age, the new global interconnectivity, and the seemingly endless flow of new products, new ways of organizing business, and new ways of linking people and production systems around the world. Although Africa remained a place of unrelieved crisis, even there the spread of democracy and the possibility of mobilizing new technologies to fight AIDS, malaria, and other diseases gave hope.

The largest gathering of world leaders in history
Perhaps the most vivid geopolitical reflection of this hope was the Millennium Assembly, which took place at the United Nations in September 2000. It was the largest gathering of world leaders in history. One hundred forty-seven heads of state and government came to New York, and did more than create a colossal traffic jam. At their historic UN meeting, the world leaders convincingly expressed a global determination to end some of the most challenging and vexing problems inherited from the 20th century. They conveyed the hope that extreme poverty, disease, and environmental degradation could be alleviated with the wealth, the new technologies, and the global awareness with which we had entered the 21st century.

UN represents 191 governments and the peoples of the world as individuals
For the occasion, Secretary-General Kofi Annan presented the world with a remarkable document. We the Peoples: The Role of the United Nations in the 21st Century reflected the secretary-general’s strong conviction that the UN represents not only its 191-member governments but also the peoples of the world as individuals, who are endowed with rights and responsibilities that have a global reach. We the Peoples laid out a discerning view of the great challenges facing global society: extreme poverty, pandemic disease, environmental harm, war and civil conflict. The document moved from a panoramic view of these great challenges through a powerful diagnosis of their root causes to a set of recommendations on how these challenges could be met through global cooperation and action.

The Millennium Declaration
The document became the basis for an important global statement, the Millennium Declaration, adopted by the assembled leaders. It is worthy and important reading for all of us. Despite our travails in the intervening years, the Millennium Declaration still inspires hope that the world, complicated and divided as it is, can come together to take on great challenges. The Declaration, like the secretary-general’s report, surveys the issues of war and peace, health and disease, and wealth and poverty, and commits the world to a set of undertakings to improve the human condition. Specifically, it sets forth a series of quantified and time-bound goals to reduce extreme poverty, disease, and deprivation. These goals were subsequently excerpted from the Millennium Declaration to become the eight Millennium Development Goals, or MDGs.

Commitments to achieve sustainable development
Table 1 lists the 8 goals and 18 targets that are commitments to achieve sustainable development for the world’s poorest people. The first seven goals call for sharp cuts in poverty, disease, and environmental degradation. The 8th goal is essentially a commitment of global partnership, a compact of rich and poor countries to work together to achieve the first seven goals. The MDGs wisely recognize that extreme poverty has many dimensions, not only low income, but also vulnerability to disease, exclusion from education, chronic hunger and undernutrition, lack of access to basic amenities such as clean water and sanitation, and environmental degradation such as deforestation and land erosion that threatens lives and livelihoods.

Saturday, February 21, 2015 @ 05:02 AM
posted by admin

A preview of the unpublished book A CIVILIZATION WITHOUT A VISION WILL PERISH: AN INDEPENDENT SEARCH FOR THE TRUTH by David Willis. CHAPTER 1: INDIFFERENCE TO POVERTY (Part 56). This blog is a continuation of the review of The End of Poverty: How We Can Make it Happen in Our Life Time, by Jeffrey Sachs, published in 2005

It is possible to bridge seemingly irreconcilable positions
The commission gave me a wonderful opportunity to test my favorite hypothesis about collective rationality, which is that if you put people of strongly opposing views in a room together, and infuse their discussion with data, background studies, and unhurried time for debate, it is possible to bridge seemingly irreconcilable positions among its members of the group. I have come to call this process analytical deliberation. It works.

We reached a consensus
The commission was deeply divided at the start about who was “to blame” for Africa’s roiling disease crisis: Africans for their mismanagement, the pharmaceutical industry for its greed, the rich world for its malign neglect. Did Africa need more aid, or just better use of those resources that it had at hand? Could anti-AIDS drug treatment be applied in Africa? On these and a dozen other issues, the first day of the two year process was contentious, to say the least. On the last day, when the report was issued, we had reached a consensus that extended not only to the 18 commissioners and hundreds or so experts in the working groups, but also to major representatives of the pharmaceutical industry and the NGO community.

