The Wall Street Journal's David Wessel writes about Hoyt Bleakley's dissertation:
Posted by DeLong at January 16, 2003 12:53 AM | TrackbackWSJ.com - Capital: At the beginning of the 20th century, the South was a blemish on the American economy. Its per capita income was a third of New England's. A 17-year-old in the Midwest was three times as likely to be a high-school graduate than a Southerner. And 40% of school-age Southern children were infected with hookworm, an energy-sapping parasite....
[John D.] Rockefeller gave $1 million -- more than $18 million in today's dollars -- to create the Rockefeller Sanitary Commission "to bring about a cooperative movement of the medical profession, public-health officials, boards of trade, churches, schools, the press, and other agencies for the cure and prevention of hookworm disease."...
Combining Rockefeller Sanitary Commission tallies with detailed census data, Mr. Bleakley, currently at the University of Chicago, found that school attendance rose sharply in places where hookworm had been most common and was then nearly eradicated. Children cured of hookworm were 25% more likely to attend school than similar children who weren't. Schooling mattered: Children in counties where the battle against hookworm was won were more likely to be able to read and write afterward.
Getting rid of hookworm, and getting an education as a result, paid off in adulthood. By 1940, a hookworm-free childhood translated into 45% higher earnings compared with Southerners infected with the parasite as children. Mr. Bleakley contemplates other explanations -- from swings in crop prices to early efforts to increase spending on black schools -- but none of them fit the facts. He argues that 20% of the huge difference between incomes in the North and the South in 1900 can be pinned on the tiny nematode.
That's not everything, but it's a lot. Translating the lessons to modern Africa, Mr. Bleakley says, "Curing hookworm in Kenya" -- where about 90% of school-age children suffer from intestinal parasites -- "will launch it into the stratospheric income levels of Zimbabwe." That would be great for Kenyans, but not nearly enough to bring their living conditions close to those of industrialized countries.
The case of the victory over hookworm demonstrates the powerful economic benefits of old-fashioned public-health programs. But it also demonstrates the importance of institutions to deliver the lasting benefits of science to people. Mr. Rockefeller didn't give out enough free medicine. His squad had to rely on publicity campaigns that, for instance, helped teachers recognize symptoms so they could send children to doctors. "And you can't cure hookworm if you have people walking around in their own excrement when they go to school or come to church," Mr. Bleakley says. "You need to build privies. Rockefeller didn't spend money on that. The doctors just said you've got to do this." And churches and schools did...
Hoyt Bleakley has indeed written an important dissertation. The need now is to apply what has been learned to the devastating AIDS epidemic in southern Africa. It is hard to properly convey the cost that is being wrought by AIDS in individual, family, community, and national terms from South Africa to Ethopia. There are all sorts of measures being taken to stem the epidemic and ease the suffering, but resources are terribly short. We can help. Africa wishes, needs and deserves help, and help is in our moral, strategic and economic interests.
This really is the hour....
Posted by: on January 16, 2003 10:40 AM“At the beginning of the 20th century, the South was a blemish on the American economy. Its per capita income was a third of New England's. A 17-year-old in the Midwest was three times as likely to be a high-school graduate than a Southerner. And 40% of school-age Southern children were infected with hookworm, an energy-sapping parasite..”
I am utterly convinced that the cause of this mess was due to the South’s economic deterioration resulting from slavery. This evil practice discouraged the white establishment from opting for more efficient methods of production. They became intellectually lazy because the slaves did all of the menial labor. It is quite appropriate to compare them to the frog that is unaware of being slowly boiled to death. A slave economy is always a poor one. An inclusive democratic culture is much more likely to be affluent.
Posted by: David Thomson on January 16, 2003 10:43 AMhttp://allafrica.com/stories/200301080529.html
January 8, 2003
The Lack of Funding for HIV/AIDS Is Mass Murder by Complacency
By Stephen Lewis - United Nations
[Stephen Lewis is the United Nations Secretary-General's Special Envoy for HIV/AIDS in Africa]
New York - Last month, I spent two weeks touring four countries in Southern Africa: Lesotho, Zimbabwe, Malawi and Zambia. The primary purpose was to view the link between hunger and AIDS. I want to look back at that visit, because little will have changed between then and now (except, perhaps, that things will have deteriorated further), and then look forward to the prospects for addressing the pandemic in 2003.
At the outset, however, let me express, yet again, the fundamental conviction I have every time I visit Africa: there is no question that the pandemic can be defeated. No matter how terrible the scourge of AIDS, no matter how limited the capacity to respond, no matter how devastating the human toll, it is absolutely certain that the pandemic can be turned around with a joint and herculean effort between the African countries themselves and the international community.
I am weary to the point of exasperated impatience at the endless expressions of doubt about Africa's resolve and Africa's intentions and Africa's capacities. The truth is that all over the continent, even in the most extreme of circumstances, such as those which prevail today in the four nations I visited, Africans are engaged in endless numbers of initiatives and projects and programmes and models which, if taken to scale, if generalized throughout the country, would halt the pandemic, and prolong and save millions of lives.
What is required is a combination of political will and resources. The political will is increasingly there; the money is not. A major newspaper in the United States, reflecting on the paucity of resources, used the startling phrase "murder by complacency". I differ in only one particular: it's mass murder by complacency....
Stephen Lewis - United Nations Special Envoy
I couldn't help but feel, on occasion, that we were witnessing the grinding down of a society. We've all imagined the catastrophe, but no one wanted to believe that it could happen. The fact that the agricultural sector is beginning to decay could simply be a harbinger of worse to come. My own sense is that education is on the brink. In all of the countries, teachers were dead, teachers were dying, teachers were ill and away from school, children, especially girls, were being taken out of school to tend to sick and dying parents, children who had lost their parents to AIDS weren't in school because they couldn't afford the school fees. It felt, in every instance, as though the education sector was under siege. In Zambia, they lost 1,967 teachers in 2001, over two thousand teachers in 2002; the Teacher's Colleges are graduating fewer than one thousand a year. In parts of Malawi, HIV-positive teachers are estimated at over thirty percent. How can education be sustained?
