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:
1. 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.
4. 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.
I just returned from this year’s meeting of the American Society of Tropical Medicine and Hygiene (ASTMH). For us in the developing country health world, it’s the biggest meeting of the year.. yet surprisingly small. Once you go to a few, you quickly realize you know just about everyone there.
Unfortunately, because I was preoccupied with a crushing NSF deadline, I didn’t get to see many of the presentations. I did, however, get to see many of the great people I know and, despite the deadline pressures, managed to have a great time.
Some highlights (for the layman), though:
1. Nipah virus: This one’s a beast. With a 70% case fatality rate (7 out of 10 people who become infected die), contact with this bug will pretty much assure there’s no tomorrow. Fruit bats area known reservoir though they seem unaffected by the virus. They urinate on pigs who transmit it to humans.
Sometimes, the bats urinate in certain tree sap collection buckets. People drink it directly, fall ill and then transmit to their families and kill them, too.
Because of Nipah’s ubiquity in fruit bats, the ease of isolating and producing stocks of the pathogen and it’s potential for major public health damage, the CDC has listed the virus as a Class C bioterror agent. Wow.
2. Imported zoonotic pathogens: More than 200 transmissible pathogens have been known to be imported into the US via the illegal wildlife trade. Remember, that most living things are mini-ecologies of bacteria, virae and fungi (yes, you too). Those people with the exotic snakes they imported in their bag? They brought more than snakes.
3. Plasmodium vivax (one of the four species of malaria parasites) relapses occur, on average, 14 months later. I found it interesting that it wasn’t 12. My mental transmission model confirmed that a 14 month relapse cycle would be much more suited to sustaining the pathogen than a more predictable 4, 6 or 12 month cycle. I will have to confirm with real (not fantasy) math, though. As vivax is a cold weather malaria, it makes a huge difference. Mosquitoes aren’t nearly as active in the winter.
It turns out, though, that I’m wrong, or misread the presentation (See Update below).
4. Nets with holes might be just as effective as nets without holes. We can stop collecting all those old nets and setting them on fire, now.
5. No one can agree on what dose of Primaquine to use during mass drug administrations to eliminate malaria. It’s kind of important. People with a particular genetic deficiency react badly to the drug, i.e. their red blood cells explode and they sometimes die.
6. A vaccine for malaria is on the way. It’s like the “check’s in the mail” for several decades. You can’t fault anyone for trying. We need one badly.
7. The Burma Restaurant in Washington, DC is truly fantastic, particularly the green tea salad, which tastes nothing like one would expect.
Outside of that, it was great to see friends. I can’t wait to see them again.
A friend wrote me to correct me on the timing of a relapse of P. vivax (and I appreciate it). Actually, it turns out he wrote a paper on it:
“Here: The Plasmodium vivax that was once prevalent in temperate climatic zones typically had an interval between primary infection and first relapse of 7-10 months, whereas in tropical areas P.vivax infections relapse frequently at intervals of 3-6 weeks. Defining the epidemiology of these two phenotypes from temporal patterns of illness in endemic areas is difficult or impossible, particularly if they overlap.”
Here: Tropical P. vivax relapses at three week intervals if rapidly eliminated anti-malarials are given for treatment, whereas in temperate regions and parts of the sub-tropics P. vivax infections are characterized either by a long incubation or a long-latency period between illness and relapse – in both cases approximating 8-10 months.
And Here: Median relapse times for malaria caused by Old World parasites (tropical, 4.5 weeks [95% CI 3.6–5.4]; temperate, 8.5 weeks [95% CI 6.8–10.3]) were shorter than those for malaria caused by New World parasites (tropical, 27.5 weeks [95% CI 21.6–33.5]; temperate, 34.0 weeks [95% CI 32.0–36.0]). In addition, in both hemispheres, median relapse times for infections caused by tropical strains were shorter than those for infections caused by corresponding temperate strains, although this difference was not significant in the New World (Figure 3). The 95th percentile relapse times for the strain categories follow: Old World tropical, 9.5 weeks (95% CI 5.4–13.5); New World tropical, 40.3 weeks (95% CI 34.4–46.3); Old World temperate, 30.9 weeks (95% CI 19.9–41.9); and New World temperate, 97.7 weeks (95% CI 97.6–97.8). The HRs from the survival models (adjusted for neurologic treatment) follow: Old World tropical, 39.6 (95% CI 9.2–171.0; p<0.001); New World tropical, 0.93 (95% CI 0.36–2.41; p = 0.89); Old World temperate, 3.1 (95% CI 2.2–4.6; p<0.001)—all relative to New World temperate (reference).
“The Top 1 Percent in International and Historical Perspective” from Alvaredo et al. tracks the share of income held by the top 1% of a number of countries and finds what we already knew. Since the 1980′s, the share of income held by the top 1% has been on the increase and is reaching levels not seen since before the Great Depression.
Though globalization, technology and a fundamental change in how the top earners make money (finance vs. investment in manufacturing) are often implicated and seen as merely an unfortunate side effect of development, Alvaredo argue that increasingly regressive taxation structures are the culprit.
Further, they argue that the end of unions and the determination of wages through collective bargaining have tipped the scales against bottom level wages earners, increasing the share of the pie taken by the very wealthy.
