A preview of the unpublished book A CIVILIZATION WITHOUT A VISION WILL PERISH: AN INDEPENDENT SEARCH FOR THE TRUTH by David Willis.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