16 Health & Development, Africa

Determinants of Health in Poor Countries

SUMMARY PREVIOUS CLASS?

Health in Poor Countries

Global health?

Relationship to inequality?

Role of health care?

Government subsidies for health care

Development process

Good examples in the past

Africa?

Deaton 2003

Learning ObjectivesContrast the colonial history of African countries with

the current situation

Present the health situation in Ghana today compared to a rich African country such as Botswana

Explain the impact of structural adjustment policies and political instability on health and development of Nigerians

Curse of resources

AGENDACurrent Health Status:

History of Africa Colonial exploitation of continent impact of recaptured slavesmanipulation of social structure for colonial economy by institutionalizing two homes for husbands

Emancipation after WWII into nation states with growth of socialist governments in 1960s

Structural adjustment policies beginning 1980sUS agricultural policies (rice, wheat, cotton)

HIV epidemic (modern day Tuskeege)Responses neededCurse of resources

Making Transition Work for Everyone: Poverty and Inequality in Europe and Central Asia, World Bank 2001

http://ucatlas.ucsc.edu/

http://ucatlas.ucsc.edu/

http://ucatlas.ucsc.edu/

CIESIN 2005

CIESIN 2005

Declining life expectancy Changes in life expectancy in selected African

countries (high and low HIV prevalence: 1950-2005)

Source: UNAIDS, 2002. Report on the global HIV/AIDS epidemic

Jamison et. al 2006

NI

0401

-2

Marmot, Lancet 05

African Political HistoryBirth of our species?

Egyptian civilization, overcome by Romans

Cattle-centered societies, tribes, evidence of empires in Sudanic belt

Empires: British Commonwealth (sun never sets)-Spain and Portugal, other European (How Europe Underdeveloped Africa Ray Rodney) carved up continent with no respect for ethnic groups, tribes

-manipulation of African social structure to suit colonial enterprise by setting up two homes for men with two wives, one in white controlled urban industrialized areas and other in traditional rural setting

African Political HistoryColonial manipulation

African social culture re-engineered for labor retention

Extracting wealth: gold, diamonds, skins, forest products

Slave trade: begun by Portuguese from 1450

Recaptured slaves in 1800s sent to schools in Europe to be educated and returned to do colonial master's bidding (Black Man's Burden Basil Davidson)

African nationalist movements began in 1800s

Maintaining DisparityState Department Policy Planning Study # 23, 1948,

George Kennan– “The US has about 50% of the world’s wealth but

only 6.3% of its population. This situation cannot fail to be the object of envy and resentment. Our real task in the coming period is to devise a pattern of relationships which will permit us to maintain this position of disparity without positive detriment to our national security.”

– “a political and economic climate conducive to private investment with adequate repatriation of profits”

African Political HistoryEmancipation of Africa

-WWII aftermath, USSR gained prestige

-UK and French liberals sympathetic to African nationalist claims

-cold war led to colonial resurgence, USSR had strong presence in many African countries (Patrice Le Mumba University in Moscow)

-nationalist movements in Ghana, Ivory Coast

Eventually colonialists were forced to give independence, except in S. Africa, led to euphoria

African Political History1960s many countries had socialist governments and

sided ideologically with USSR which threatened US and other powers, led to economic ways of empire

1980s structural adjustment programs (SAP's)

Social engineering created tissue culture for HIV

Health in Africa declined

Present Condition of Africa

But the actual and present condition of Africa is one of deep trouble, sometimes a deeper trouble than the worst imposed during the colonial years. For some time now, deserts have widened year by year. Broad savannahs and their communities have lost all means of existence, or else are sorely threatened. Tropical forests such as the world will never see again have fed the export maw. Cities that barely deserve the name have spawned plagues of poverty on a scale never known in earlier times, or even dreamed of. Harsh governments of dictatorships rule over peoples who distrust them to the point of hatred, and usually for good and sufficient reason; and all too often one dismal tyranny gives way to a worse one. Despair rots civil society, the state becomes an enemy, bandits flourish. Meanwhile the "developed" world, the industrialized world, has continued to take its cut of Africa's dwindling wealth. Transfers of this wealth to the "developed" countries of Europe and America have annually expanded in value: in 1988, for example, to what was then a record figure, an immense figure, paid out to "developed" creditors. And multitudes starved.

Black Man's Burden

Basil Davidson1992

Third world debt:Much of it was/is to private banks, taken on by leaders who used the

money in various ways

Many private banks were concerned about defaults on these huge loans

One way to shift the risk was for IMF and WB to make loans to countries at very low interest rates for discretionary purposes, so the private banks would not have to incur the risk as their loans were paid back

Conditions attached to SAP loans would benefit foreign investors and encourage poor country governments to avoid social spending which is anathema to the Washington Consensus

ENTIRELY A VIOLATION OF MARKET MECHANISMS

STRUCTURAL ADJUSTMENT

Since 1983Promotion of exportsDevaluationTrade liberalization-Imports flooding marketIncreased investment in infrastructureRemovable of government subsidiesIncreased taxationDownsizing of civil service -- Lay offsPrivatization

Effect of SAP

Massive lay offs of workers

Marginalization of domestic agriculture and local manufacturing industries

Decrease in overall poverty in some cities, but with widening poverty gap between rural and urban and within urban

North-South RELATIONSHIPSDimension North/Upper South/Lower

Spatial Urban/Industrial Rural Agricult.

Internat. /Dev. IMF/WB

Donors/Creditors

PoorRecipients/Debtors

Ascriptive Male/White Female/Black

Life Cycle Parent Child

Bureaucracy/Org. Manager/Official Worker

Social Patron Client

Learning Teacher Student

S

N

Development capital flows

Development Capital Flows

927 billion official bilateral and multilateral aid, grants by private charities,

trade credits plus direct private investment and bank loans OECD data, $1345 billion (interest and principal) to the creditor countriesdoes not include other South-to-North outflows such as royalties, dividends, repatriated profits, underpaid raw materials etc.

New York Times April 30, 1995

New York Times April 30, 1995

NYT 071107

NYT Oct 12, 2005

NYT Oct 12, 2005

US Generosity to other nations

NYT 050417

Clinton asked why Washington seemed so impervious to demands

to increase aid. ''Because nobody will ever get beat for Congress or president for not doing it''

President Bill Clinton

Total

8.7 million

WIDER World Wealth 2006

Total

8.7 million

WIDER World Wealth 2006

Resource Depletion reduces economic growth

Highly oil dependent countries–increased under 5 mortality

–authoritarian

–likely civil war

–high military spending

Highly mineral- dependent countries–increased under 5 mortality

–population in poverty

–low life expectancy

–high income inequality

–authoritarian

–likely civil war

–high military spending

Ross: Extractive IndustriesAnd the poor, Oxfam 2001

Curse of ResourcesRich countries plundered

poor ones (British in India)

TODAY: Civil wars–Africa is rich in resources:

–minerals

–oil

–timber

–gold

Spending: Donor $ /cap

0

10

20

30

40

50

60

70

80

Iraq Somalia Liberia DRC

Curse of ResourcesWhen God created the world, He endowed Sierra Leone with such a wonderful wealth of natural resources that the angels protested.

“Don’t worry,” God replied. “Just wait until you see the people I’ve put there.”

"Root of conflict is diamonds, diamonds and diamonds" (UN ambassador 2000)

"$11.5 trillion of assetsheld offshore is serious money and sum increasing

at a rising rate"

"Latin America ~300,000 people hold about $3.7 trillion personal assets, half offshore"

Race to the bottom in tax rates to attract corporationsJersey reduced rate on all businesses to 0% to competewith other havens offeringsame rate

Secret World of Offshore BankingJohn Christensen

Five trillion dollars ("conservative estimate")corruptly removed from world's poorest countries -lodged permanently in world's richest countries. -by American businessman enthusiast for capitalism -in study of howmultinational corporations, wealthy individuals and unscrupulous governments using world's banking systems in ways that spread poverty.

Deaths(Millions)

0.8

2

11

30

270

0 100 200 300

1994 Genocide inRwanda

1970's Khmer RougeGenocide

1940's GermanHolocaust

1959-62 "Great LeapForward" Famine

Deaths

Worldwide PovertyDeaths 1988-2003

Tuskegee Syphilis Study1932-1972 (press leak)

SOUTH AFRICABlacks believed they had the right to

reclaim and distribute their oppressor's ill-gotten gains, key strategy ANC, and spelled out in Freedom Charter beginning in 1955

South African gov't banned ANC and other parties, but charter circulated

Charter: right to work, decent housing, thought and share in wealth of richest country in Africa (diamonds, gold)

ANC's Freedom Charter"The national wealth of our country, the

heritage of South African's, shall be restored to the people; the mineral wealth beneath the soil, the Banks and monopoly industry shall be transferred to the ownership of the people as a whole; all other industry and trade shall be controlled to assist the well-being of the people."

SOUTH AFRICANelson Mandela 1990 in prison "The nationalization of the mines, banks

and monopoly industries is the policy of the ANC and the change or modification of our views in this regard is inconceivable. Black economic empowerment is a goal we fully support and encourage, but in our situation, state control of certain sectors in the economy is unavoidable."

SOUTH AFRICA 1994Opportunity to reject free-market ideologyMandela then a living saintANC did adopt neoliberal ideology and

inequality exploded, so most unequal country on the planet today, surpassing Brazil

SOUTH AFRICA 1994Negotiations between F. W. de Klerk and

Mandela who had millions behind himWhites worked to safeguard their wealthWhite negotiated trade agreements to hand

power to IMF, World Bank and National Park, and ANC leaders were duped "we were caught completely off guard"

Ended up with a Reserve Bank & treasury run separately (by old apartheid bosses) from the gov't, which could restrict policies of ANC

ANC outmaneuvered in rules and regulations

SOUTH AFRICA 1994Land reform became impossibleJoined GATT which restricted subsidizing

factories, so job creation not possibleMoney tied up in servicing massive debtCan't impose currency controls (to avoid capital

flight) because of an IMF deal that was signed"We'll keep everything and you [ANC] will rule

in name…. Have political power and façade of governing but real governance will take place somewhere else"

SOUTH AFRICA after 1994Tried to make good on redistributionIncreasing debt and pressure to privatize so gov't

had to raise pricesFOUR white-owned megaconglomerates

controlled 80% of Johannesburg Stock Exchange

Life expectancy dropped 10+ yearsANC leadership accepted the new economic

orderGlobalization: mobility of capital and markets

give countries few options today

Mandela in 1994"In our economic policies … there is not a single

reference to things like nationalization and this is not accidental….. There is not a single slogan that will connect us with any Marxist ideology"

"Mr. Mandela has in recent days sounded more like Margaret Thatcher than the socialist revolutionary he was once thought to be."

Wall Street Journal Oct 6, 1994

SOUTH AFRICA RESULTSSince 1994 number of people living on less than $1 a day has

doubled, from 2 million to 4 million in 2006Between 1991 and 2002, the unemployment rate for black

South Africans more than doubled, from 23 percent to 48 percent.

Of South Africa's 35 million black citizens, only five thousand earn more than $60,000 a year. The number of whites in that income bracket is twenty times

higher, and many earn far more than that amount.

The ANC government has built 1.8 million homes, but 2 million people have lost their homes.

1 million people have been evicted from farms Shack dwellers has grown by 50 percent. In 2006, more than one in four South Africans lived in

shacks located in informal shantytowns,without water or electricity

http://www.ukzn.ac.za/CCS/files/Shock%20Doctrine%20ch%2010%20pt.pdf

NIGERIA 1985 - 2000

1985 1990 1999

GNP per capita US$510 US$325 US$310Exchange rate – Naira to dollar N1 N1 N120Total external debt/GDP - 126.3 83.8

Population of the poor 36.1 million

34.7 million

55.8 million

% contribution of oil to national income earnings

77.8%

Imports of goods and services (% of GDP)

25.2 38.1 42.3

Nigeria compared to other OPEC countriessource: Human Development Report, 1997

OPEC countries

Human Poverty

index(%)

Survival deprivation

(%)

Deprivation in adult literacy

(%)

No access to

safe water(%)

No access to

health care (%)

(%) under weight

children under 5 years

Indonesia 20.8 14.8 16.8 38.0 7.0 35

Mexico 10.9 8.3 10.8 17.0 7.0 14

Iran 22.6 11.7 31.4 10.0 12.0 16

Nigeria 41.6 33.8 44.4 49.0 49.0 36.0

Nigeria CORRUPTION

Corruption perception index (TI)

Denmark-10.0

Finland 9.6

Sweden 9.5

New Zealand 9.4. USA 7.5[18]

Nigeria ranked- at 1.9[81]

2001 Nigeria- ranked 2nd most corrupt

Nigeria DEBT TRAP

$27-32 billion

75% GDP

186% export earnings

Trapby 2020 “ paid $5 for $1 borrowed and owe

$27 Billion”.

4

Nigeria: Debt Trap

Loans of dubious value

Low impact, high cost projects

Oil doom

– attrition of agric sector

– import dependence.

Dividends of Democracy

Nigeria national anthems

–1960 people oriented

–1978 focused on structure

6245433117

Nigeria's Resource Curse

Chevron Shell responses

Media as BusinessProduct Buyer Seller

Print Times, PI

The Stranger

Television XBC, CNN

Cable

Radio commercial

PBS

Internet