Archive | Development RSS for this section

Noah and the cursed Africa

noah-posterI was just watching Russel Crowe’s version of the Noah story at some friends’ house. Setting all of the other absurdities of the story aside, like the impossibility of successfully saving all the animals on the earth from only a pair of each (the lions alone would decimate any chances for herbivore reproduction in days, let alone the massive problems of an extremely limited gene pool), I remembered the crux of the story.

Noah discovers grapes, learns to make wine and then proceeds to become a raging alcoholic. The movie implies that he’s drowning his sorrows over failing to kill his two female grandchildren, thus preventing God’s plan to eliminate humanity from coming to fruition.

His son Ham finds Noah drunk and sees Noah’s genitals. The 950 year old Noah then curses Ham. Noah’s three sons then move out to establish the three races of humanity, the Europeans, the Asiatics and the Africans.

Ham moves to the African continent. All Africans, then, are descended from Ham.

To racists, this would provide a great explanation for Africa’s developmental problems. Africans are suffering under an ancient curse, because a guy saw his drunk Dad’s penis.

People in the United States believe this shit. What’s scarier is that they vote.

The need to look for more than just malaria

I was just reading a comment in the new Journal of the American Society of Tropical Medicine and Hygiene “After Malaria is controlled, what next?”

Fortunately for all of our jobs, there is little to worry about. Malaria, as a complex environmental/political/economic public health problem, won’t be controlled anytime soon. As there’s no indication that many sub-Saharan countries will effectively ameliorate their political problems and also no sign that, despite the “Rising Africa” narrative, African countries will develop in such a way that economic rewards will trickle down to the poorest of the poor, malaria transmission will continue unabated. This is a horribly unfortunate outcome for the people, particularly small children, who have to live with malaria in their daily lives.

In all of the places it occurs, malaria is merely a symptom of a greater political and economic failure.

Indeed, we really know less about the causes of suffering and death in the tropics than many believe. Even vital statistics of birth and death are unrecorded in many areas of the world, much less the accurate causes of disease and death. Some diagnoses, such as malaria, dengue fever, and typhoid fever, are often ascribed to patients’ illnesses without laboratory confirmation. Under the shadow of the umbrella of these diagnoses, other diseases are lurking. I have found significant incidences of spotted fever and typhus group rickettsioses and ehrlichiosis among series of diagnostic samples of patients suspected to have malaria, typhoid, and dengue in tropical geographic locations, where these rickettsial and ehrlichial diseases were previously not even considered by physicians to exist.4–8 Control of malaria or dengue would reveal the presence and magnitude of other currently hidden diseases and stimulate studies to identify the etiologic agents.

This is the problem with our public health fascination with malaria. We are missing all of the other pathogens and conditions which case untold suffering in the poorest and most isolated communities. It can’t be the case that malaria acts in a box. In fact, it could be the case, that multiple pathogens coordinate their efforts to extract as many human biological and behavioral resources as possible to obtain maximum opportunities for reproduction and sustenance. A public health system only designed to look for and treat a limited window of diseases misses the opportunity to disrupt what is probably a vast ecological complex.

First, we have a problem of poor diagnostics. Facilities traditionally treat most fevers presumptively as malaria, dispensing drugs appropriate to that condition. However, conditions like dengue fever exhibit similar symptoms. While is it extremely likely that dengue is all over the African continent, particularly in urban areas, there is little ability to identify true dengue cases in the public health sector, and thus, in addition to mistreating patients, the extent of the disease burden is unknown. We cannot tackle large public health issues without proper data.

Second, we have the problem of all of the “known unknowns,” that is, we know for a fact that there’s more out there than we have data for but we also know (or at least I do) that there is a greater disease ecology out there. We know that many pathogens interact with one another for their mutual advantage or to haplessly effect significantly worse outcomes. The awful synergy of HIV and TB is just one example.

OK, I’m going to go and deal with my own pathogenic tenant which I think I’ve identified as an enteric pathogen of the genus Pseudomonas, which might have taken hold opportunistically through an influenza infection. This is complete speculation, however. Data quality issues prevent a reliable diagnosis!

Mfangano (and missionaries in Kenya)

White lady comes to save African children from themselves by having her photo taken with them.

White lady comes to save African children from themselves by having her photo taken with them.