Three basic issues
We had worked diligently and assiduously to bring forward evidence and a consensus on three basic issues:
First, is disease a cause of poverty, a result of poverty, or both? The commission concluded that causation runs strongly in both directions. Poor health causes poverty and poverty contributes to poor health.
Second, why do poor countries have a life expectancy several decades shorter than rich countries? Why, especially, is Africa’s life expectancy, at 47 years in 2000, more than three decades less than the 78 years of the rich countries? The commission identified eight areas that accounted for the vast proportion of the gap in disease burden: AIDS, malaria, TB, diarrheal disease, acute respiratory infection, vaccine-preventable disease, nutritional deficiencies, and unsafe childbirth.
Third, how much should the rich world help the poor world to invest in health? The commission calculated that donor aid ought to rise from around $6 billion per year to $27 billion per year (by 2007). With the combined GNP of the donor countries equal to around $25 trillion dollars as of 2001, the commission was advocating an annual investment of around one thousandth of the rich-world income. The commission showed, on the best epidemiological evidence, that such an investment could avert eight million deaths per year.

The report found a wide audience
The report of the Commission on Macroeconomics and Health had quite a notable reception. Reports come and go. This one, I think it is fair to say, came and stayed. It made the important point that we, as a generation, can do something dramatic to improve our world. The report found a wide audience, in part, because it was based on a broad and surprising consensus. It was launched with the kind of pizzazz that it deserved, with Brundtland; the UK Secretary of State for International Development Clare Short; Ray Gilmarin, the CEO of Merck; and Bono as enthusiastic supporters.

A decade of intensive work in Africa has added to my determination to fight against the prejudices and misperceptions that leave hundreds of millions of impoverished people stranded in unnecessary suffering. Africa gets a bad rap as the “corrupt continent.” Even when such sentiments are not racist in intent, they survive in our societies as conventional wisdom because of existing widespread racism. Many African governments are desperately trying to do the right thing, but they face enormous obstacles of poverty, disease, ecological crisis, and geopolitical neglect or worse.

Africa lacks irrigation, and more than 90% of the food crops are rain fed
Since the issuance of the Macroeconomics and Health Report and the launch of the Global Fund, I have turned my own attention in Africa to issues beyond public health. Africa needs solutions not only for disease control, but also for chronic hunger, rural isolation, and growing environmental degradation, often the result of still-booming populations. As in the case of disease, there are special reasons why Africa is particularly hard pressed in each of these areas. In other words, geography has conspired with economics to give Africa a particularly weak hand. I have noted that Africa lacks navigable rivers with access to the ocean for easy transport and trade. Moreover, much of Africa’s population lives in the interior of the continent rather than at the coast. Indeed, sub-Saharan Africa’s highest population densities are in the highland regions, such as Ethiopia and Rwanda, because rainfall reliability and soils tend to be a bit better there than in the interior lowlands and coast. Yet these highland populations are isolated from the international divisions of labor. In general, Africa lacks irrigation, and more than 90% of the food crops are rain fed. Rainfall tends to be highly variable in the subhumid savannah and the arid Sahel near the Sahara. Farmers lack access to roads, markets, and fertilizers. Soils have been long depleted of nutrients as the result of repeated harvests without benefit of chemical or organic nutrient inputs. Without transport, telecommunications, clinics, and fertilizers, the hunger-disease-poverty nexus has only deepened.

The worst poverty trap in the world
The combination of Africa’s adverse geography and its extreme poverty creates the worst poverty trap in the world. Yet the situation in Africa is not hopeless. Far from it. Just as my malaria-expert colleagues taught me about bed nets, indoor spraying, and effective antimalarial medicines, and just as my HIV/AIDS-knowledgeable colleagues taught me what can be accomplished through effective prevention programs linked to access to anti-AIDS drugs, so my colleagues in tropical agriculture, rural electrification, road building, and safe water and sanitation began to teach me what could be done in these other areas of vital concern.

A combination of investments well attuned to local needs
Africa’s problems, I have come to understand, are especially difficult but still solvable with practical and proven technologies. Diseases can be controlled, crop yields can be sharply increased, and basic infrastucture such as paved roads and electricity can be extended to the villages. A combination of investments well attuned to local needs and conditions can enable African economies to break out of the poverty trap. These interventions need to be applied systematically, diligently, and jointly, since they strongly reinforce one another. With focused attention by African countries and the international community, Africa could soon have its own Green Revolution, and achieve a takeoff in rural-led growth, thereby sparing the coming generation of Africans the continued miseries of drought-induced famine. Sooner that I expected, I received an important new opportunity to put these ideas into practice.

