Why is Africa still the poorest continent?

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Why is Africa still the poorest continent?
CHRISTOPHER DYE
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Why is Africa still the poorest continent?
CHRISTOPHER DYE
?
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Why is Africa still the poorest continent?Why do
Africans have the poorest health?
CHRISTOPHER DYE
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The Royal Society of Tropical Medicine and
Hygiene 1907-2007
CONQUEST AND DISEASE OR COLONISATION AND
HEALTH? Professor Frank Cox17 Sep 2007
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State of Africa's health1950-present
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World wealth in year 2000
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Africa has a major share of the world's poorest
people
Share of total population
Poorest Richest
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Africa trapped?

• Bad government
• Biogeography
• Conflict
• Demography
• Foreign aid
• Illiteracy
• Malthusian curse
• Natural resources
• Poverty
• Tariffs and trade
• Tropical diseases

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• "If all you have is a hammer, everything looks
  like a nail" Bernard Baruch

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The political development game as a
basis for public health

• State works through institutions to achieve goals
  in collective interest
• Social contract - government taxes majority of
  individuals in return for public services
• Public services include health services, where
  governments and individuals have opportunities
• Health evolves for the majority where interests
  coincide

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Earned versus unearned income in political
developmentMoore/Grabowski

• Unearned (patronage politics)
• foreign aid, minerals, drugs, oil, primary
  products from privileged groups (e.g. timber)
• Earned (civic politics)
• tax revenue in return for services e.g. public
  health

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Template for developmentGeographyBiologyCulture
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Food production spread east-west, not north-south
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African food crops centre of origin but not
productivity
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Africa's animals cannot be tamed
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Natural resources blessing curseblood (etc)
diamonds (etc)
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Malaria Risk Parasite Incidence
Malaria Risk Temperature, and Aridity
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Birth and death rates converging
slowly in sub-Saharan Africa
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death
50
birth
40
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Crude rate (per 1000 per yr)
20
10
0
1950
1970
1990
2010
2030
2050
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Incentives for high fertility in Africa

• In Africa (cf India)
• Shared costs of kinship
• parents benefit from more children, costs paid by
  extended family
• large families have rights to more land
• large families and communal ownership pools risk
• (2) Children are assets
• more children to offset fewer environmental
  assets

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"Demographic dividends" and "economic miracles"
From health to wealth?
0.75
education
public health
economics
family planning
0.7
governance
East Asia
0.65
One third economic growth from "demographic gift"
Share population of working age
0.6
0.55
Sub-Saharan Africa
0.5
1950
1960
1970
1980
1990
2000
2010
2020
2030
2040
2050
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Political development
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Institutional quality

• (1) Voice and accountability
• (2) Political stability and absence of violence
• (3) Government effectiveness public service,
  civil servants
• (4) Light regulatory burden
• (5) Rule of law protection of persons and
  property
• (6) Freedom from graft

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Progress in achieving freedom and transparency
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Africa fewer colonial (European) settlers, worse
governance?
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Heart of darkness Belgian Congo
huge income generated by the export of rubber,
but Congo "Free" State heavily indebted to
Belgium
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"A common consensus to invest in the future"?
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Divide and rule the kleptocrat game
tax
bribe
tax
invest
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Variable investment in African agriculture

• Ghana
• Coca farmers small and unorganized
• Ethnically different from ruling elite
• Politically weak
• Low prices to farmers through marketing boards,
  surplus to urban politicians
• Kenya
• Pro-farmer policies and institutions
• Large-scale farming with greater political power

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Democracy in Africa Kenya for all its flaws, an
example to others Dec 19th 2007 The Economist The
example Kenya can set for South Africa and the
rest of the continent
Kenya tension rises after polls Kenya tension rises after polls Kenya tension rises after polls

Odinga rejects victory of President Kibaki
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National or official languages of Kenya Swahili,
English Plus 59 other languages spoken in Kenya
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More foreign aid fails to sustain
economic growth in Africa
20
2
1.5
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1
Aid/GDP ()
GDP growth/capita
0.5
10
0
5
-0.5
1970
1975
1980
1985
1990
1995
2000
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Foreign aid to improve health and relieve poverty?
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Water how your donations can help
"providing water, hygiene and sanitation reduces
the number of deaths caused by diarrhoea-related
diseases by up to 65..."
"to be sustainable, the community must own the
process and be committed to maintaining the water
source"
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Worldwide adoption of technology in
AD 0 and AD 1500
agriculture, transportation, military, industry,
and communications
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Technology in AD 1500 is linked to developmental
outcomes today
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Collateral damageHealth workersMedicines
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Exodus health workers leaving Africa

• 13,272 African-trained doctors working
• in Australia, Canada, UK, USA
• 1/3 Nigerian medical graduates
• emigrating within 10 years to
• Canada, UK, USA
• 250 Nurses graduating in Ghana
• each year
• 500 Nurses leaving Ghana in year 2000

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Thomas Robert Malthus 1798Gregory Clark 2007

• Principle of Population (Malthus)
• population, if unchecked, increases geometrically
  
• 2, 4, 8, 16, 32, 64, 128
• but food supply grows arithmetically
• 1, 2, 3, 4, 5, 6, 7, 8
• so population outruns food supply
• Farewell to alms (Clark)
• medicine extends life, not food supply

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Insult to injuryTariffs and tradeConflictClimat
e change
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Tariffs and tradeselling African cotton to the
world
West Africa (Benin, Burkina Faso, Chad, Mali,
Togo) 1/3 Export income 1m farmers 5-10
GDP Production costs 0.40 West Africa 0.80
USA - no subsidy lt 0.30 USA - subsidy 4bn/year

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Rising food prices worldwide

• Surge in middle-class demand for animal protein
  (meat, milk etc), which needs grain (China,
  India)
• Surge in middle class (rising global population)
• More land used to grow crops for biofuel
• Positive high food prices for investment in
  African agriculture?
• Negative productive land and water with growing
  population?

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Health and the environment the draining of Lake
Chad
1972 1987
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The Three Trillion Dollar WarJ Stiglitz L
Bilmes

• 16bn monthly running cost to US of wars in Iraq
  and Afghanistan - on top of regular defence
  spending
• 138 paid monthly by every US household
• 3 trillion low estimate of true cost of Iraq war
  to America, 2 for total cost to world
• 3 drop in income of 13 African countries due to
  rise in oil prices, more than offsets recent
  increase in foreign aid to Africa

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Health and disease
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Bed nets treated with insecticide prevent malaria

• Reductions compared with no nets in 22 trials
• Child deaths gt20
• Mild malaria cases 50-60
• Severe malaria cases 45
• Parasites 13
• Enlarged spleen 30

Insecticide treated bed nets to prevent malaria
The challenge lies in implementation Umberto D'Al
essandro British Medical Journal 2001
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Vaccination a qualified success story

• Measles deaths in Africa fell by 91
• 2000-06, from 396 000 to 36 000

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Why is Africa still the poorest continent?

• (1) Public services (health) need "common
  consensus"
• (2) Absent from Africa because leaders gained
  power from unearned income colonial extraction,
  natural resources, urban investment, aid
• (3) Extraction rather than settlement because of
  biogeography, including tropical diseases
• (4) Problems reinforced by international trade,
  food prices, war, diseases, climate change
• (5) Solutions come from understanding incentives
  and the rules of the political game

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Mankala simple rules, complex outcomes