I went and checked out Mfangano, an island close to here that’s home to about 25,000 people (or 16,000 depending on who you ask). It is famous for some 2,000 year old rock paintings done by the Twa people, a group of hunter gatherers whose range historically extends all the way over to Western Africa.

Unfortunately, the Twa are long gone from the island, which is now occupied by Suba and Luo people, though the Suba are quickly being assimilated into the Luo through marriage.

It’s an odd place. They’ve got a small tourism industry, are currently installing new power lines and have recently gotten true ferry service from the mainland, but the roads are still terrible.

We ran into a group of missionaries on the way back. I always feel somewhat violated after talking with missionaries in Africa. What are they doing here? This looked like some polygamous group of Mormons but it turned out they were from Alberta and Kansas.

One of them asked us what we were “lonesome for.” I didn’t know how to respond so we asked them what they were lonesome for, to which they said “Wal Mart.”

While I hate to judge, it was telling that they all introduced themselves to us, but not Victor, an employee of the Kenyan Medical Research Institute who was standing right next to us. I’m convinced that they don’t see the locals as people.

What developmental role do missionaries play? They make no demands on politicians to solve pressing problems of political dysfunction, infrastructural weakness, employment, a lack of access to capital, crippling bureaucracy, corruption, graft, nepotism and terrorism. None of these problems can be solved through missionary activities which emphasize odd moral codes more fitting to white, rural Kansas than complicated and chaotic Kenya.

Development as unfreedom….

Was reading Chris Blattman’s list of books that development people should read but don’t and found this in the Amazon description of “The Anti-Politics Machine: Development, Depoliticization, and Bureaucratic Power in Lesotho.”

Development, it is generally assumed, is good and necessary, and in its name the West has intervened, implementing all manner of projects in the impoverished regions of the world. When these projects fail, as they do with astonishing regularity, they nonetheless produce a host of regular and unacknowledged effects, including the expansion of bureaucratic state power and the translation of the political realities of poverty and powerlessness into “technical” problems awaiting solution by “development” agencies and experts.

Note that I do not harbor any ill will toward development or even, as a general rule, “technical solutions.” Having been involved with bed net distributions and having watched the outcomes of reproductive health interventions, for example, I can say that there are many positive outcomes of development projects. In my area, fewer kids are dying and women are becoming pregnant a whole lot less, decreasing the risk of maternal mortality.

Disclaimers aside, there is no doubt that development projects often fail for a number of reasons, the first of which is that leaders have no interest in seeing that they succeed. While leaders are indifferent to the outcomes, they happily take on the power that comes with them, embracing bureaucratic reforms, which are mostly just expansions of power at all levels of government.

This wouldn’t necessarily be a bad thing, except that African countries never embraced many of the protections of individual rights which restrict the powers of the state. Independence movements in much of Africa was predicated on an eventual return of power to the majority. Not many (none?) of these movements sought to protect the rights of the minority, much less the individual. Thus, there is little restriction on the types of rules which may be created and since many of these development projects influence policy, development projects unwittingly feed into the autocracy machine.

What if Godzilla came to Kenya?

OLYMPUS DIGITAL CAMERAThis question has been bothering me for a while. While it’s obvious that Godzilla would only visit Japan and the US given that the US and Japan are the only countries which make Godzilla movies, I’ve long been puzzled as to why Godzilla would visit those two exclusively. Specifically, why doesn’t Godzilla visit poor countries? (Note: I realize that Godzilla is a good guy, but ask readers to remember that he didn’t start out that way)

Certainly, the environmental devastation in poor countries is as extensive as in wealthy countries (and perhaps moreso, given the lack of financial and political resources to measure it, let alone do anything about it), making Tanzania, for example, just as much a candidate for kaiju destruction as any other.

But what would happen? First, were Godzilla appear on the shores of the coast of Kenya, he’d (is it male?) have to plow through the port of Mombasa. Godzilla may be destructive, but he’s known to follow standard immigration procedures. He’d meet little resistance, given Kenya’s lax border protection. At the worst, he’d be asked to pay $50 to stay for three months.

Mombasa isn’t a big town, so he’d be over the island and into the country in a matter a seconds, though he might consider a pleasant break on the beach. After finally eradicating Kenya’s terror problem and quashing any ideas of Mombasan separatism, he’d stroll to the Mombasa highway and lumber up to Nairobi, where the real action could start.