Or maybe the collapse of agriculture and education are happening simultaneously, and we fasten on agriculture simply because the human damage is visible and immediate. If you don't eat for five days, the consequence is far more dramatic than being out of school for five days. In Malawi they've done an analysis of the impact of AIDS on four different Ministries, and the erosion in each, in human terms, to a lesser or greater degree, is inescapable. It's necessary to recognize that even at a prevalence rate of fifteen or twenty percent, let alone thirty or thirty-five percent as in Botswana, Lesotho, Zimbabwe and Swaziland, the incessant, irreversible, cumulative death of so many productive members of society means, ultimately, that things fall apart. When Chinua Achebe wrote his novel of that title several decades ago, little did he know that it would be the mantra of whole societies.
Posted by: on January 16, 2003 11:50 AMStephen Lewis
The little country of Lesotho has a most impressive political leadership, but is absolutely impoverished. If it had some significant additional resources, with which to build capacity, it could begin to rescue countless lives. I vividly remember the Prime Minister of Lesotho saying to me "We're told repeatedly by donors that we don't have capacity. I know we have no capacity; give us some help and we'll build the capacity". It's worth remembering that Lesotho has a population greater than that of Namibia and Botswana, but it has nowhere near the same pockets of wealth. It has, however, one of the highest prevalence rates for HIV on the continent ... higher than Namibia; almost as high as Botswana ... and is fatally compromised in its response by the lack of resources.
2,057,000 total population of Lesotho.
984,000 population of adults 15 to 49.
330,000 adults HIV/AIDS positive.
31.0% adult rate of infection.
54.5% of infected adults are women 15 to 49.
24.75 - 51.40% range of women 15 to 24
infected.
27,000 children 0 to 14.
25,000 AIDS deaths in 2001.
73,000 AIDS orphans cumulatively to 2002.
Stephen Lewis
What has changed is the maturity, vehemence and confidence of the organizations of People Living With HIV/AIDS. Time and again we met activists who know everything there is to know about CD4 counts and viral loads; they know the cost of generic drugs; they know about the treatment regimens; they know that WHO has undertaken to have three million people in treatment by 2005; they know that the rich members of society vault down to South Africa for treatment, while the poor remain helplessly behind; they know about Doha and intellectual property rights and the WTO; they know, from bitter experience, about all the false political promises. Increasingly, we're dealing with sophistication and determination in equal measure.
When I met with the group of People Living With HIV/AIDS in Lusaka, they presented me with a powerful and encyclopedic brief, a small part of which read as follows: "...for each day that passes without people accessing treatment we attend funerals. People die. We hear a hundred reasons for not providing people with treatment. For each reason given, lives are lost. The government must realize that it has a responsibility to provide health care for its people. Any government that fails to put in place measures to ensure the health of its citizens is not a government worth its name. Such governments should resign. If it does not do so, then people are justified to remove it by any means necessary. The right to life and dignity should not be a preserve of the rich and powerful.
Posted by: on January 16, 2003 01:16 PMLusaka -
10,649,000 total population of Zambia.
4,740,000 population of adults 15 to 49.
1,000,000 adults HIV/AIDS positive.
21.5% adult rate of infection.
59.0% of infected adults are women 15 to 49.
16.78 - 25.18% range of women 15 to 24
infected.
150,000 children 0 to 14.
120,000 AIDS deaths in 2001.
570,000 AIDS orphans cumulatively to 2002.
Source UNAIDS
Posted by: on January 16, 2003 01:55 PMNature: The economic and social burden of malaria
...
Between 1965 and 1990, countries in which a large proportion of the population lived in regions with Plasmodium falciparum malaria experienced an average growth in per-capita GDP of 0.4% per year, whereas average growth in other countries was 2.3% per year.
...
he causation in the other direction, from malaria to poverty, also seems to be robust and powerful. Cross-country regression analysis estimating the long-term impacts of malaria on economic growth and development suggest the significance of the economic burden of the disease. This analysis finds that countries in which a high proportion of the population lived in regions of P. falciparum malaria transmission in 1965 had annual economic growth rates that were 1.3% lower than other countries over the period 1965–1990, even after controlling for the other standard growth determinants used in macroeconomic analyses. These other determinants include levels of human capital, life expectancy, initial income, and macroeconomic policy indicators of various kinds as well as geographical factors such as tropical location that could be simultaneously influencing malaria and economic growth. Because this shortfall refers to the annual growth rate, the long-term effect on the level of gross national product (GNP) per capita is the cumulative effect of an annual reduction in growth.
Wessel's Capital column runs a Sunday addendum on the wsj.com site where readers respond to the article. And amongst the responses was this one:
[Capital column reader responses Jan 19 extract]
Garland Brinkley writes:
For additional information on the effects of hookworm in the American South, you should see the dissertation by Garland Brinkley, MPH, PhD, published in 1994 -- note the date -- which finds the same results as Hoyt.
David Wessel responds:
As you know, Hoyt Bleakley does cite your research in his paper on the impact of the Rockefeller initiative on kids, though I did not. The very interesting Brinkley work argues. among other things, that the spread of hookworm brought about by substandard living conditions after the Civil War reduced per capita agricultural output sharply in the late 19th century and that the success of the Rockefeller initiative can be seen in the improved agricultural productivity years immediately following the hookworm-eradication campaign.
[end of extract]
Go to Brinkley's homepage and see for yourselves.
http://trc.ucdavis.edu/glbrinkley/