A preview of the unpublished book A CIVILIZATION WITHOUT A VISION WILL PERISH: AN INDEPENDENT SEARCH FOR THE TRUTH by David Willis.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