In contrast to Japan and the US, Godzilla would find the response by the local military to be tepid at best. A few planes might buzz around aimlessly and a couple of tanks might lob some rounds at his legs, but the military, lacking any incentive to loot cell phones or liquor would probably simply slink away in short order. Response from the African Union or the UN would be slow coming, as they’d have to wait to see if the media reacted with sufficient outrage to warrant action. The US would most certainly refuse to be involved in anything other than a support role.

Godzilla would plod through Nairobi and lay waste to the City Centre in a matter of seconds. It would be like a child stepping through a grandmothers flower garden. He’d probably quickly become bored, lacking much to topple over outside of a few unfinished apartment buildings and maybe a mall here and there. If he were after human destruction, he might take a few steps through Kibera, where he’d certainly kill a half a million people in the space of a single Godzilla breath.

After an anti-climactic fight in Nairobi, he’d have to take a break in Karen to consider what to do next. Maybe he’d move on to Kampala? Or regret his decision and move back to India? It’s hard to say.

The human costs would be incredible. A couple of million people would likely die immediately, the majority of which would be poor given the incredible density in slums like Kibera and their inability to properly evacuate from the city. The sleep inducing traffic jams are unavoidable even under normal circumstances. A manic run for the countryside by all of Nairobi would only make things worse but squatter settlements and slums would reappear within days.

In the long term, however, Godzilla’s destruction of Kenya might pay off. Massive amounts of funding would appear from a number of international sources to rebuild Nairobi’s devastated infrastructure. The Chinese would appear and immediately start rebuilding the highway system from scratch using cheap imported labor. The Americans would set about reconstructing Kenya’s likely devastated military and ports. The British would dump money into overhauling Nairobi’s failing sanitation system, long due for replacement. Kenya would get an infrastructural reboot.

On the other hand, real estate speculators would flow in like flies on roadkill, hoping for a payoff once Kenya’s economy got back on track. Where real estate prices would have crashed immediately following the destruction of Nairobi, leading to a cheap scramble for land, the current real estate boom soon again be underway. Domestic investors would now have even less incentive to develop Kenya’s manufacturing sector and the economy would hobble along as it did before.

Given the political chaos following Godzilla’s destruction of the central government, Chinese investors would grab as much agricultural land as possible, citing “gifts” of highways and football stadiums further entrenching China’s increasingly overbearing presence in the country.

In essence, Kenya, as independent state, would cease to exist.

It might be the case, however, that the destruction of Kenya’s cities might finally sway the Kenyan citizenry away from tribal politics and toward a truly democratic state. People can, and do, often surprise us, but this would be a hard, hard road given that most of the reconstruction would not be democratically determined, but rather orchestrated by World Bank and UN technocrats and Chinese land grabs. It’s clear that Kenya’s self interested leaders would do nothing to stop it.

So, conclusion? Kenya would win big in improved infrastructure, but lose big given the resultant political weakness. In the long term, Kenya might regain some of it’s political footing given improvements in the domestic economy, but it would take decades and a lot of political will to make this happen.

Academics as iconoclasts…

This struck me this morning while reading a post on Chris Blattman‘s development blog where he refers to Harvard academic, Matthew Stephenson’s anti-corruption blog:

But as long as folks having this conversation feel free to engage in armchair psychoanalysis of others’ motives, I’ll throw out my own hypothesis about why so many academics in the blogosphere are drawn to the anticorruption-is-a-Western-obsession-that-doesn’t-matter-much-for-development canard: academics (and I speak as a member of the tribe) enjoy feeling like iconoclasts willing to speak uncomfortable truths to power. And in the development field, a certain type of academic particularly enjoys attacking anything that the major institutions (World Bank, U.S. government, OECD, etc.) seem to be for. That’s not a bad thing in and of itself – a contrarian cast of mind is often conducive to questioning received wisdom and pointing out contradictions, self-serving justifications, and the like. But in this case, I think it’s lazy and counterproductive.

Well, yeah, it’s usually lazy and unproductive. As a member of the tribe, I feel vindicated. I find that too many academics aren’t as concerned with bettering to world so much as making themselves feel good about themselves by following a political script. If we’d worry more about pragmatics and less about ideology, we might be able to help make the world a better place.