Friday, February 20, 2015 @ 06:02 AM
posted by admin

A preview of the unpublished book A CIVILIZATION WITHOUT A VISION WILL PERISH: AN INDEPENDENT SEARCH FOR THE TRUTH by David Willis. CHAPTER 1: INDIFFERENCE TO POVERTY (Part 55). This blog is a continuation of the review of The End of Poverty: How We Can Make it Happen in Our Life Time, by Jeffrey Sachs, published in 2005

Africa’s AIDS cataclysm
The same three questions applied for AIDS as for malaria. What does the disease do to economic growth and poverty? What accounts for Africa’s special circumstances? And what must be done. The answers are similar, but they have one important difference: as of today there is no solid explanation for why Africa’s AIDS prevalence is at least an order of magnitude higher than anywhere else in the world. Perhaps the sexual networking is different in Africa. The truth is that nobody is sure. The only certainty is that HIV/AIDS is an unmitigated tragedy and a development disaster throughout Africa, especially in the hardest hit regions of eastern and southern Africa.

Africa is losing teachers, doctors, civil servants, farmers, mothers and fathers
As for the economic costs of the disease, these certainly rival or exceed malaria’s in the disaster at hand. Africa is losing its teachers and doctors, its civil servants and farmers, its mothers and fathers. There are already more than ten million orphaned children. Business costs have soared because of disarray from massive medical costs for workers, relentless absenteeism, and an avalanche of worker deaths. Foreign investors are deterred from stepping into Africa’s AIDS morass. And millions of households are battling the illness of the head of household, resulting in an incredible toll in time and expense, to say nothing of the emotional trauma for the family.

Just $70 million to all Africa to fight AIDS?
By the late 1990s, AIDS in the rich counties was being treated, with growing success. Individuals infected with HIV now had hope. Certainly, I thought, the same must be happening in the low-income world. With all the worldwide attention on AIDS, and all the hand ringing and speeches, surely the donor world was gearing up to help the impoverished world to fight this terrifying epidemic. But once again my presumptions were wrong. Could it really be true that the world was giving just $70 million to all Africa to fight AIDS?

Public health spending in 1996 was below $10 per person
Over and over again I saw the difference between spin and reality in how the world community faced AIDS and malaria. At one point, for example, an IMF official published a letter in the Financial Times noting that health and education spending in poor countries with IMF programs was actually up 2.8% between1985 and 1996. The fact is, however, that although the IMF official was correct in a strictly technical sense, health spending was disastrously, indeed shockingly, low in African countries with IMF programs. In most cases, public health spending in 1996 was below $10 per person, so the increase had been from almost nothing to almost nothing.

Amazed that the IMF would play such tricks with the public
I was initially amazed that the IMF would play such tricks with the public, but I came to realize that the fund had no special feel for these numbers. The IMF management and staff know very little about public health, and traditionally they pay almost no attention to whether health spending in their client countries is $10 or $100 or $1,000 or more per person (as it for the rich countries that dominate the Executive Board of the institution).

I went on the warpath
In the late 1990s, in the wake of my public spats with the IMF over their mismanagement of the 1997-98 East Asian financial crisis, I went on the warpath with the international financial community over AIDS and malaria. I called for an end to the international community’s gross negligence regarding the diseases ravaging Africa. I complained that the IMF and World Bank had been in Africa for decades, but had remained blind to the most basic realities there, and to the growing human and economic catastrophe.

Rigorous emphasis on economic costs and benefits
At about this time I received a call from Dr. Gro Harlem Brundtland, who had recently been appointed director general of the World Health Organization. Brundtland was former prime minister of Norway and, without doubt, one of the world’s most skilled political leaders. In the mid-1980s she chaired the famous Brundtland Commission, which had launched the concept of sustainable development. She said to me, “If you want to get someone’s attention about the health crises in Africa, ‘show them the money.’ Help them to understand the economic costs of the disease pandemics, as well as the economics of disease control. Above all, propose practical solutions based on rigorous emphasis on economic costs and benefits.”

