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Do Americans know that there are cities in Africa?

I’m convinced that they do not.

Two articles have appeared in the NYT in the past week on development. One dealt with agriculture in South America, and the other with power and electricity.

The first, “Iowa in the Amazon,” was written by Stephen Porder, an associate professor of ecology and evolutionary biology at Brown. He write on soy beam farming in Brazil:

Despite what you might hear at your local farmers’ market or Whole Foods, not all big farms are bad. Nor are all small organic farms sustainable. They may produce high-quality food, but if they don’t produce a lot of calories per acre, they are doing little to help increase the global food supply. How we increase this supply over the next few decades will determine agriculture’s sustainability. It’s worth exploring why this is so, because sustainable food production is a fundamental human need. Getting it right will require us to carefully assess the consequences of where and how we farm.

Which is a reasonable position to take. Farming is (and has always been) about maximizing yield from a limited amount of land. The responses to his article are telling, most notably this one:

“Highly mechanized farms in the poor countries of the world create numerous environmental and social problems. These mega-farms rely on large quantities of relatively cheap fossil fuels as well as pesticides that contaminate water, soil, food and people.”

Also, a reasonable position. Now, I’m willing to entertain the costs of large scale, efficient farming, but the comments suggest that readers haven’t considered the costs of small scale agriculture, most notably in sub-Saharan Africa. I’m thinking that the American readers believe that a lady cultivating maize in her yard in Kenya, is the same as a household garden in the United States. It is not.

Small scale farmers face massive levels of risk on a daily basis. A poor rainy season could devastate the small crop intended to provide sustenance and livelihood for a likely growing family. Without developed systems of production, transportation and market efficiency, small holder farms have no way to supplement major crop losses. Thus, efforts which seek to exclusively bolster this sector overlook the importance of 1) large scale agriculture as a buffer against individual crop losses 2) transportation (roads) development which links producers to markets (and vice versa) and 3) how the labor intensive and inefficient nature of small scale agriculture impedes participation in other economic activities.

I fear that Americans have an image of Africa which doesn’t fit the realities on the ground and I fear that we in the development world are somewhat guilty for propagating it. Pictures of happy though poor maize producing households are great for getting us to donate to microcredit causes (for example) romanticize rural poverty, but risk whitewashing the precarious nature of this lifestyle.

The truth is, that African urbanization is occurring at the fastest pace that humanity has ever seen. Malawi’s cities grow by more than 6% per year, and by 2050, nearly 60% of Africans will live in cities. African cities are so huge as the make NYC seem like a small hamlet. Lagos, Nigeria has 21 million people.

Though many urban dwellers are growing crops in the cities, it is impossible to assume that small holder agriculture alone can possibly support hundreds of millions of non-crop producing Africans. Though we may dislike images of tractors moving through giant African farms, the reality is that Africa is facing the same challenges we did during our own development booms. Emphasizing efficiency of production at all levels should be the biggest item on the agenda.

As for energy, I’ll leave to reader to explore the vitriolic nature of the comments on this piece in the times, that had the gall to suggest that developing countries, facing increasing demand for stable sources of power, might simply consider domestically abundant coal as one of many options. The readers are apparently under the impression that the only energy requirement that Africa needs is for cooking. Apparently, they’ve never experienced a blackout in Nairobi.

Though I’m no coal fan, African countries have to consider their needs and weigh out the costs and benefits of the methods of addressing them.

Nairobi for a day (I think I will spend more time on a plane)

I’m back in Nairobi for a day. I think that I will have spent more time on airplanes that in Nairobi on this trip. It’s a pretty silly way to do business, but I wanted to be back home in time for Thanksgiving so I couldn’t extend it.

My friend Tirus picked me up from the airport. I mean, I pay him, but he’s still my friend. (Things are always quite gray in Africa.)

After the fire, the Kenyatta airport is still being run like patchwork, but it was the fastest that I’ve ever gotten through customs. Departures are routed through a giant tent. Arrivals have to go to a different part of the airport. It used to be that the two mixed, which created awful congestion throughout the airport. I think the fire actually did Kenya a favor. It’s still unclear when construction on the new terminal will begin.

It was interesting hearing Tirus recount his close call with the Westgate Mall attack. Apparently he was at Westgate relaxing and looking trough his phone not but an hour before the guns started to fire. Turns out it only took four guys to kill more than 70 people and wound nearly 200. Awful.