Do malaria interventions cause human suffering through population growth?

041614_1200_Theimpactof3People often ask me this. I mostly find the question annoying since a dead kid is, well, a dead kid.

The thinking, however, isn’t entirely illogical and can, of course, even be traced back to Malthus himself. Malthus believed that helping the poor would only increase their misery through worsening conditions of crowding and starvation. If Malthus had lived in 2013 and were concerned with welfare policy, he’d probably be a card carrying member of the Republican Party.

For the record, I despise Malthus (and his spawn, Paul Ehrlich). I can’t think of a more cynical and heartless thinker. It’s disturbing to me that his ideas continue to permeate today, despite being wrong at best and simply hateful, at worst. More disturbing is how eagerly his ideas are absorbed by even otherwise well meaning people.

“It’s obvious,” I’ve heard people say while implicitly suggesting the some lives (ours) are worth more than others (theirs). As cliched as it may sound, I think that every human has both a right to live and the right to a life that is healthy and meaningful. Not saving kids from malaria compromises the ability to do either.

So far, though, no one really knows whether life saving interventions in developing countries fuel population growth. Does saving a child’s life simply increase the number of mouths to feed, thereby straining resources and insuring misery for everyone? David Roodman, a public policy consultant working on behalf of GiveWell, a group which does analyses on the effectiveness of charity programs, has searched the published literature to find the answer.

I think the best interpretation of the available evidence is that the impact of life-saving interventions on fertility and population growth varies by context, above all with total fertility, and is rarely greater than 1:1. In places where lifetime births/woman has been converging to 2 or lower, family size is largely a conscious choice, made with an ideal family size in mind, and achieved in part by access to modern contraception. In those contexts, saving one child’s life should lead parents to avert a birth they would otherwise have. The impact of mortality drops on fertility will be nearly 1:1, so population growth will hardly change.

He goes through the available data and finds evidence to suggest that averted child deaths are associated with a decrease in the number of births over the lifetime of a woman. This is somewhat non-controversial. It has long been noticed that economic development and increased access to medical care is associated with decreased lifetime fertility.

Where things become controversial is in the case of developing countries, where saving a child’s life might not have the same effect on reducing births overall. This might be true in the short term, and Roodman finds evidence to suggest this. A short term reduction in child mortality might not yield immediate results.

The issue might be more nuanced, however. Merely providing malaria interventions such as insecticide treated nets to prevent disease without increasing access to quality health services might lead to a situation where population increases quite rapidly. I would think that this might explain why some of the most malarious countries in the world are experience the most rapid population growth. Malawi would be an example.

The strategy, then, is incomplete and Roodman’s analysis might suggest that we need to take a holistic approach to include both malaria prevention and reproductive health services.

I would, however, suggest that the problem is more complicated, particularly when reflecting on Kenya, where the most effective method of reducing fertility has probably been the imposition of school fees. The issue then isn’t merely a matter of saving kids and Depo shots, it’s also a matter of finances. If people can’t afford kids, they won’t have them, but the only way to arrive at economic barriers to reproduction is to have an economy, which is exactly what a country like Malawi doesn’t have.

Capital and inequality

Joseph Joyce, professor of economics at Wellesley College wrote and interesting piece to day on capital liberalization and inequality.

I’m glad to see that so much attention is being fawned on Piketty’s most excellent book, “Capital in the 21sr Century.” It’s sure to go down as a classic in the economics literature, but the debate and discussion surrounding the book couldn’t come at a better time.

I don’t think it’s an accident that Piketty’s book, would top the NYT best seller list just a week after appearing, that a sitting President of the US would mention that inequality is one of the most important issues of our time, or that Christine LaGarde, head of the IMF would make a case that we need to address inequality at a global level.

They (Florence Jaumotte, Subir Lall and Chris Papageorgiou) analyzed the effect of financial globalization and trade as well as technology on income inequality in 51 countries over the period of 1981 to 2003. They reported that technology played a larger role in increasing inequality than globalization. But while trade actually reduced inequality through increased exports of agricultural goods from developing countries, foreign direct investment played a different role. Inward FDI (like technology) favored workers with relatively higher skills and education, while outward FDI reduced employment in lower skill sectors. Consequently, the authors concluded, while financial deepening has been associated with higher growth, a disproportionate share of the gains may go to those who already have higher incomes.