The WHO Commission on Macroeconomics and Health (CMH)
Brundtland suggested that I chair a commission of macroeconomists and public health specialists to do just that. The WHO Commission on Macroeconomics and Health (CMH) was born. I chaired the commission for two years, from the start of 2000 to the end of 2001. In December 2001, the CMH published its report, Investing in Health for Economic Development. This was the work of 18 commissioners, including Harold Varmus, Nobel laureate and former director of the National Institutes of Health; Supachai Panitchpakdi, who would go on to lead the World Trade Organization; Robert Fogel, the Nobel laureate economic historian at the University of Chicago; and Manmohan Singh, the former finance minister and future prime minister of India. In addition to this stellar commission, we drew upon six task forces that included more than a hundred specialists from around the world. The commission and task forces had senior representation of the IMF, the World Bank, and several donor agencies.

Thursday, February 19, 2015 @ 05:02 AM
posted by admin

A preview of the unpublished book A CIVILIZATION WITHOUT A VISION WILL PERISH: AN INDEPENDENT SEARCH FOR THE TRUTH by David Willis. CHAPTER 1: INDIFFERENCE TO POVERTY (Part 54). This blog is a continuation of the review of The End of Poverty: How We Can Make it Happen in Our Life Time, by Jeffrey Sachs, published in 2005

Good governance and market reforms
Although predatory governance can soundly trounce economic development, good governance and market reforms are not sufficient to guarantee growth if the country is in a poverty trap. Botswana, Ethiopia, Ghana, Malawi, Mozambique, Nigeria (under President Olusegun Obasanjo), Senegal, Tanzania, Uganda, to name just a few, all have better governance than might have been expected given the burdens of extreme poverty, illiteracy, lack of financial resources, massive debt overhang, AIDS, malaria, and repeated droughts.

Free-trade zones would not suffice
In all these cases, but especially in the landlocked countries (which number a whopping 15 in Africa, by far the most of any continent), free-trade zones would not suffice, nor would they relieve extreme poverty on any kind of realistic timetable. To understand – and overcome – such crises, it would be necessary to unravel the interconnection between extreme poverty, rampant disease, unstable and harsh climate conditions, high transport costs, chronic hunger, and inadequate food production.

AIDS and malaria
My first foray into this complex mix was via disease – mainly AIDS and malaria – which I began to study in detail in 1997. More recently, especially in the context of the UN Millennium Project, I have also focused my attention on the issues of infrastructure and increased food production.

The malaria mystery
I had a lot to learn about disease and public health. It took me a while to understand the dire state of affairs. I still remember asking, “What do you mean they are not going to doctors? They have AIDS but they are not seeing doctors? Their children suffer from malaria-induced anemia but are not treated? How can this be?” “You know, there are treatments for AIDS and malaria,” I spluttered. “What do you mean, there are no medicines here? What do you mean, there’s no treatment program? What do you mean, USAID is doing nothing? What do you mean that the World Bank hasn’t had an AIDS or malaria program in this country for years?” These were basic questions that I had never asked before coming to Africa. Strangely, neither had other economists, including those leading the IMF and World Bank missions to Africa.

Low cost treatments exist, but they do not reach the poor
Malaria is utterly treatable, yet, incredibly, it still claims up to 3 million lives a year, mostly young children, about 90% of whom live in Africa. Low cost treatments exist, but they do not reach the poor. The first finding I tried to establish was whether malaria and poverty were intertwined because poor countries lacked the means to fight malaria, or also because malaria contributes to extreme poverty. The evidence suggests both directions of causation.

Malaria can stop a good investment project in its tracks
It is worth remembering how malaria and yellow fever delayed the construction of the Panama Canal for more than thirty years. Malaria to this day can stop a good investment project in its tracks, whether a new mine, farm, or tourist site. When children die in large numbers, parents overcompensate and have more children, with devastating results. Too poor to invest in the education of all of their children, the family might educate just one child, usually the elder son. If children in malarious regions manage to survive, they enter adulthood without the proper education they need to succeed.

A unique disease environment
Malaria in the United States, and indeed in every other place in the world outside Africa, was easier to control. Africa had it the worst, not because of poor governance and lack of public health services, but because of a unique disease environment. Malaria had coevolved with humans in Africa, and the result was a special intensity of transmission unequaled in any other part of the world.

Africa has a mosquito which prefers human biting nearly 100% of the time
Some types of mosquito prefer to bite people, whereas others feed off cattle. Transmitting malaria requires two successive human bites: the first for the mosquito to ingest the parasite and the second for the mosquito to infect another person. In India the predominant type of anopheles tends to bite humans about one third of the time, and cattle the rest. Africa has another predominating mosquito type which prefers human biting nearly 100% of the time. The force of transmission of malaria in Africa is roughly nine times that of India because of the difference of mosquito species.