The ICC trials of the President and Vice President of Kenya are still news here. Actually, they are still news everywhere. Thinking about it, Kenya is in the American news on a daily basis. I think it might be the only African country that is.

I don’t know how the trials can proceed. Kenyatta’s and Ruto’s actions during the 2007 post-election violence were despicable, but it’s going to be rather difficult to successfully prosecute and sitting head of state, and maintain credibility for a struggling African country and a fledgling government. The ICC could actually cause more damage in the long term by pursuing the case, at least while Kenyatta is in power.

More later….. time for breakfast at the Seventh Day Adventist house. The claim to encourage “health living” by eschewing meat, spices and caffeine but the large amounts of salt in the food at this hotel are borderline dangerous!

What I’m Reading Now

A couple of weeks ago, I was mulling over writing a book. Now that I’m fully disoriented from the ASTMH meetings and the submission of a giant NSF grant, I can’t really put my head together well enough to get it going.

So maybe I’ll briefly write about other peoples’ books instead.

As always, I’m reading several books at once. I’m usually horribly bad at finishing anything at all, and books are no exception. Right now, I’ve got the following on my desk:

cover-davis-quammen-spillover-book1. Spillover: Animal Infections and the Next Human Pandemic (David Quammen, 2012) - Many human diseases actually have their origins in animals. HIV moved from primates to humans. All human influenzas are diseases of animals. Awful infections like ebola and nipah virus are, in fact, bat diseases. However, the story isn’t as simple as humans simply becoming infected through contact with animals. Complex dynamics of inter-species transmission can create a situation where a pathogen turns from benign to deadly. The future of infectious threats requires that we understand these dynamics and prepare for them, particularly as mankind urbanizes and human movement intensifies. A great and easy to read work that doesn’t sacrifice details. Highly recommended.

2. Why Africa is Poor and What Africans Can Do About It (Greg Mills, 2010) - A truly sensible assessment of the roots of Africa’s economic and development problems. Instead of looking backward to colonialism and ambiguous global threats, Mills picks apart what’s wrong with modern African states and pulls no punches. The solutions presented, however, mostly rely on sacking most of the present leaders of African states, a tall order for some places. Even more odd, however, is the glaring absence of the structural adjustment era which attempted to free African states from crushing bureaucracy by dismantling typical state provisions like health care and schools. A great read, though.

3. The Great Escape: Health, Wealth and the Origins of Inequality (Angus Deaton, 2013) Though the 20th century saw incredible advances in living conditions, sanitation and medical technologies which have extended and improved the quality of human life, the benefits have not been uniform. Deaton offers that inequality is not a given, but rather a consequence of progress. It is the case that health disparities between social groups are highly correlated with economic inequality. Health disparities, a consequence of systems which encourage political and social inequality, in turn exacerbate the gaps between the haves and the have-nots. Another great and easy read.

exodus4. Exodus: How Migration is Changing Our World (Paul Collier, 2013) Economist Paul Collier takes on modern human migration, the extent of which the world has never seen before. He explores the political problems behind migration, the process by which people move from migrants to immigrants to citizens and the political implications of newly pluralistic states and an economically integrated world.

5. Asian Industrialization and Africa: Studies in Policy and Alternative to Structural Adjustment (Edited by Howard Stein, 1995) - It’s pretty much what the title says. There are several chapters tracking Asia’s move from a disastrous formerly colonized, agrarian area and poverty stricken area of the world to a powerhouse of industrial development and a major success story. African countries, however, have failed to develop as quickly, some even regressing economically during the 80’s and 90’s. The specific policies that allowed Asia’s success are contrasted with Africa’s failures and recommendations are offered to foster pro-active development in Africa. Asian policies, which were often protectionist and required the active hand of government but worked well at their particular stage of development, were at odds with those recommended during the structural adjustment era which recommended full privatization and haphazard relaxation of government controls.

What the hell was I going to write about?

I can’t remember, but it was one of three things:

1. To complain about Dambisa Moyo’s 2009 book Dead Aid, which I finally got around to reading. Basically, she says that Africa should give up on Western backed “aid” (she makes no effort to distinguish between different types of aid, and the contexts under which it is given), and do three things: 1) Have the west give African countries 5 years to phase out “aid” 2) Let China build all of Africa’s infrastructure for them (rather than the West) 3) Borrow money from private capital markets (she used to work for Goldman Sachs).