This is a scenario we’re all mostly familiar with, though the broad effects are still debatable. Increasing investment by giants like the US in overseas manufacturing push down wages on domestic unskilled labor, but it’s hard to say whether this had a major effect on overall employment. Unemployment remained steady even after Clinton signed NAFTA, and continues to remain well under European levels today, though the lowest level of workers feel the worst pain. I’m not sure if I can really advocate for protectionist measures to keep capital at home or dissuade foreign investment on principle alone, but it is true that the worst effect of foreign competition has been the erosion of labor’s political power.

Jayati Ghosh of Jawaharlal Nehru University of New Delhi has examined the role of capital inflows in developing countries. She maintains that the inflows appreciate the real exchange rate and encourage investment in non-tradable sectors and domestic asset markets. The resulting rise in asset prices pulls funds away from the financing of agriculture and small firms, hurting farmers and workers in traditional sectors. Eventually, the asset bubbles break, and the poor are usually those most vulnerable to the ensuing crisis.

Well, this is somewhat more interesting. Foreign investment in developing countries appreciates the exchange rate, leading domestic investors to put their money into, say, real estate assets. This is certainly the case all over Africa. Land and building developments are occurring at a breakneck pace, with the hopes that expensive properties will be bought up by foreign companies and individuals. It’s certainly the case that no common African could ever afford some of these places (or would even want to buy them if they could). Nairobi, Dar es Salaam and Luanda, Angola are all in the middle of a real estate bubble. The problem, of course, is that domestic investors are hoping to make a quick buck, rather than attempting to create long term, profitable industries. No wonder Africa imports the lion’s share of it’s manufactured goods. No local will invest in the infrastructure to create it locally since urban real estate is so absurdly profitable right now. This, of course, means that money flows directly into the pockets of the urban elite and then sent back out to bank accounts and retailers in France and England, further entrenching the poorest of the poor.

Without the development of local industries, domestic economies can’t function and opportunities for revenue collections are missed. and countries like Tanzania and Kenya, for example, will continue to be beggar economies which depend on the good graces of the international community to support domestic social programs.

Articles I liked 4/12/2014

Here’s a few articles I’ve been reading this morning that I liked.

Intellectual Property Rights, the Pool of Knowledge, and Innovation by Joe Stiglitz (National Bureau of Economic Research)

We began by noting that some observers of innovation have claimed that a more important determinant of the levels of investment in R & D and the pace of
innovation than the intellectual property regime is the “opportunity set,” the knowledge pool from which applied researchers can draw. Knowledge, it is has long been recognized, is a public good—a
common resource from which all can draw (see, e.g., Stiglitz 1987).32 Intellectual property provides a way of appropriating the returns to investments in knowledge, but in doing so, effectively privatizes a public good. But every innovation draws upon prior knowledge, and the boundaries of “new” knowledge are inherently imprecise. Patents inevitably enclose what would otherwise have been in the
public domain. In doing so, not only do they impede the efficient use of knowledge, but because knowledge itself is the most important input into the production of further knowledge (innovations),
they may even impede the flow of innovations.

Democracy does cause growth (National Bureau of Economic Research)

Our baseline results use a linear model for GDP dynamics estimated using either a standard within estimator or various different Generalized Method of Moments estimators, and show that democratizations increase GDP per capita by about 20% in the long run. These results are confirmed when we use a semiparametric propensity score matching estimator to control for GDP dynamics. We also obtain similar results using regional waves of democratizations and reversals to instrument for country democracy. Our results suggest that democracy increases future GDP by encouraging investment, increasing schooling, inducing economic reforms, improving public good provision, and reducing social unrest. We find little support for the view that democracy is a constraint on economic growth for less developed economies.

Abe’s Law: Domestic Dimensions of Japan’s Collective Self-Defense Debate (HERE)

The Edutainment Industrial Complex (Africa is a country)

So this is their strategy? Ask a bunch of relatively wealthy, globally-mobile pop superstars to tell rural youth to not participate in the flashy urban lifestyle they (the artists) usually promote–to stay in the countryside and participate in the resource extraction side of global capitalism? As Sean pointed out to me over email, the video isn’t unlike the type campaign some dictatorship (South Africa’s racist regime was fond of it) might use as a tool of “national development” or to fight crime or build national morale.

