A summary of The End of Poverty Chapter Eight – The Voiceless Dying: Africa and Disease
I’ve just finished re-reading this – It mainly focusses on how Malaria and AIDs have prevented development in Sub-Saharan Africa and what can be done about it – basically a precursor to the establishment of the Millennium Development Goals. It’s 10 years old now, but fascinating nonethless, especially if you read it along with current progress reports on efforts to combat these two diseases I’ll add in a few updates on the later l8r.
The chapter begins by reminding us that corruption alone is not enough to explain Africa’s poor economic growth in the post-colonial period. In fact, charging Africa with corruption is hypocritical – little surpasses the cruelty and depredations that the West has long imposed on Africa, firstly in the form of Colonialism itself which left Africa bereft of educated leaders and infrastructure, and with arbitrary boarder lines which divided ethnic groups, water courses and mineral deposits in arbitrary ways.
On top of this, as soon as the cold war ended, Africa became a pawn in the Cold War. Assistance was refused to governments who were seen to be pro-communist and some terribly oppressive regimes were actually supported if they were seen to be anti-communist….The most obvious example provided is the installation of Mobutu Sese Seko in the now DRC following the murder of the first Primeminister of the Congo – Patrice Lumumba by CIA and Belgian Operatives, with a similar process happening in at least Angola, Ghana, South Africa (US support for Apartheid), Mozambique and Somalia.
Sachs now cites a 1965 CIA report which summed up the potential for economic growth in Africa as minimal, and stated the view that Africa was unlikely to receive signficant enough investment from the US to make a difference – basically what Africa needed was a Marshall Plan level of investment, but the US was not prepared to invest this money in Africa.
Instead, what Africa got (during the 1980s and 1990s) was Structural Readjustment Policies which encouraged ‘budgetary belt tightening’ which left many African countries poorer by 2000 than they were in the 1960s immediately after the end of colonial rule. Sachs says that these policies had little scientific merit and produced little results
Deeper Causes of African Poverty
Sach’s starts of this section by pointing out that the corruption levels between 1980 – 2000, as measured by Transparency International, were higher in various Asian countries (for example Pakistan, India and Bangladesh) compared to various African countries (for example Malawi and Mali), and yet Asian countries grew at around 3% a year, while Africa stalled. NB – it’s worth noting as a quick aside that a 3% year on year growth rate might not sound like a lot, but over 20 years this compounds signficantly.
Sachs draws on his visits to Sub-Saharan Africa (the first in 1995) to explain the factors which have hindered economic growth…..
Environmental factors hinder attempts towards economic growth – Disease, Drought and distance from world markets are all features of the African environment – Adam Smith, in fact, noted in 1776 that Africa lacked the kind of navigable rivers which gave Europe an advantage in world trade.
To emphasise this Sachs also talks about just how dispersed the rural populations of Africa are, which, combined with poor soil fertility, hinder their ability to produce sufficient food for themselves, let alone producing enough to export.
Then he gets onto the prevalence of disease – AIDS was already rampant by the mid 90s, but he also cites Malaria – he states that all of his Africa Colleages lost a few days a year to boughts of Malaria, some of the boughts being serious and leading to hospitalisation. He says that nowhere on earth had he experienced so much illness and death as in Sub-Saharan Africa – in the year 2000, SSA’s LE stood at 47, a good 20 years below Asia’s and 30 years below Europes.
According to the historian Angus Maddison, SSA had experienced the lowest levels of economic growth in the world even before colonial times, which leads Sachs to theorise that the disease burden may be able to explain both this long-term historical low economic growth rate and the more recent low growth rate.
There are some other factors which might explain low growth – Firstly poor leadership is sufficient to explain this in the case of Zimbabwe.
Next Sachs asks why there is such a lack of Free Trade Zones for exporting in Africa, given that these were the path to growth which Asian countries used form the late 1960s onwards, which grew mainly through exporting garments. There is one African country which did the same – Mauritius in 1968 – Here one ethnic-Chinese academic on the island happened to visit his brother in Taiwan . The brother was playing a lead role in the new export processing zones which were then being established in Taiwan, and his brother took the concept back to Mauritious, and the rest is history….
He then points out that free market reforms would not work in African countries which were caught in a poverty trap, especially those which are landlocked (15 countries are in Africa) – even those which had generally good governance.
The Malaria Mystery
Malaria is an entirely treatable disease, and yet it still claims 3 million lives a year, 90% of which are in Africa. After pointing to the correlation between low GDP and Malaria and then asks four questions….