High temperatures, plenty of breeding sites, and mosquitoes that prefer humans
Africa is really unlucky when it comes to malaria: high temperatures, plenty of breeding sites, and mosquitoes that prefer humans to cattle. Household spraying, insecticide-treated bed nets, and antimalarial medicines all work in Africa. No children need to die, and none will if they have access to all of the modern tools of disease prevention and treatment. Yet malaria sets the perfect trap: it impoverishes a country, making it too expensive to prevent and treat disease. Thus malaria continues and poverty deepens in a truly vicious circle.

The level of rich-country help to Africa to fight malaria was minimal
I fully expected to find that whatever could be done to fight malaria was already being done. Surely, I thought, the world community would not simply be standing by while millions of children were dying each year. The level of rich-country help to Africa to fight malaria was minimal, in the tens of millions of dollars per year when $2 to $3 billion was needed.

Malaria was not on the policy radar screen
I was shocked. I started to scour the World Bank and USAID Web sites and project descriptions. Surely we had overlooked a massive effort to help Africa fight the disease. But no, the original calculations were correct. Malaria was not on the policy radar screen. The IMF and World Bank were apparently too busy arguing for budget cuts and privatization of sugar mills to have much time left to deal with malaria.

Wednesday, February 18, 2015 @ 05:02 AM
posted by admin

A preview of the unpublished book A CIVILIZATION WITHOUT A VISION WILL PERISH: AN INDEPENDENT SEARCH FOR THE TRUTH by David Willis. CHAPTER 1: INDIFFERENCE TO POVERTY (Part 53). This blog is a continuation of the review of The End of Poverty: How We Can Make it Happen in Our Life Time, by Jeffrey Sachs, published in 2005

Both the critics of African governance and the critics of Western violence and meddling have it wrong. Politics, at the end of the day, simply cannot explain Africa’s prolonged economic crisis. The claim that Africa’s corruption is the basic source of the problem does not withstand practical experience or serious scrutiny. During the past decade I witnessed close at hand how relatively well-governed countries in Africa, such as Ghana, Malawi, Mali, and Senegal, failed to prosper, whereas societies in Asia, Indonesia, and Pakistan, enjoyed rapid economic growth.

The Transparency International “corruption perception” rank
Table 1 compares the Transparency International “corruption perception” rank for these African and Asian countries and their respective economic growth rates. We see that African countries lag behind in economic growth even when they are perceived to be less corrupt than their Asian counterparts. Using formal statistical tests, it turns out that Africa’s per capita economic growth is significantly lower, by around 3 percentage points per year, than in other developing countries with comparable levels of corruption and income.

Vietnam is a case in point
At the same time, Africa’s harsh colonial legacy and the West’s very real depradations in the postcolonial period also do not explain the long-term development crisis. Other regions of the world that are now growing rapidly also experienced severe damage from decades or centuries of colonial rule and postcolonial meddling. Vietnam is a case in point, a country that had to fight for independence for decades and yet emerged from that brutal experience to achieve very rapid economic growth.

Some promising solutions
In sub-Saharan Africa, therefore, a good differential diagnosis is urgently needed. The political story lines of both the left and the right reflect platitudes and prejudices, with little explanatory power about economic development. I was intent on finding a better approach. My work in Africa has been both an intellectual as well as a human adventure, and I think the effort has paid off in helping to uncover some of the deeper roots of Africa’s predicament, as well as some promising solutions.

From my first drive across the border from Zimbabwe into Zambia, and during innumerable visits since, what has impressed me most is the distinctive physical ecology, and how it has helped to shape Africa’s recent economic history. The great biologist E.O. Wilson is correct, I believe, when he argues that human beings are “hard-wired” to feel a special resonance (“biophilia”) with the African savannah, the place where our species arose some 150,000 years ago. Yet however captivating these savannahs are, they pose innumerable and unique challenges for modern economic development: disease, drought, and distance from world markets, to name just three. Adam Smith, I noted earlier, had already pointed out the third of this trilogy in The Wealth of Nations, when he observed in 1776 that Africa had been poor from time immemorial because it lacked the navigable rivers and natural inlets that afford the benefits of low-cost, sea-based trade.

