A preview of the unpublished book A CIVILIZATION WITHOUT A VISION WILL PERISH: AN INDEPENDENT SEARCH FOR THE TRUTH by David Willis.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.