Given it’s haphazard treatment of details, it’s a pretty comedic book, but she gets accolades from right wingers who hate giving money to poor people. If you merely replace “aid” with the word “food stamps,” you’ll end up with the basic message of the American Tea Party: any amount of free stuff creates a “culture of dependence.” I’m sure she’s more educated and articulate than her book would suggest, but it appears that she is less concerned with writing useful policy analysis, and more concerned with waving a wide brush so she can raise her status as a celebrity.

While I don’t agree with everything Bill Easterly writes, he gives the subject a much better treatment.

2) To write about realism and caricature in Breaking Bad, or at least to note that I never get to see TV shows until after they are cancelled.

3) To reflect on the conservatism of punk rock music. I was listening back to some 80’s hardcore and remembering how horribly conservative a lot of this was. They had more rules on behavior than the Taliban (an inappropriate joke, but you get the idea…). Exactly what were they rebelling against, and what were they offering? Even Reagan was less uptight. A lot of us came out of some really chaotic situations, it’s odd (or maybe expected) that we’d gravitate toward dogma. Still, this stuff is no fun at all!

4) To complain about my low salary and uncertain prospects to make more money. This would make a horribly uninteresting post, however.

For now, though, here’s a trailer from a new movie on Punk from Southern Africa.

The Epidemiologic Transition in Kenya: Are Pastoralist Communities Benefitting?

demographic_transition_detailedIn epidemiology, we have a concept called the “epidemiologic transition,” which illustrates the shift in the the causes of illness and death as humans change from pre-agricultural to agrarian to affluent societies (Omron, 1971).

Traditionally, humans die from infectious causes, limiting their lifespan to a few decades at most. Through agriculture, they are able to increase their nutritional profiles, reducing infant mortality and allowing rapid population increases. As societies introduce efficiencies in transport and trade and move to technological solutions to former pathogen threats, infectious diseases become controlled and chronic conditions become more prevalent. Economic challenges restrict family size so that births and deaths reach equilibrium and population ceases to increase.

While it’s a great model for understanding the shifts in the health profile of worldwide or continental populations, it is fairly unsatisfying when examining within country or within community health and useless when looking at individuals.

The Health Transition and the Maasai

I’ve been thinking about a Maasai community in Laikipia, Kenya that I was working with this summer. We were looking at Q fever, a bacterial disease which can infect all mammals, but is particularly common in domesticated herd animals. The pathogen is transmissible to humans and can cause fevers, malaise, cardiac problems and miscarriages in pregnant women. It is an occupational hazard to those who work with animals, and potentially a threat to pastoralist communities, who depend on livestock for money and sustenance.

Now, it’s hard to know what was really happening before humans moved to agriculture for sustenance. Paleolithic peoples weren’t known for leaving written records or for data collection. We can, however, look at hunter gatherers in Sub-Saharan Africa or South America to give us at least some idea of what human health was like before we started growing crops in fixed locations.

More relevant to the Maasai, we can look at nomadic-pastoralists, who rely on domesticated animals but move from place to place, and sedentarized pastoralists, who also rely on livestock, but reside in mostly fixed locations. Sedentarization can occur due to land constraints which might include scarcity of water or the introduction of political or property boundaries.

DSC_0685Research has indicated that sedentarized pastoralists are more unhealthy than still nomadic livestock herders. Women and children in sedentary communities have been shown to have poorer nutritional profiles than nomads (Nathan, Fratkin et al. 1996, Fratkin 2001). Incidence of diarrheal and respiratory disease is lower in nomadic children than in children in sedentarized communities. Sedentarism and interaction with commercial livestock markets has been associated with declines in social cohesion, which has been associated with declining health profiles of pastoralist communities in Uganda (Pearson 2010). Sedentarization isn’t all bad, however. Nomadic communities have been found to be at greater risk for zoonotic diseases (like Q and Brucellosis), have lower rates of vaccination, poorer vitamin profiles and high rates of infant mortality(Montavon, Jean‐Richard et al. 2013).

The Direction of the Health Transition in Pastoralist Communities

In actuality, it is difficult to quantify “health,” though if we take infant mortality and life expectancy as an indicator of the quality of life of communities, we might find that sedentarized pastoralists do worse than nomadic pastoralists. This contradicts the “epidemiologic transition,” which posits that any shift towards fixed agrarian societies is beneficial to human health.

Modern societies, characterized by technological efficiencies, diversified economies and sophisticated transportation networks are significantly better for human health than nomadic hunter-gatherer contexts and pastoralist communities which exist at the mercy of weather and environmental pressures. Though it is definitely tempting to romanticize the days when humans quietly roamed the grasslands of Africa, eating whatever was available to them, it is hard to deny that humans were better off in a distant past. This would confirm the model of the epidemologic transition.

However, I believe, that though the trajectory toward development may be beneficial in the long term, the disruptions which occur along the transition have deleterious effects on humans health. I found this in Laikipia. Within a Maasai community, there were two distinct groups of people. One held on to traditional herding techniques and relied heavily on traditional medications to treat animals health problems. They mostly refused to send their children to formal school, had large numbers of children, and seemed ambivalent toward household economic diversification. The other was characterized by smaller families, eagerly sent their children to receive formal education, were open to modern herd management techniques and often took jobs or started business to diversify their household economic activities.

Financial losses from livestock death by occupation. "None" means no economic activities outside of herding.  "Mpala" refers to those working as security guards at a local research station. "Other" comprises a number of activities.

Financial losses from livestock death by occupation. “None” means no economic activities outside of herding. “Mpala” refers to those working as security guards at a local research station. “Other” comprises a number of activities.

I found that those resistant to sedentarization and economic integration with the Kenyan market economy did significantly worse than those who embraced change. I collected data on herds, asking households how many animals they possessed, what kinds, how many were born in the past year and how many died. What I found was that households which engaged with the Kenyan market economy through formal employment as security guards or herders on large commercial ranches had larger and more diverse herds since they did not have to sell animals to obtain cash for health services or school fees. They sprayed their animals for ticks more often and they overwhelmingly reported fewer animals deaths as a proportion of their total herd, indicating that herds were healthier overall.

If we were to take animal health as a proxy of human health (as herding households are in maximal contact with livestock at all times), then we might see that the epidemiologic transition among the Maasai might not be linearly increase consistently, but might rather be J-shaped. Health might decline on the shift from purely nomadic to sedentarized, by might improve again as households adapt to new conditions. Thus, the pattern of the epidemiologic transition, while holding overall, might experience a series of dips along the way, presumably representing disruptions and adaptation to new conditions. It will be interesting to formally test this hypothesis.

Abdel, R. O. (2001). “The epidemiological transition: A theory of the epidemiology of population change.” World Health Organization. Bulletin of the World Health Organization 79(2): 161.
Fratkin, E. (2001). “East African Pastoralism in Transition: Maasai, Boran, and Rendille Cases.” African Studies Review 44(3): 1.
Fratkin, E. M. and E. A. Roth (2005). As Pastoralists Settle. Boston, MA, Springer US
Kluwer Academic Publishers-Plenum Publishers.
Montavon, A., V. Jean‐Richard, M. Bechir, D. M. Daugla, M. Abdoulaye, R. N. Bongo Naré, C. Diguimbaye‐Djaibé, I. O. Alfarouk, E. Schelling, K. Wyss, M. Tanner and J. Zinsstag (2013). “Health of mobile pastoralists in the Sahel – assessment of 15 years of research and development.” Tropical Medicine & International Health 18(9): 1044.
Nathan, M. A., E. M. Fratkin and E. A. Roth (1996). “Sedentism and child health among Rendille pastoralists of northern Kenya.” Social science & medicine (1982) 43(4): 503.
Omran, A. R. (1977). “A century of epidemiologic transition in the United States.” Preventive Medicine 6(1): 30.
Pearson, A. L. (2010). Health and vulnerability: Economic development in Ugandan pastoralist communities, ProQuest, UMI Dissertations Publishing.

The Ninth Millennium Development Goal: Business Development?

7_MDG_IconsLast night I was reading up Japan’s road to industrialization. Specifically, I was learning how it went from a backwards set of earthquake prone islands in 1868 to one of the most powerful economies on the planet.

In 1900, the average Japanese person could expect to live to be about 44 years old, which is almost the same as a Malawian, both in 1900 and in 2013. However, a Japanese person in 2013 can expect to live to be more than 80 years old.

How did it do this? Ignoring the complexities and numerous details, Japan developed because it recognized early on that it had to develop its business sector. Development can’t occur without livelihoods and livelihoods come from cash producing jobs.

For example, following the Meiji restoration, Japan developed a system of land taxation, took the funds and invested them into buying second hand sewing machines from Europe. Rather than aiming for labor saving technologies, Japan aimed for labor intensive, individual sewing machines so that it could leverage as many people as possible. What it lacked in economic resources, it made up for in hands. Japan in the 1920’s then became a major exporter of textiles to Europe.

