African Development for the Completely Bloody Ignorant

We’ve followed Jeffrey Sachs through his book The End of Poverty as he outlines his basic theories of economic growth and developmental economics, as he recounts his personal experience in Bolivia, Poland and Russia, and as he offers his view on the economic booms in China and India. Finally, in the books’ tenth chapter, he turns his attention squarely on Africa.

Sachs first visited sub-Saharan Africa in 1995; he made several followup visits, particularly to Zimbabwe. He went on to chair a World Health Organisation commission looking at the links between epidemic disease and economic stagnation, and to play a part in the setting up of the Global Fund to Fight AIDS, TB and Malaria. He then went on to lobby more widely for Africa, which we’ll look at next time.

Sach’s initial focus is to outline the causes for Africa’s tremendous poverty. The explanation most common in the West - that Africa’s plight is primarily the result of corruption and poor governance - he disputes with striking vehemence. Africa, he notes, has barely had the chance to govern itself long enough to fail. The long period of the slave trade, around 1500 to 1800, was followed by over a hundred years of colonialism, which Sachs argues prevented education and divided the continent up along arbitrary lines. Then, after independence, African politics was the victim of massive meddling by US and USSR. “Almost every African political crisis - Sudan, Somalia, and a host of others - has a long history of Western meddling among its many causes.” Then, in the 1980s and 1990s, the West established further control over Africa through the IMF and World Bank, which imposed conditions on loans that effectively left them in charge of many African economies. “These programmes,” Sachs argues, “had little scientific merit and produced even fewer results.” Sach’s criticisms, particularly of the structural adjustment programmes of the 1980s, are decidedly controversial. But his point is not to emphasise the importance of Western intervention. “Both critics of African governance and critics of Western violence and meddling have got it wrong,” he argues. “Politics, at the end of the day, simply cannot explain Africa’s prolonged economic crisis.” Relatively low-corruption countries such as Ghana and Senegal, Sachs notes, still struggle to grow, while deeply corrupt regimes like Indonesia preside over fast growth. And similarly, other areas that suffered colonialism such as India are growing fast.

In previous chapters, Sachs has emphasised the role geography can play in deciding a region’s development destiny - in its implications for agriculture, disease, trade. The African Savannah, Sahcs argues, faces a triple challenge: “disease, drought, and distance from world markets.” A “complex mix” of “extreme poverty, rampant disease, unstable and harsh climate conditions, high transport costs, chronic hunger, and inadequate food production” create a ‘poverty trap’ that locks even well-governed African states with growth-friendly policies into slow growth.

Sachs focuses in this chapter primarily on disease.

I began to suspect that the omnipresence of disease and death had played a deep role in Africa’s prolonged inability to develop economically… Even before the Industrial Revolution, Africa had the lowest urbanization rate… and apparently the lowest living standards… [and] Africa’s growth rate has been among the lowest of any world region during each major period since 1820… Could the exceptional burden of illness be a significant reason?

In short, Sachs answers, yes. Take Malaria, which kills over 2 million Africans each year, mostly children. Bouts of Malaria that don’t kill a child can still lead to their dropping out of school, blighting their future prospects. It can leave them weak and disabled, reducing their future productivity. And the risk of losing children to the disease causes parents to have more children, slowing the demographic transition from a high-birth, high-infant mortality society to a low-birth, low-infant-mortality society.

Why does Africa suffer so badly with disease? In part, sheer bad luck. Taking Malaria as the example again: The variety of malaria pathogen present in Africa is far more dangerous than that in other areas; Africa’s rainfall and climate are ideally suited to mosquito breeding, and Africa’s native mosquitoes spread the disease more quickly than those in other tropical areas. But other factors come into it, too. Poverty itself can worsen the spread of disease: poor families can’t buy mosquito nets or health care.

When Sachs began to look at the figures, he found a close relationship between malaria prevalence and poverty across Africa. But in all the main aid efforts, little energy or money was being spent on it. The same was true of AIDS.

“There is no solid explanation for why Africa’s AIDS prevalence is at least of an order of magnitude higher than anywhere else in the world,” Sachs admits. It’s possible differences in African sexual activity are the reason, although Sachs disputes the idea that Africans are more promiscuous. What’s certain is how deeply AIDS is worsening Africa’s economic crisis: killing teachers and farmers; burdening businesses with problems of worker absence and health costs; deterring foreign investors. But like Malaria, AIDS was being largely ignored by aid donors. In 1998 only $70 million of aid to Africa was earmarked for AIDS prevention. The purchase of AZT treatment, which had saved thousands of lives in the West, wasn’t contemplated. So Sachs helped set up the aforementioned Commission to measure the impact of disease on economic growth, and lobbied for increased aid spending on disease. The eventual result was the birth of the Global Fund in 2001.

It’s not just AIDS and malaria, of course: Sachs also identifies tuberculosis, diarrhoea, acute respiratory infections, vaccine-preventable disease (I suspect this primarily means measles), malnutrition and unsafe childbirth are all part of Africa’s health problem. The Global Fund tackles some of these, and in general awareness of health issues amongst aid donors has increased - note, for example, the Africa Commission’s substantial section on public health. But having helped create some progress on Africa’s disease burden, Sachs turns his attention to the rest of Africa’s problems. His focus remains the same, on practical obstacles. “Africa’s problems…. are especially difficult but still solvable with practical and proven technologies. Diseases can be controlled, crop yields canbe sharply increased, and basic infrastructure such as paved roads and electricity can be extended to the villages. A combination of investments well attuned to local needs and conditions can enable African economies to break out of the poverty trap.”