Zambia was losing trained capacity much faster than it was being gained
I was in the Bank of Zambia on the second or third day after my arrival, when my colleague from Harvard University explained to me that a Zambian coworker in the financial reform project had recently died. “How old was he?” I asked. “Oh, our age.” “But why?” “AIDS, Jeff. AIDS.” This project was meant to be “capacity building,” but Zambia was clearly losing trained capacity much faster than it was being gained.

AIDS and malaria
AIDS was not alone in its devastating impact on African society. Soon I became vividly aware of another insidious killer: malaria. Everyone’s children – rich and poor alike – contracted malaria. And all risked grave complications. Never, not even in the highlands of Bolivia, where illness is rife, had I confronted so much illness and death. India had never evoked the same sense of death in the air.

Sub-Saharan Africa’s life expectancy stood at 47 years
By the turn of the new millennium, sub-Saharan Africa’s life expectancy stood at 47 years, more than two decades lower than in East Asia (69 years) and 31 years lower than the average age in developed countries (78 years). The worldwide map of life expectancy in Map 8 highlights Africa’s unique and extraordinary situation.

Could the exceptional burden of illness be a reason?
According to economic historian Angus Maddison, Africa’s growth rate has been among the lowest of any world region during each major subperiod since 1820. That includes a long stretch before Africa fell to European colonial rule in the 1880s and the period since independence. Could the exceptional burden of illness be a significant reason?

Monday, February 9, 2015 @ 08:02 AM
posted by admin

A preview of the unpublished book A CIVILIZATION WITHOUT A VISION WILL PERISH: AN INDEPENDENT SEARCH FOR THE TRUTH by David Willis. CHAPTER 1: INDIFFERENCE TO POVERTY (Part 44). This blog is a continuation of the review of The End of Poverty: How We Can Make it Happen in Our Life Time, by Jeffrey Sachs, published in 2005

Ascending the ladder of development
The developing world falls into four broad categories. Malawi with 84% in rural areas, where men of working age have died of AIDS and the margin of survival is extraordinarily narrow but funding for one of the best conceived strategies was a fraction of that required – a perfect storm bringing together climatic disaster, impoverishment, AIDS, malaria, and schistosomiasis.
Bangladesh, with 76% in rural areas, the international basket case, not out of the grip of extreme poverty but where the fight for survival is gradually being won, with its foot on the first rung of the development ladder.
India, with 72% in rural areas, the center of an export services revolution and where overall economic growth is 6% per year.
China with 61% in rural areas, where economic development is speeding ahead at full throttle, economic growth is above 8% pa and annual income has surpassed $4,000 per capita.
If economic development is a ladder there are roughly one billion who live as the Malawians; a few rungs up there are 1.5 billion like those in Bangladesh; 2.5 billion another few rungs up like those in India; and still higher up the ladder one billion in the high income world.
The greatest tragedy of our time is that one sixth of humanity is not even on the development ladder, trapped by extreme poverty, disease, physical isolation, climate stress, environmental degradation.
Even though life-saving solutions exist to increase their chances for survival, these families and their governments simply lack the financial means to make these crucial investments.

Our generation’s challenge
Our generation’s challenge is to help the poorest of the poor to escape the misery of extreme poverty so that they may begin their own ascent up the ladder of economic development.
When I speak of the ‘end of poverty’ I speak of two closely related objectives. The first is to end the plight of one sixth of humanity that lives in extreme poverty and struggles daily for survival. Everybody on Earth can and should enjoy basic standards of nutrition, health, water and sanitation, shelter, and other minimum needs for survival, well-being, and participation in society.
The second is to ensure that all of the world’s poor, including those in moderate poverty, have a chance to climb the ladder of development. As a global society, we should ensure that the international rules of the game in economic management do not advertently or inadvertently set snares along the lower rungs of the ladder in the form of inadequate development assistance, protectionist trade barriers, destabilizing global financial practices, poorly designed rules for intellectual property, and the like, that prevent the low-income world from climbing up the rungs of development.
These, then, are the economic possibilities of our time: To meet the Millennium Development Goals by 2015; To end extreme poverty by 2025; To ensure well before 2025 that all of the world’s poor countries can make reliable progress up the ladder of economic development; To accomplish all of this with modest financial help from the rich countries, more than is now provided, but within the bounds of what they have promised.
To meet these challenges, we first have to understand how we got to where we are, for in that understanding we will also find the way forward.