Is it Malaria that causes poverty, or vice-versa? Or both?
Why was the Malaria problem so much worse in Africa
What was being done about the Malaria problem?
What more could be done?
Is it Malaria that causes poverty, or vice, versa, or both….?
Poor countries cannot afford Malarial prevention strategies – such as spraying with insecticide or putting up treated mosiquito nets, or even houses with doors and windows which keep the mosquitos out.
Malaria also prevents econommic growth – not only because of work days lost, but also because mass illness can stop infrastructure development projects in their tracks – Sachs reminds us that the building of the Panama canal was hindered because of Malaria.
Malaria also means high birth rates – when children die, parents overcompensate and have more children…. then large numbers of children and poverty means the family can only afford to educate one child, so large numbers of children enter adulthood with no education.
It also means those children who do get an education taking time of school because of sickness and poor education.
In short (p199) ‘Malaria sets the perfect trap: it impoverishes a country, making it too expensive to prevent and treat the disease. Thus malaria continues and poverty deepens in a truly vicious cycle.
Why is Africa more vulnerable than other regions?
Basically because of the disease ecology – a combination of high temperatures (the parasite develops faster), moist breeding grounds, and a variety of mosquito which prefers bighting humans rather than cattle means the transmission rate is higher in SSA than Europe and Asia (with the exception of Papua New Guinea). This all leads to the transmission rate being 9 times faster in Africa than it is in Asia.
However, Malaria is treatable and a combination of spraying, bed nets, and anti-malarial drugs means that no child at least needs to die from the disease.
What was being done (in 1995) to combat Malaria?
Hardly anything – tens of millions were being spent in aid, when $2-3 billion was required ($5billion a year in today’s money)…. The world bank was too busy arging for budget cuts and privatisation to even notice Malaria.
Africa’s AIDS cataclysm
Why is AIDs more of a problem in Africa?
No one’s really sure – the common assumption is that people have more sexual partners in Africa, although data puts this in doubt – So it might be that the patterns of copulation are different (more older men with younger women), it might be more concurrent relationships (faster turn over), it might be less use of condoms.
What are economic costs of AIDs?
This is possibly worse than Malaria, at the time 10s of millions of deaths – and many adults dying – teachers/ doctors/ civil servants, not to mention the strain on the health services, the heads of households being ill and the orphaned children. Also businesses don’t invest out of fear.
What was being done?
By the late 1990s, Anti-retroviral therapy in the West was giving people with AIDS hope – which meant more people were coming forwards to be tested for the disease, but only $70 million was being spent on combatting the disease in SSA. Apparantly the World Bank did not make one single loan specifically for combatting AIDs in the Africa from between 1995-2000.
Eventally Sachs ended up charing a WHO commission on macroeconomics and health which made the case for economic investment in health to improve economic development. They found eight major causes of disease in Africa – of which AIDs and Malaria were the top two.
The commission also suggested that $27 billion of aid focussed on health a year could save 8 million lives – equivalent to 1/000 of the combined annual income of all donor countries.
The birth of the global fund to fight AIDs, TB and Malaria
This was established in 2001, following agreement from drugs companies to provide AIDs drugs for the $500 cost price (for low income countries) rather than the $10000 market price in high income countries.However, there is still an ongoing battle to secure funding and encourage low income countries to implement the necessary procedures to make all this worthwhile.
In the final section of this chapter Sachs reminds us that Africa faces other barriers to growth rather than just disease – he notes that a combination of environment and poverty creates a poverty trap – He comes back again to the point that intermittent rain fall doesn not help crop fertility, but also the fact that the most heavily populated areas are the most fertile regions in Africa – which is Rwanda (and DRC I thought) – basically inland areas furthest away from the coast.
However, he notes that there are many things which could be done to assist Africa – Poor soil can be improved by organic and artificial fertilisers, irrigation schemes could help – (Africa, basically, needs its own Green Revolution), and infrastructure improvement could connect inland rural populations.
At the end of the day – if a combined effort of the International Community and African Countries can combat Malaria and AIDs, then the same can be done to improve farming and develop roads and electric infrastructure.
I’m reminded about one quote from near the beginning of the book – What does Africa need to focus on most urgently – health/ education/ infrastructure or what – the truth is, everything at once.
The chapter rounds off by mentioning that this was about to be put in place big time by the introduction of the Millennium Development Goals in 2015 – Which Sachs played a central role in….