I promised myself the other day that I would write a post about something that I view as a serious fallacy related to development: the notion that dealing with infectious disease will just shift the death toll to hunger, rather than genuinely saving people. This view is misguided for reasons both moral and pragmatic. I will focus on the pragmatic here, since people who advance this neo-Malthusian argument tend to think of themselves as well-meaning but realistic. The first set of arguments have to do with the local capabilities of communities. The second, lesser, set have to do with the nature of the provision of aid. I will quickly examine each in turn.
The three big diseases upon which I will concentrate are HIV/AIDS, malaria, and tuberculosis (TB). These have been rightly banded together as the three most serious global health concerns, with regards to infectious diseases. Each kills more than a million people a year, as well as making far more ill. As a bacterial illness, effective cures exist for all but the most resistant strains of tuberculosis. While no effective cure exists for either malaria or HIV/AIDS, drugs exist that can extend survival dramatically, and mechanisms exist to greatly restrict the spread of such illnesses. The notion that doing so would produce an equally severe problem elsewhere is based on a misconception about how such illnesses affect communities.
Local capabilities
Sick people are not productive people. Communities with high prevalance rates of infectious diseases lose agricultural productivity as members of the working population either become ill or need to spend their time caring for those who are. This is especially bad with regards to HIV/AIDS, which tends to kill people during their most productive years. That has left behind millions of orphans, who further draw upon the capabilities of the community in which they live. All manner of grim statistics could be brought to bear upon this point, but it seems intuitively obvious enough to stand on its own.
The possibilities of simultaneously dealing with the various factors that make extreme poverty endemic are demonstrated by the ’12 research villages’ that Jeffrey Sachs has established throughout Africa. The plan is to have 1000 by 2009. Each receives practical aid at the level of $250 per inhabitant: directed towards dealing with disease, boosting agricultural output, education, and other objectives espoused by the Millennium Development Goals. The whole program can be expressed in terms of seven simple goals:
Fertiliser and seed to improve food yield; anti-malarial bed nets; improved water sources; diversification from staple into cash crops; a school feeding programme; deworming for all; and the introduction of new technologies, such as energy-saving stoves and mobile phones.
The results so far seem to be very good, in terms of declining levels of infectious disease, improved crop yields and educational results, and the like. As with so many other projects, the difficulty is in scaling up the the point where millions of lives can be changed, but the example demonstrates how even a relatively inexpensive aid policy can produce tangible results in a number of crucial areas, without hitting any of the Malthusian barriers imagined by those who say that feeding hungry children just makes hungry adults. Another laudable feature of the program: all aspects of it are implemented and directed at a local level, reducing the extent that neocolonialist intentions can be attributed to the donors or international organizers.
World capabilities
Even in those cases where a sudden burst of attention enormously lessens the burden of disease in a food-strapped community, the difficulties of dealing with that situation are far easier than those of dealing with a place where one of these big three diseases has become endemic.
That’s partly because food provision doesn’t require the delivery of expertise into an area. The lack of qualified medical personnel in places like Sub-Saharan Africa is a major reason for which infectuous disease is so problematic there. The rich world has a double guilt in this capacity: because the austerity programs that were part of the structural adjustment policies of the IMF and World Bank have prevented governments from investing in such human capital, and because lots of rich countries (including Canada and the UK) have been doing all they can to buy up doctors and nurses from the poor world to help address problems in their own health systems.
Conclusions
Obviously, just providing food aid or help with specific problems isn’t adequate for dealing with persistent extreme poverty. That said, it seems foolish to voluntarily refrain from deploying such assistance as is politically and economically viable because of concerns about “feeding those who will die anyhow.” On the global level, the economic emergence of Asia – in which extreme poverty levels have seen amazing reductions in recent decades – shows what is possible even in the face of considerable levels of corruption, disease, and mismanagement.
This story reminded me of your discussion of The Constant Gardner, particularly the comments about the implausibility of drug companies releasing drugs that they knew would harm people.
http://www.medicalnewstoday.com/healthnews.php?newsid=42922
How so? In that you find both positions I expressed questionable?
Ending extreme poverty, as you argue, is a good mechanism for dealing with the disjoint between the availability of food and the availability of hungry mouths, largely for a reason you don’t mention.