Japan didn’t stop there. Out of its land taxation system, it also made sure that capital was available for merchants wishing to diversify their businesses and encouraged farmers to convert their crops into products. A soy farmer can process his output into tofu and soy sauce. Similarly, a rice farmer can manufacture sake and sell it.

I am looking at the UN’s Millennium Development Goals:

Eradicating extreme poverty and hunger
Achieving universal primary education
Promoting gender equality and empowering women
Reducing child mortality rates
Improving maternal health
Combating HIV/AIDS, malaria, and other diseases
Ensuring environmental sustainability
Developing a global partnership for development

Out of eight goals, not a single one focuses on private sector development and entrepreneurship, which is arguably, if the cases of Japan and Korea are to be applicable to the African context, the key to consistent economic growth.

Where is the ninth goal? Where is the goal which calls for increased access to capital for small and mid level entrepreneurs? Where is the goal that calls for an elimination of onerous export taxes and corruption which kills the ability for businesses to competitively sell their products to the rest of the world? Why is there no call for proper systems of taxation which allow domestic investment?

The goal of sustainable business development is fundamental to the success of at least each of the other eight goals. I suspect that suspicion and cynicism toward the private sector is the culprit. No doubt, this ambivalence toward business killed the Affordable Medicines Facility – malaria, a supply side subsidy intended to increase access to anti-malarial medications in small private drug shops.

Even in public health, which is supposedly focused on holistic solutions to public health problems, the issue of private sector development and the relationship of economics to human health hardly appears.

People in my field seem to be happy to stick with models of pharmaceutical solutions to health problems, delivered through publicly funded health systems. What they fail to address is how to support those public clinics and hospitals though other means than donations from first world countries.

The evidence that Africans will flourish when given appropriate amounts of capital under reasonable terms (not microfinance as it currently exists) is out there. A strategy to give money to the poor, without strings or promise to repay, conditional on a reasonable business plan found that African households will invest in tools or technology to provide them income in the long term. They find that households which enlarge their business through an influx of capital keep their kids in school longer than households which do not.

I did a small survey of business on Lake Victoria, Kenya and found that businesses’ second most common stumbling block (the first was security) was a lack of access to capital. They need money to expand. Microfinance schemes, with their very high interest rates, are not a viable option to most, though loans at more favorable terms to the right people might make a huge difference.

True development will require a dramatic shift in focus for the development world. We will have to face the reality that business is good for human health, that the negatives of entering the cash economy are small compared with the negatives of trying to fruitlessly maintain a pre-colonial lifestyle in a post-colonial world and that Africans themselves are willing to step up to the plate.

Blog of the Week: Africa is a Country

AfricaisaCountryI just ran across this great must follow blog, “Africa is a Country.”

It’s a collective of many people who write and think about Africa who seek to shatter common notions of what Africa “is” (or “isn’t”). The writing is great and the subject matter fantastic. Posts cover present and past film, books, music, photography and politics form all over the continent.

It’s the blog that “isn’t about famine, Bono, or Barack Obama.”

“Africa is a Country” sports some great articles on such subjects as:

People who go to Africa to snatch up vinyl
Cape Town hip hop
New developments in Nigerian cinema
The beginning of Africa’s first Libertarian political party
One man’s irrepressible hatred for Bono
New music in Mozambique
Mozambiquan photographer Felipe Branquinho
A crazy article on surreal Germans who get wild in Africa

and a great and truly frightening article on how a batshit church in Kansas exports hate and homophobia to Uganda.

In their words:

Of course we don’t literally believe Africa is a Country (unlike say rapper Rick Ross). The title of the blog is ironic and is a reaction to old and tired images of “Africa”. We deliberately challenge and destabilize received wisdom about the African continent and its people in Western media — that definition includes “old (nationally oriented) media,” new social media as well as “global news media”.

Media here means more than journalism; it is also art, music, film, books, graphic design, etcetera. We don’t spend all our time criticizing though. We also celebrate and feature work that we think complicate the old, ahistoric and objectional images. We want to introduce our readers to work by Africans and non-Africans about the continent and its diaspora that have worked against the old and tired images of Africa.

The blog is that, and more. As one of the core members of the collective, Neelika Jayawardane, explains in the “About” section on our Facebook page, Africa is a Country is also about constructing a state of mind. One where the “nation” operates outside the borders of modern nation states in Africa and its continental and conceptual boundaries. So, yes, the blog announces that Africa is indeed a “country,” an imagined community whose “citizens” must reinvent the narrative and visual economy of Africa.

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