Top tax rates have moved in the opposite direction from top pre-tax income shares. The second factor is a richer view of the labor market, where we have contrasted the standard supply-side model with the alternative possibility that there may have been changes to bargaining power and greater individualization of pay. Tax cuts may have led managerial energies to be diverted to increasing their remuneration at the expense of enterprise growth and employment. The third factor is capital income. In Europe—but less so in the United States—private wealth (relative to national income) has followed a spectacular U-shaped path over time, and inherited wealth may be making a return, implying that inheritance and capital income taxation will become again central policy tools for curbing inequality.
Of course, it’s not like most of us didn’t know this already.
Whether or not a very wealthy class becoming wealthier relative to everyone else is good or bad for society is a topic up for debate. The trouble, however, is that mass inequality give a small sliver of the population greater political power, which they can use to influence policy, to realize a limited number of self interested goals.
But we knew that already…..
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.
Last 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.
Movie of the Week: 三里塚 第二砦の人々 (Sanrizuka: People of the Second Fortress) (Dir: 小川紳介 Ogawa Sinsuke) 1971
The University of Michigan is hosting a series of films from Japanese documentary film production group, Ogawa Productions. Last night I had the pleasure of seeing “Sanrizuka: People of the Second Fortress” for the first time.
Narita airport was built on agricultural land claimed through eminent domain. Some of the residents, who were nearly all peasant families, sold early on and left. A number of families, however, feeling slighted by the Japanese government’s unwillingness to engage them in dialogue, stayed and fought.
This was no sit in protest, but a violent confrontation of peasants against government and private forces. The peasants built elaborate fortresses to prevent construction on the land, deep tunnels to hide in , and used spears, molotov cocktails and hurled projectiles to protect themselves. The Zengakuren (an anarchist group similar to America’s SDS) maintained the front lines armed with spears and throwing stones at riot police.
The entire scene is filmed like a grand Kurosawa epic. Armed forces besiege a well defended fortress on a hill top, while troops on the ground go toe to toe in battle. The riot police were clearly unprepared for the level of violent resistance they encountered and retreat more than once. In desperation, the Japanese government hires non-locals (at a rate of 20,000 yen a day, presumably to minimize liabilities and accountability) to charge in on their behalf.
A few questions came to mind. First, where did the non-locals come from? I’m wondering if they were hired from the day laborer slums of Kamagasaki and Sanya, again illustrating the complex relationship between anti-social dropouts and the State. Day laborers are simultaneously marginalized by the State and completely necessary to its survival. Even as recently as 2011, despite decades of exclusions and abuse, the Japanese government called upon day laborers in Kamagasaki to clean up Fukushima (again for 20,000 yen a day), presumably since few would care about the threats to their health.
Second, the Zengakuren play a major role in defending the fortress. It is mentioned during the film that the Socialist Party of Japan (社会党) initially involved itself, acting on the behalf of the farmers, but at some point during the five year struggle, became disinterested. It was mentioned by others that the Communist Party of Japan (共産党）was also involved. As I was watching the film, I was wondering how the situation could have become as extreme as it did, and though that these political actors might have agitated the farmers to move to more and more extreme methods. If that was the case, then the farmers might have been mere political pawns for an anti-establishment agenda. Though the Zengakuren obviously stuck it out to the bitter end, I’m wondering if they too might have self-servingly exacerbated the situation.
While Ogawa takes time and care to film and interview the farmers, both individually and as a group, not a single member of the Zengakuren speak for the entirely of the film. In fact, Ogawa never even shows them in close-up. Not only do we not know what they think, we don’t even know what they look like. Even more mysterious are the large crowds of bystanders, which are shown only through holes in the barricades the farmers have constructed or on the tops of hills in the distance. We actually know more about the riot police than any of the Zengakuren.
Third, and a minor point, the farmers had set up a tower with which to broadcast inspirational leftist music and speeches to the riot police and bystanders. It’s not clear why the riot police didn’t knock the largely unguarded tower out immediately. Also, though the film is incredibly violent, one has to wonder how much of the violence is performance. All sides had ample opportunity to kill and injure people, but, miraculously, only a handful of people were killed.
When farmer ladies are chaining themselves to trees to prevent airport crews from entering, they make a big production out of wrapping the chains around their neck, but have arranged them in such a way that one would merely have to bend down a bit to break free. One has to question how serious the farmers were, and how much of the fighting they preferred to leave to the Zengakuren, and whether they wanted the anarchists there at all. Though some of the farmers suggest directly engaging the riot police at one point, it is clear that there isn’t much consensus on how violent they were willing to become.
The relationship of the farmers, who prior to the planned building of the airport had likely lived in relative isolation from the rest of Japan, to the outside political upheaval of Japan is perhaps the most interesting part of the film. Though the farmers are very serious about protecting their land and continuing their lifestyles, they seem rather ambivalent to Japan’s political problems, but are regardless resigned to become a part of them.
As with many documentaries from Japan, it’s unclear how sympathetic the film’s producers are to the subjects they have chosen. On the one hand, Ogawa seems to want to advocate on behalf of the farmers, but on the other, he spends much time showing them as isolated and slightly naive. He makes no attempt to deny the futility of their cause.
“People of the Second Fortress” is a fantastic film. The producers risked their lives to make the film. Miraculously, the camera wasn’t smashed during filming.
Here are some great pictures from that time.
Unfortunately, I couldn’t find a clip of “People of the Second Fortress,” but here is an extended clip of one of the films from the same series: