Transcript 16 Health & Development, Africa

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 Objectives
Contrast 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
AGENDA
Current Health Status:
History of Africa Colonial exploitation of continent impact of
recaptured slaves
manipulation 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 1980s
US agricultural policies (rice, wheat, cotton)
HIV epidemic (modern day Tuskeege)
Responses needed
Curse 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 History
Birth 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 History
Colonial manipulation
African social culture reengineered 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 Disparity
State 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 History
Emancipation 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 History
1960s 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.
Black Man's
Transfers of this wealth to the "developed" countries of
Burden
Europe and America have annually expanded in value: in
Basil Davidson
1988, for example, to what was then a record figure, an
1992
immense figure, paid out to "developed" creditors. And
multitudes starved.
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 1983
Promotion of exports
Devaluation
Trade liberalization-Imports flooding market
Increased investment in infrastructure
Removable of government subsidies
Increased taxation
Downsizing of civil service -- Lay offs
Privatization
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 RELATIONSHIPS
Dimension
North/Upper
South/Lower
Spatial
Urban/Industrial
Rural Agricult.
Internat. /Dev.
IMF/WB
Donors/Creditors
Poor
Ascriptive
Male/White
Female/Black
Life Cycle
Parent
Child
Bureaucracy/Org.
Manager/Official
Worker
Social
Patron
Client
Learning
Teacher
Student
Recipients/Debtors
Development Capital Flows
N
S
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 countries
does 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
Highly mineral- dependent
countries
–increased under 5 mortality
–authoritarian
–likely civil war
–high military spending
–increased under 5 mortality
–population in poverty
–low life expectancy
–high income inequality
–authoritarian
–likely civil war
–high military spending
Ross: Extractive Industries
And the poor, Oxfam 2001
Curse of Resources
Rich countries plundered poor
ones (British in India)
TODAY: Civil wars
–Africa is rich in resources:
–minerals
–oil
–timber
–gold
Spending: Donor
$ /cap
80
70
60
50
40
30
20
10
0
Iraq
Somalia Liberia
DRC
Curse of Resources
When 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)
Race to the bottom in tax
rates to attract corporations
Jersey reduced rate on all
businesses to 0% to compete
with other havens offering
same rate
"Latin America ~300,000
people hold about $3.7
trillion personal assets,
half offshore"
Secret World of Offshore Banking
John Christensen
"$11.5 trillion of assets
held offshore is serious
money and sum increasing
at a rising rate"
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 how
multinational corporations,
wealthy individuals and
unscrupulous governments
using world's banking
systems in ways that
spread poverty.
Deaths
(Millions)
270
Worldwide Poverty
Deaths 1988-2003
1959-62 "Great Leap
Forward" Famine
Deaths
Tuskegee Syphilis Study
1932-1972 (press leak)
30
1940's German
Holocaust
11
1970's Khmer Rouge
Genocide
2
1994 Genocide in
Rwanda
0.8
0
100
200
300
SOUTH AFRICA
Blacks believed they had the right to
reclaim and distribute their oppressor's illgotten 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 AFRICA
Nelson 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 1994
Opportunity to reject free-market ideology
Mandela then a living saint
ANC did adopt neoliberal ideology and
inequality exploded, so most unequal
country on the planet today, surpassing
Brazil
SOUTH AFRICA 1994
Negotiations between F. W. de Klerk and
Mandela who had millions behind him
Whites worked to safeguard their wealth
White 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 1994
Land reform became impossible
Joined GATT which restricted subsidizing
factories, so job creation not possible
Money tied up in servicing massive debt
Can'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 1994
Tried to make good on redistribution
Increasing debt and pressure to privatize so gov't
had to raise prices
FOUR white-owned megaconglomerates
controlled 80% of Johannesburg Stock
Exchange
Life expectancy dropped 10+ years
ANC leadership accepted the new economic
order
Globalization: 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 RESULTS
Since 1994 number of people living on less than $1 a day has
doubled, from 2 million to 4 million in 2006
Between 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$310
Exchange rate – Naira to dollar
N1
-
N120
83.8
Total external debt/GDP
Population of the poor
36.1
million
N1
126.3
34.7
million
% contribution of oil to national
income earnings
Imports of goods and services
(% of GDP)
55.8 million
77.8%
25.2
38.1
42.3
Nigeria compared to other OPEC countries
source: Human Development Report, 1997
OPEC
countries
Human
Poverty
index(%)
Survival
deprivation
(%)
Deprivation in
adult literacy
(%)
No
No
access to access to
safe
health
water
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
4
$27-32 billion
75% GDP
186% export earnings
Trap
by 2020 “ paid $5 for $1 borrowed and owe
$27 Billion”.
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
17 31
43
45
62
Nigeria's Resource Curse
Chevron Shell responses
Media as Business
Product
Print
Times, PI
The Stranger
Television
XBC, CNN
Cable
Radio
commercial
PBS
Internet
Buyer
Seller