Poverty causes rapid population growth. Virtually all places with mean fertility per woman above 5.0 are extremely poor (with the exception of a few oil states). Fertility rates, in turn, reflect expected rates for child mortality.
Likewise, education – and especially education for girls – is tightly correlated to slowing rates of population growth. Firstly, having children in school makes them into a cost to their parents instead of a source of labour to exploit. That changed incentives. Next, educated children are more effectively empowered to make lifestyle choices, including controlling fertility.
Lots of factors go into it, from the availability of contraception to economic opportunities for women, but the trend towards greater health and wealth needn’t and almost never is a track towards greater hunger.
Aside from the pensions mess, I see shrinking populations in the rich world as an almost unambiguously good thing. Overall GDP doesn’t matter a whit, except in some strategic calculations. It’s per-capita welfare that’s important, and more space and less pressure on the planet bolster that.
All the hand-wringing in Germany and Japan about fertility rates below the natural replacement rate may represent a fallacy akin to the one you’re discussing here.
Good points, RK!
Also Milan, if you actually research the details of most famines in the past say 40 years, overpopulation and food scarcity are generally not the primary cause. The Ethiopian famine in the 1980’s was a direct cause of war and poor infrastructure-Ethiopian food production was technically high enough for no one to starve. Similar stories for the other major famines I’m aware of.
Dr. Kotwal told our class about a 1974 famine in Bangladesh that was almost entirely attributed to hoarding-agric output in that year was actually higher than 1973 when there was no famine. Basically, a rumour about shortages began and everyone who could afford it started buying up all the food they could hoard. This led to shortages, and a sharp rise in the price of basic staples, making them unaffordable to the average Bangladeshi. The death toll was crazy.
As for these apocalyptic, mass-death arguments, I think many neo-Malthusans need to be reminded that humans are not fruit flies. We have one or two babies at a time and a gestation period of 9 months…the kind of population horror stories (like the so-called “carrying capacity” that Robert Hardin bitches about in his lifeboat theory essay) make no biological sense, even in countries with high fertility rates.
First off, regarding the side point about falling populations in the rich world, I agree that fewer people on Earth, overall, is probably a good thing. That said, the strategic calculations that R.K. largely dismisses weigh heavily in the minds of policy makers. It’s your state’s overall economic clout that helps determine which tables you sit at, not your wealth per capita.
Kerrie,
While it is obviously true that for any balance of land, technology, and other inputs there will be a maximum food production capacity for the planet, there is no evidence whatsoever that we are close to it. Likewise, Hardin style arguments completely overlook the kind of demographic shifts induced by greater wealth that have been mentioned above.
Do you know where some specific statistics on the diminished agricultural productivity due to malaria and AIDS can be found?
Hmmm…some suggestions would be Oxfam, UNDP…you could go to a major AIDS NGO and then see who they quote for their stats? Just off the top of my head.
I previously discussed some of the connections between population and the environment.
What an interesting discussion…you raise very good points about the idea
that gains made by dealing with infectious disease will only be offset by
hunger. But I think there’s at least two more points that can strengthen
the argument.
One is the physiological reinforcement of infectious disease and hunger-
people who are sick need more nourishment and people with less nourishment
are more vulnerable to disease. Not everyone who gets bitten by a malarial
mosquito gets malaria, or gets exposed to TB shows signs of TB. People’s
responses are largely based on their immune system which is largely mediated
by their level of nourishment. So, dealing with infectious disease actually
lessens the need for more food and providing food aid actually lessens the
burden of infectious disease.
The other point that is important that your friend touched on was the causes
of hunger and famine. With the exception of conflict, most hunger and
famine is caused by a lack of access and distribution of food (see Sen’s
Poverty and Famine). There is actually a surplus of food in the world but
it is the distribution of food in the world that is the problem. Dealing
with infectious disease and making people healthier can actually increase
their human capital and access to food.
These are some of my thoughts as I read your discussion. Finally this paper
on health and productivity is useful! Additionally, in all my experience in
Global Health, I have never heard anyone seriously offer the argument that
it is useless to treat infectious disease because of underlying hunger
issues or vice versa. I have only heard about multi-prong approaches that
take into account the interplay between the two.