Is this a surprise? Western liberals have long romanticized rural poverty and encouraged Africans to simply do nothing about their developmental problems. Sorry, I had to put on my curmudgeon hat for a while.

Did pathogens influence the course of human development?

Roman toilets

Roman toilets

I would say “it depends.” I was just reading an interesting article on the “pathogen stress theory” of the development of human societies, most often attributed to Randy Thornhill, an evolutionary biologist at the University of New Mexico.

According to the “pathogen stress theory of values,” the evolutionary case that Thornhill and his colleagues have put forward, our behavioral immune systems—our group responses to local disease threats—play a decisive role in shaping our various political systems, religions, and shared moral views.

If they are right, Thornhill and his colleagues may be on their way to unlocking some of the most stubborn mysteries of human behavior. Their theory may help explain why authoritarian governments tend to persist in certain latitudes while democracies rise in others; why some cultures are xenophobic and others are relatively open to strangers; why certain peoples value equality and individuality while others prize hierarchical structures and strict adherence to tradition. What’s more, their work may offer a clear insight into how societies change.

This is a reasonable view, and something I’ve long observed from working on infectious diseases in developing countries. The developmental trajectory of a country is influenced by the deliberate avoidance of illness. An example can be seen in the locations of African cities. Many African administrative capitals are located on isolated, cool hilltops, far away from rivers and lakes. Colonialists would intentionally set up shop in areas where they were unlikely to encounter malaria.

Developmentally, this has had major implications for trade within Africa. European cities are often placed along water ways amenable to domestic European trade. The lack of trade between African countries is one of the reasons the continent has developed so poorly. This is the direct result of not only colonial priorities of resource extraction to Europe, but also the unfortunate placement of economic centers in response to malaria.

Certainly, the nature of cities themselves have much to do with the control of infectious diseases. Public works often involve the management of sewage waste and the delivery of clean water. Thornhill might suggest that the development of democracy, citizen involvement and taxation to pay for urban improvements are in direct response to enteric diseases.

However, while it is interesting to try to apply this view, it can be taken to the extreme:

Fincher (a graduate student of Thornhill) suspected that many behaviors in collectivist cultures might be masks for behavioral immune responses. To take one key example, collectivist cultures tend to be both more xenophobic and more ethnocentric than individualist cultures. Keeping strangers away might be a valuable defense against foreign pathogens, Fincher thought. And a strong preference for in-group mating might help maintain a community’s hereditary immunities to local disease strains. To test his hypothesis, Fincher set out to see whether places with heavier disease loads also tended toward these sorts of collectivist values.

I’m not sure it’s that easy to boil down political differences between Asia and Europe to a need to manage infectious disease. Certainly, Sweden is more collectivist than England, but I wouldn’t say that their infectious disease profiles are all that different.

Worse yet, if taken to the extreme, this “hunt for significance” will provide one with evidence to support any crazy theory at all. Pathogens exist wherever humans do. Moreover, we risk attributing the contribution of pathogens to human development based on current conditions, assuming that the present is deterministically preordained centuries ago. Until very recently, nearly the entire world was at risk for malaria, but despite this, various societies have embarked on different social and political trajectories.

The biggest problem I have with the theory is in its basic in rational theory. It assumes that humans are making rational choices based on pathogen threats, when we know, and particularly those of us who work in the tropics, that humans often have poor conceptions of disease transmission and causes of illness. At times, despite very obvious threate, humans will act in manners which exacerbate that threat. The history of enteric disease is filled with tales of ignorance and folly.

If we are going to subscribe to a rational model of political and social development which includes pathogens, then we have to also address first, the ability of pathogens to hijack human behavior to create new opportunities for replication and survival and second, that social changes can exacerbate the worst effects of infection. For the first point, I would look to the development of international trade systems which allow pathogens such as influenza to move around the world quickly, increasing opportunities for mutation to avoid immune responses. For the second I would point to polio, a disease which becomes a problem on after the introduction of water sanitation practices.

Thornhill’s ideas are interesting, and certainly provide good material for the popular press and BBQ conversation, but they require that the reader suspend too much consideration of the details of the complex history of human social and political development. Taken with restraint, as in the example of the locations of African cities, they can provide interesting insights into how current conditions are impacted by past pathogenic threats.

%d bloggers like this: