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"Roll Back Malaria, Roll in Development"? Reassessing the Economic Burden of Malaria
Abstract
Recent efforts to mobilize support for malaria control have highlighted the economic burden of malaria and the value of malaria control for generating economic development. These claims have a long history. Beginning in the early twentieth century, they became the primary justification for malaria-control programs in the American South and in other parts of the globe, including British India. Economists conducted none of these studies. Following World War II and the development of new anti-malarial drugs and pesticides, including DDT, malaria control and eradication were increasingly presented as instruments for eliminating economic underdevelopment. By the 1960s, however, economists and demographers began to raise serious substantive and methodological questions about the basis of these claims. Of particular concern was the role of rapid population growth, resulting in part from the decline of malaria mortality, in undermining the short-term economic gains achieved through malaria control. Despite these concerns, malaria continues to be presented as an economic problem in the work of Jeffrey Sachs and others, justifying massive investments in malaria control. The methodological basis of these claims is examined. The paper concludes that while malaria takes a dreadful toll in human lives and causes significant economic losses for individuals, families, and some industries, the evidence linking malaria control to national economic growth remains unconvincing. In addition, the evidence suggests that there are potential costs to justifying malaria-eradication campaigns on macroeconomic grounds. Copyright (c) 2009 The Population Council, Inc..
... A report developed by the United Nations and the World Bank found that reducing the gender gap in agricultural productivity could enable as many as 119,000 people to escape poverty in Uganda (Women & Others, 2015). A separate study by the World Bank found that women farmers produce significantly less per hectare than men (O'Sullivan et al., 2014). For example, in Uganda the production of farm plots managed by women was 13% less per acre than the plots that men managed (O'Sullivan et al., 2014). ...
... A separate study by the World Bank found that women farmers produce significantly less per hectare than men (O'Sullivan et al., 2014). For example, in Uganda the production of farm plots managed by women was 13% less per acre than the plots that men managed (O'Sullivan et al., 2014). This study suggests that the provision of community-based childcare centers could reduce the gender gap (O'Sullivan et al., 2014), positing that childcare duties are, in part, responsible for the gender gap. ...
... For example, in Uganda the production of farm plots managed by women was 13% less per acre than the plots that men managed (O'Sullivan et al., 2014). This study suggests that the provision of community-based childcare centers could reduce the gender gap (O'Sullivan et al., 2014), positing that childcare duties are, in part, responsible for the gender gap. A study in Ghana found that 83% of caregiving activities for malaria cases in agricultural households were provided by women (Asante & Asenso-Okyere, 2003). ...
Background : Progress in suppressing malaria over the next two decades may have a significant impact on poverty among agricultural households in sub-Saharan Africa. A recent study found that if malaria were eradicated by 2040, poverty rates among such households would fall by 4 to 26 percentage points more from 2018 to 2040 than if the burden of malaria remained at its current level. The relatively wide range of these estimates is due to a lack of evidence regarding the long-term impact of suppressing malaria on the incomes of agricultural households. The objective of this study is to describe a research framework that would generate the necessary evidence for developing more precise estimates.
Methods : First, we developed a conceptual framework for understanding the potential long-term impact of suppressing malaria on the incomes of agricultural households. Next, we established a research framework for examining each component of the conceptual framework.
Results : Our proposed research framework enables a comprehensive examination of how malaria affects the decisions, productivity, harvest value and expenditures due to morbidity and mortality within an agricultural household. This contrasts with the 27 existing relevant studies that we have identified, of which 23 focused only on household productivity and expenditures, two focused on decisions, and two focused on harvest values.
Conclusion : By implementing the research framework presented in this study, we will increase our knowledge of how suppressing malaria over the next two decades would affect the incomes of agricultural households in sub-Saharan Africa. Evidence generated from the framework will inform funding allocation decisions for malaria elimination initiatives.
... Malaria has been successfully managed and eradicated in developed nations, yet it continues to represent a leading threat to health and underdevelopment in less-developed nations (Packard 2009;WHO 2013). 1 The World Health Organization (2013) reports that there were approximately 207 million documented cases of malaria in 2012, resulting in nearly 700,000 deaths. Although malaria represents a leading infectious disease globally along with HIV/AIDS and tuberculosis, in comparison, in 2012 there were about 33 million HIV cases and 1.6 million deaths, and 9 million tuberculosis cases resulting in 1.5 million deaths. ...
... The bulk of the malaria burden is concentrated in sub-Saharan Africa, where rates of malaria are especially high among children and pregnant women (WHO 2013). Since malaria is transmitted to humans by mosquitoes that are often found in rural areas, scholars and practitioners commonly consider it a "rural disease" (Packard 2009;WHO 2012;Williams et al. 2009). They argue that rural people live closer to mosquito habitats, such as streams and slow-moving waterways, and numerous studies document that vulnerability and rates of infection tend to be higher in rural settings than in urban areas (e.g. ...
... The relatively few studies of malaria that do exist focus on individual behaviors or patterns within localized regions, or they are descriptive in nature (e.g. Bates et al. 2004;Norris 2004;Vittor et al. 2006Vittor et al. , 2009Williams et al. 2009). More insight is needed to investigate the larger social, economic, and environmental conditions that perhaps interact with rurality, conditions that result in a high variation of malaria cases in different countries (e.g. Bates et al. 2004;Farmer 2001;Packard 2009); understanding the underlying causes of malaria prevalence requires investigating these large-scale social forces, because they transcend conventional medical or biological reasoning (e.g. Bates et al. 2004;Farmer 2001). ...
Although often forgotten among people in affluent nations, malaria represents a leading global health concern in poor, rural countries. Malaria is traditionally thought of as a rural disease, given the close proximity of rural households to mosquito disease vectors. However, more insight is needed to investigate the larger social, economic, and environmental conditions that perhaps interact with rurality to explain why some nations continue to have high levels of prevalence of this preventable and eradicable parasitic infection. We employ structural equation modeling to efficiently test for both direct and indirect effects of rurality. The results demonstrate that rurality works in important indirect ways; although rurality has indirect links to malaria through export agriculture, health spending, and sociohealth resources, careful decomposition of the indirect effects illustrates that the indirect effects through heath spending and sociohealth resources are most important. Overall, the findings suggest that rural vulnerabilities to malaria are not inherent and can be largely addressed by increasing public health provisions among rural populations.
... Approximately 3 billion people who live in tropical and subtropical regions where Anopheles mosquitoes are endemic are at risk of acquiring malaria (WHO, 2013). Significantly, poverty is concentrated in the tropical zones of the world, the same geographical boundaries that frame malaria transmission (Packard, 2009;Sachs and Malaney, 2002). Those living in poverty face increased risk of acquiring malaria for many reasons. ...
... Impoverished people lack knowledge of diseaseprevention techniques, have little access to modern 'Western' medicine, and face limited access to appropriate preventative strategies such as screened windows or bed nets. Also, many poor households lack adequate sanitation systems, increasing potential mosquito habitats (e.g. Bates et al., 2004;Lowassa et al., 2012;Packard, 2009;Sachs and Malaney, 2002;Williams et al., 2009). ...
... As previously mentioned, pregnant women, infants, and young children face a greater biological susceptibility to malaria. Socially, gender stratification and conditions of poverty only heighten the risks of acquiring malaria for these already vulnerable segments of the population (Fried et al., 1998;Gupta, 2004;Ogbodo et al., 2009;Packard, 2009;Sachs and Malaney, 2002;WHO, 2013). For example, various epidemiological studies illustrate that acquiring malaria during pregnancy leads to deleterious maternal and neonatal outcomes such as maternal anemia, preterm labor, maternal death, stillbirths, low birth weight, and high infant mortality rates (e.g. ...
Although seldom noted in scholarly accounts, malaria represents a leading cause of death and underdevelopment in poor nations. Enormous cross-national variation in malaria rates across its endemic zones suggest the importance of large-scale factors in explaining comparative disease trends. While the biological vulnerability of women and children to malaria is often acknowledged, the literature has yet to investigate how gender inequalities contribute to patterns of malaria prevalence. Utilizing structural equation modeling on a sample of 90 less-developed nations and engaging insights from gender stratification perspectives, we consider the influence of both legal economic status and social dimensions of women’s status on malaria rates. We find that women’s legal economic status has an indirect relationship on malaria rates by enhancing women’s social standing and strengthening general health provisions. The results suggest that addressing issues of gender inequality in poor nations is central to tackling this persistent pandemic.
... There is strong evidence that the MEI satisfies the exclusion restriction inasmuch as it is difficult to see how the aforementioned public health innovations that led to the decline in malaria, which were limited in scope to malarial areas and were focussed on the aforementioned malaria-specific technologies like spraying and bednets, could have had an independent effect on urbanization that was not via mortality decline. Indeed, as spelled out clearly by Packard (2009), efforts to combat malaria have actually had little to no effect on GDP levels and industrialization inasmuch as they have increased population size via lower infant and child mortality but not economic growth. 18 This evidence is consistent with other recent population-wide studies that ...
... Bleakley, 2010 for an overview), but do not examine any macro-economic effects on urbanization or economic growth. As both Packard (2009) and Hansen and Lønstrup (2015) have noted, these micro-and macro-economic effects are not contradictory. 20 We also generated GMM estimates of equations 1-3, which in all cases were in full agreement with our main results in Tables 1-2 and A1-A2 (results available from authors). ...
We investigate the relationship between mortality decline and urbanization, which has hitherto been proposed by demographers but has yet to be tested rigorously in a global context. Using cross-national panel data, we find evidence of a robust negative correlation between crude death rates and urbanization. The use of instrumental variables suggest that this relationship is causal, while historical data from the early 20th century suggest that this relationship holds in earlier periods as well. Finally, we find robust evidence that mortality decline is correlated with urbanization through the creation of new cities rather than promoting urban growth in already-extant cities.
... Malaria eradication can be correlated with many other factors that influence economic growth including governance and the quality of public policies that have been omitted from econometric models. Packard (2009) notes that 'given the multiple difficulties associated with past efforts to demonstrate the impact of malaria on economic development and the economic benefits of malaria control, it is surprising that Gallup and Sachs stated their conclusions with such confidence and that their conclusions have been accepted with so little question.' ...
... Other studies analyse different delivery strategies and the cost-effectiveness of ITN/LLINs(Thomson et al. 1995;Goodman et al. 1999;Chima et al. 2003;Morel et al. 2005, Worrall et al., 2005, Chuma et al., 2006. For a literature survey of studies assessing the economic burden of malaria since 1909, seePackard (2009). ...
... US Secretary of State George C. Marshall justified the expense in dynamic terms: "Little imagination is required to visualize the great increase in the production of food and raw materials, the stimulus to world trade, and above all the improvement in living conditions, with consequent social and cultural advances, that would result from the conquest of tropical diseases" (52, p. 64). Controlling malaria would, according to proponents, pave the way for economic development on a national and global scale (53). ...
... Soper served as director of the Pan American Health Organization from 1947 to 1959, and many JHSPH experts in tropical disease gravitated to the organization. But if, as Andrews posited, poverty and low living standards created conditions ripe for the spread of epidemic disease, including malnutrition and poor sanitation, then these problems could not be solved solely with Soper's technocentric philosophy, which traced its roots directly back to the Rockefeller Sanitary Commission for the Eradication of Hookworm Disease (53,54). ...
In 1915, William Henry Welch and Wickliffe Rose submitted a report to the Rockefeller Foundation that became the template for public health professional education in the United States and abroad. Based on the Welch-Rose Report's recommendations, the Foundation awarded a grant to Johns Hopkins University in 1916 to establish the first independent graduate school of public health, with Welch serving as the founding dean. The Welch-Rose Report and, by extension, the Johns Hopkins School of Hygiene and Public Health established and transmitted a new model of scientific training that wove the laboratory mindset together with the methods of public health administration and epidemiologic fieldwork. During the School's first quarter-century, faculty and alumni were remarkably active in frontline public health problem-solving, as well as launching public health agencies and schools of all types and sizes. The most lasting contribution of the Welch-Rose Report and the Johns Hopkins School of Hygiene and Public Health, now the Johns Hopkins Bloomberg School of Public Health, has been to "cultivate the science of hygiene" to bring about exponential growth in the evidence base for public health. The schools that have adopted the Johns Hopkins model of public health education worldwide have produced professionals who have worked to achieve wide-ranging reforms dedicated to preserving life, protecting health, and preventing injury across populations and continents.
... However, use of these measures did not perform well in the model, and this was also confirmed with follow-up OLS regression analyses. Substantively, physicians, secondary schooling, sanitation, and the fertility rate represent the most common predictors of malaria cited in prior research (e.g. Bates et al. 2004;Sachs and Malaney 2002;Norris 2004;Packard 2009; WHO 2011b) and thus confirm the statistical results favoring these measures over the others tested. Burroway 2010;Brady et al. 2007;Shen and Williamson 2001;Soares 2007). ...
... Poverty is often singled out as the major cause of infectious disease in less-developed nations (e.g. Packard 2009;Sachs and Malaney 2002). But poverty itself is a multidimensional concept and can include economic as well as social components. ...
Malaria rates remain high across many less-developed regions, including Southeast Asia, Sub-Saharan Africa, and parts of Latin America. Although case studies find elevated malaria rates in locales with increased levels of environmental degradation, the current body of comparative environmental research lacks investigation of infectious disease trends. This study draws upon world-system theorizing to consider agricultural export flows and resulting alterations to the natural environment in poor nations as key causes of malaria prevalence. Additionally, relationships among world-system position, economic development, and socio-health characteristics are examined alongside the environmental predictors using structural equation modeling for data on 99 less-developed nations. The findings emphasize that deforestation and biodiversity loss associated with primary sector export flows are key drivers of malaria rates, alongside notable influences of basic health and social services. The results suggest that environmental and social conditions greatly shape malaria transmission in poor societies.
... In a 1977 report, EMCF quoted a CDC physician's comment that schistosomiasis was 'one of the forgotten problems of forgotten people' (Edna McConnell Clark Foundation 1977, 22). Advocates argued primarily that people 'forgotten' or neglected by biomedical research mattered because their individual economic productivity and livelihood were negatively impacted by disease, which in turn had implications for entire nations cast as 'underdeveloped' (Packard 2009;Staples 2006). This followed a logic linking health and development that had deep roots in the postwar era. ...
This article explores the development and evolution of 'neglected tropical diseases' (NTDs) as an operative and imaginative category in global public health, focusing on the early intellectual and institutional development of the category in the 1970s. It examines early work around 'neglected' diseases in the Rockefeller Foundation's Health Sciences Division, specifically the Foundation's 'Great Neglected Diseases of Mankind' initiative that ran between 1978 and 1988, as well as intersections with the WHO's parallel Special Programme for Research and Training in Tropical Diseases and efforts by the US-based Edna McConnell Clark and MacArthur Foundations. A key concern of advocates who influenced initial programmes focused around 'neglect' was a lack of sophistication in medical parasitological research globally. Central to the NTDs' capacity to animate diverse energies were claims about parasitic diseases and their place in new biotechnological approaches to medicine. This article explores how the emphasis on 'neglected', 'tropical' or even 'endemic' diseases encoded specific concerns and desires of parasitologists in the early 1970s. Despite the desire to prioritise the needs of 'endemic' countries and the recognition of a widening cohort of experts from both high-income and low-income nations, NTD advocates often recapitulated historic power dynamics privileging research institutions in the USA and Europe. Historicising and contextualising 'neglect' illuminates the contingent and changing politics of global health in a formative period in the late twentieth century.
... In fact, although the economically active population may be composed of unoccupied people, this does not prevent an ill person from pushing the occupied to take care of them. Thus, in addition to the monetary expenditure, care-seeking generally results in a loss of working time, which can affect the efficiency of work [22][23][24][25][26][27][28][29][30][31][32]. ...
Malaria constitutes, beyond a public health problem, a major challenge for the development of endemic countries. The objective of this study is to estimate the economic cost of malaria in Senegal. A logarithmic double model with interaction effect is used and estimated, using a time series data from 1995 to 2019, by Ordinary Least Squares (OLS) method. At the macroeconomic level, when malaria morbidity increases by 1%, GDP per capita falls by 0.00467. Applied to total GDP, this corresponds to an average annual loss of US $ 108 million. In addition, the study shows a decrease of the labour factor impact when taking into account the interaction effect of malaria. In fact, in the case of a 1% increase in malaria, the contribution resulting from a 1% increase in the labour force decreases by 0.48 point. Such consequences due to malaria can lead in the long run to adverse effects on economic growth and on efforts to fight poverty in Senegal.
... Similar evidence is extracted from the Great Leap Forward famine in China during the 1950s and 1960s as well as hookworm elimination in the USA (Bleakley, 2010). However, it is also worth noting that better health does not establish a relationship with lower poverty levels and economic growth at the country level (Acemoglu and Johnson, 2007;Packard, 2009). ...
The purpose of this paper is to review and analyse poverty alleviation and health outcomes through the effectiveness of two major programs launched by the government to uplift social welfare in Pakistan (Benazir Income Support Program (BISP) and the Sehat Sahulat Program (SSP). We also aim to explore the link between poverty and health in light of the BISP and SSP. Secondary data is utilized to carry out this study, where qualitative data is gathered from the beneficiaries’ interviews while quantitative data is based upon the poverty line. Through this study, we can conclude an overall positive impact of the BISP and SSP on two components of the Human Development Indicator (HDI) concerning poverty and health: standards of living and life expectancy. Although positive conclusions have been brought about by BISP such as a reduction in wasting (girls) and increased food consumption, it fails to substantially cover health and may even be ineffective if individuals face external shocks such as dangerous illnesses. Such findings strengthen the importance of the SSP as a social welfare program alongside the BISP to secure far more wholesome and successful outcomes. By exploring the interchangeable link between poverty and health and connecting it to these programs, we further assert the complimentary nature of the BISP and SSP and base our evaluation on it.
... While this association between malaria and poverty has long been recognized Laxminarayan, 2004;Malaney et al., 2004;Chuma et al., 2006;Teklehaimanot and Mejia, 2008), the direction of this causality and the relative importance of the potential feedbacks in the two opposite directions remain the subject of debate (Packard, 2009(Packard, & 2007. ...
Malaria and human prosperity had been intimately connected since the beginning of human civilization through agriculture, and today most of its burden is concentrated in poor and rural communities. While this connection has been recognized, the contribution of agricultural development on the distribution and abundance of malaria, and the influence of the feedback that can operate between the disease and the agrarian economy, remains poorly understood. The purpose of this dissertation is to examine the role of irrigation and agricultural development in determining the distribution, abundance, and dynamics of malaria populations and simultaneously the role of malaria on human behavior related to mosquito control policy and economic productivity. This dissertation examines the current malaria situation in the semi-desert and monsoon-driven region of Northwest India and, retrospectively, malaria elimination in Mississippi, United States.
This work shows that in highly irrigated areas malaria predictability based on rainfall is reduced due to intense vector control programs, most successfully implemented by authorities in more prosperous and irrigated places. I show that this vector control strategy generates a mechanistic feedback between the disease and the control itself, which decreases the effectiveness of the intervention and the likelihood of elimination. In addition, I provide evidence suggesting that this period of high risk and high control in irrigated settings is a transient period, lasting for more than a decade when poor areas with low irrigation development transition to becoming areas with sustainable low risk and better socioeconomic conditions. Finally, I provide evidence to suggest that income and other economic factors had a large influence in driving malaria interannual variability and its elimination in Mississippi. The influence of malaria on cotton production, which dominated the economy of the region at this time, was limited.
Together, the results from this dissertation provide insight to support the idea that including socioeconomic factors, while indirectly related to malaria transmission, with detailed ecological knowledge of the malaria system can provide valuable information to generate more sustainable and effective strategies to decrease malaria burden and eventually eradicate the disease.
... In addition, policies of debt forgiveness should be granted on a wide scale, and nations should be extremely cautious when engaging in structural adjustment reforms as to not sacrifice investments in social and health resources in the name of short-term economic gains. Given the well-documented relationship between disease and economic growth (e.g., Packard 2009), less developed nations should deeply reconsider any strategy that potentially sacrifices health and social well-being, as this will only lead to continued impoverishment in the long term. ...
Tuberculosis (TB) and malaria remain leading causes of death in certain areas of the world system and directly contribute to persistent patterns in global inequality. I employ structural equation modeling for a sample of 135 nations to appropriately test for indirect and complex relationships among economic, social, and environmental indicators. The results demonstrate that economic dependency and environmental decline lead to increased urban slum populations in less developed nations, and that nations with larger urban slum populations have higher rates of TB and malaria. Important interrelationships also are evidenced among additional predictors, such as socio-health characteristics, economic development, and location in Sub-Saharan Africa. Overall, this research demonstrates that current epidemiological patterns in TB and malaria prevalence have important sociological underpinnings. Public policy should be directed toward addressing the social causes of these diseases, including improved access to schooling, health care, and other basic resources, especially in urban areas characterized by slum conditions.
... Several authors have considered that communicable diseases, among others, had contributed to slow down economic development of low income countries. The latter proposition is still hotly debated as some methodological issues are not satisfactorily addressed (see the comprehensive and critical review ofPackard, 2009). For instance, ...
This dissertation investigates theoretically and empirically the interrelationships among population's health, environmental degradation and economic development, its consequences for developing countries, and some effective policy responses. The first part explores the association between health, environment, and inequalities. It firstly analyzes whether environmental degradation could be considered as an additional channel through which income inequality affects infant and child mortality (chapter 2). Theoretical and empirical investigations show that income inequality affects negatively air and water quality, and this in turn worsens population's health. Therefore, environmental degradation is an important channel through which income inequality affects population health. Then, it is shown that sulphur dioxide emission (SO2) and particulate matter (PM10) are in part responsible for the large disparities in infant and child mortalities between and within developing countries (chapter 3). In addition, we found that democratic institutions play the role of social protection by mitigating this effect for the poorest income classes and reducing the health inequality it provokes. The second part is devoted to the link among health, environment, and economic growth. The effect of health (global burden of disease, communicable disease, and malaria) on economic growth is assessed in Chapter 4. This chapter shows that health indicators, when correctly measured by the gap between current health status and an ideal health situation where the entire population lives to an advanced age, free of disease and disability, and when accurately instrumented have significant impact on economic performance. The consequences of these interrelationships on the convergence of poor countries towards their steady state are theoretically and empirically investigated in the last Chapter (chapter 5). It is found that environment degradation reduces the ability of poor countries to reach their own steady state, reinforcing our argument according to which environment quality improvement plays a considerable role in economic convergence process. Moreover, the degradation of air and water quality affects negatively economic performance, and health status remains an important channel through which environment degradation affects economic growth even if it is not alone. The Environmental Kuznets Curve (EKC) hypothesis is also verified.
... Some authors challenge these results, however, in particular Acemoglu and Johnson (2007), although they use similar methods to Sachs' approach (Packard, 2009). The authors use historical data on the change in life ex- pectancy (from the 1940s to the 2000s) to produce an estimate of instru- mental variables designed to control endogeneity bias. ...
Historically population health improvements and economic development are closely interrelated. The theme “Health and Development” poses indeed a large number of both theoretical and empirical questions, and social policy issues in this area are obvious. The issue of bidirectional causality between health and development has contributed to one of the most lively debates in the last two decades in development economics, with an alternation of mainstreams rather than a real dialogue. We offer four pathways to overcome these limitations, some of which are not new but have not been integrated together: (i) reconcile the microeconomic and macroeconomic analyses, (ii) explore the channels of influence to better resolve the ambiguity of the relationship, (iii) establish a dialogue with the epidemiology and biomedical sciences – the definition of a good or bad health is not neutral in this debate, neither are the health indicators used, (iv) develop a supply side analysis, while so far the demand side has received more attention.
JEL Classification : I15.
... 19 Packard went one step further by calling into question the work of Sachs and others, and highlighting the general lack of evidence that authors have to support their claims of large forward impacts from reducing malaria prevalence. 20 One concern about malaria eradication is the possibility of rapid population growth. Malthusian pessimists argue that rapid population growth in poor countries can exacerbate existing problems. ...
... For example, one slogan for the malaria initiative was, 'Roll Back Malaria, Roll in Development', and the first executive director for the Roll Back Malaria initiative, Dr David Nabarro, stated, 'Malaria is taking costly bites out of Africa . . . It is feasting on the health and development of African children and it is draining the life out of African economies' (cited in Packard, 2009). For all three diseases, cost-effectiveness determined the choice of the preferred initiatives. ...
Most descriptions of the spread of neoliberal economic policies since the 1980s overlook the significant contribution of international organizations not only to the dissemination of these policies, but also to their making. The scholarship often regards international organizations as passive trans- mission belts that merely comply with the demands of their member-states. Scholars who do identify the constitutive role of international organizations consider them to be enthusiastic supporters of the neoliberal project. There were cases, however, when international organizations were opposed to ne- oliberal reforms imposed from above. This paper draws on the experience of the World Health Organization (WHO) to show that in the process of adapting to the emerging neoliberal regime, international bureaucracies ac- tively restructured this regime in accordance with their own institutional cultures. Some neoliberal prescriptions were successfully transmitted, but others were transformed, with the result that the global regime was hardly monolithic and included elements that were introduced by the international bureaucracies themselves. In developing this argument, the paper identi- fies the adaptive strategies that allow international bureaucracies, in spite of their vulnerability to external forces, to incorporate their own organizational agendas into what has consequently become a more heterogeneous global neoliberal regime.
... On the one hand, then, researchers have examined how malaria affects SES factors. At the national level, a widely cited set of studies has associated malaria endemicity with substantially slower economic growth and decreased per capita GDP (Gallup andSachs 2001, Sachs andMalaney 2002), although the causality of these relationships has been questioned given the inadequacy of data, complexity of interrelationships among social and economic factors and health, and difficulty of extrapolating microlevel results to the macro level (Packard 2009). At the household and individual levels, malaria imposes significant burdens, both direct, in terms of the costs of prevention and treatment, and indirect, in the form of lost wages. ...
Despite evidence that they play similar but independent roles, maternal education and household wealth are usually conflated in studies of the effects of socioeconomic status (SES) on malaria risk. Demographic and Health Survey and Malaria Indicator Survey data from nine countries in sub-Saharan Africa were used to explore the relationship of malaria parasitemia in children with SES factors at individual and cluster scales, controlling for urban/rural residence and other important covariates. In multilevel logistic regression modeling, completion of six years of maternal schooling was associated with significantly lower odds of infection in children (OR = 0.73), as was a household wealth index at the 40th percentile compared to the lowest percentile (OR = 0.48). These relationships were nonlinear, with significant quadratic terms for both education and wealth. Cluster-level wealth index was also associated with a reduction in risk (OR = 0.984 for a one percentile increase in mean wealth index), as was urban residence (OR = 0.59). Among other covariates, increasing child's age and household size category were positively correlated with infection, and sleeping under an insecticide-treated bednet the previous night (OR = 0.80) was associated with a moderate reduction in risk. Considerable variation in parameter estimates was observed among country-specific models. Future work should clearly distinguish between maternal education and household resources in assessing malaria risk, and malaria prevention and control efforts should be aware of the potential benefits of supporting the development of human capital.
... Malaria is caused by a parasite called Plasmodium falciparum and transmitted by anopheles mosquitoes that act as a vector for the spread of this disease among the human hosts (Lalloo et al. 2007, Tuteja 2007, Mueller et al. 2009, Alonso 2010. Worldwide, malaria is considered to be a major impediment to manpower and economic development due to its negative impact on the health of the infected humans causing high morbidity and mortality rates in the prevalent areas (Barnes et al. 2009, Komba et al. 2009, Packard 2009, Poespoprodjo et al. 2009). Nigeria being a developing country has to earmark a huge sum of its limited financial resources for the control of this pandemic disease leaving little or nothing for other developmental projects that would have improved the livelihood of the already vulnerable society. ...
The aim of this study is to derive environmental factors that are likely to influence malarial distribution from Nigeriasat-1 in a geographical information systems (GIS) environment and relate it to the empirical evidence of reported malarial cases in the hospitals using discriminant analysis (DA) to characterize, identify and map malarial risk zones. It is found that using a stepwise DA, Nigeriasat-1 and GIS it is possible to classify the accurately the low malarial risk zone (100%), medium and high risk zones (83.33%), with an overall accuracy of 88.9% being achieved for the study area. The results obtained were in agreement with the ground validation exercise that was carried out and the cross validation method of ‘‘leaving-one-out’ in DA function. These findings indicate that Nigeriasat-1 and GIS combined with statistical technique of DA can be utilized as a decision support tool for a precise identification of the areas warranting mitigation efforts.
... Packard (2009) also, within the context of controlling malaria, has argued that a reduction in the incidence of this disease in a developing country may bring no immediate increase in economic activity in this country.4 The relevant literature has been surveyed to some degree from various perspectives byJack and Lewis (2009: 12 -19) andPackard (2007: 146 -7;). ...
The conjectures examined are that: (i) advances in the medical knowledge are likely to have comparatively little (resp. considerable) impact on the rate of the growth of gross domestic product per capita (GDPPC) in a poor developing country if economic institutions are weak (resp. adequate); (ii) apparently strong economic institutions will have comparatively little (resp. considerable) impact on this rate of economic growth in this country if previously the level of health had not been (had been) raised to a minimum threshold level. The (limited) evidence presented indicates that the contribution that advances in medical knowledge are likely to make, in raising the rate of growth of GDPPC in developing counties, appears to be constrained at least by the level of economic institutions present in the country concerned.
... Nevertheless, their affirmation on this negative macroeconomic effect is still hotly debated as some methodological issues are not satisfactorily addressed (see the comprehensive and critical review of Packard, 2009). Moreover, several studies argue that the negative effect of health on growth is not so obvious. ...
Relationships between health and economic prosperity or economic growth are difficult to assess. The direction of the causality is often questioned and the subject of a vigorous debate. For some authors, diseases or poor health had contributed to poor growth performances especially in low-income countries. For other authors, the effect of health on growth is relatively small, even if one considers that investments which could improve health should be done. It is argued in this paper that commonly used health indicators in macroeconomic studies (e. g. life expectancy, infant mortality or prevalence rates for specific diseases such as malaria or HIV/AIDS) imperfectly represent the global health status of population. Health is rather a complex notion and includes several dimensions which concern fatal (deaths) and non-fatal issues (prevalence and severity of cases) of illness. The reported effects of health on economic growth vary accordingly with health indicators and countries included in the analyses. The purpose of the paper is to assess the effect of a global health indicator on growth, the so-called disability-adjusted life year (DALY) that was proposed by the World Bank and the WHO in 1993. Growth convergence equations are run on 159 countries over the 1999-2004's period, where the potential endogeneity of the health indicator is dealt for. The negative effect of poor health on economic growth is not rejected thus reinforcing the importance of achieving MDGs.
... This non-linearity reflects, in part, the possibility that the influence of the level of health on the level of GDPPC varies at different stages in the economic development of this country. At one stage in this non-linear process application of relevant medical knowledge will have little or no influence on the aggregate economic performance of this country, while at some threshold or inflexion point the appropriate application of relevant medical knowledge appears to be of vital importance for assisting the economy of this country to attain a much 3 Packard (2009) also, within the context of controlling malaria, has argued that a reduction in the incidence of this disease in a developing country may bring no immediate increase in economic activity in this country. 4 The relevant literature has been surveyed to some degree from various perspectives by Jack and Lewis (2009: 12 – 19) and Packard (2007: 146 – 7;). ...
This paper provides a survey on studies that analyze the macroeconomic effects of intellectual property rights (IPR). The first part of this paper introduces different patent policy instruments and reviews their effects on R&D and economic growth. This part also discusses the distortionary effects and distributional consequences of IPR protection as well as empirical evidence on the effects of patent rights. Then, the second part considers the international aspects of IPR protection. In summary, this paper draws the following conclusions from the literature. Firstly, different patent policy instruments have different effects on R&D and growth. Secondly, there is empirical evidence supporting a positive relationship between IPR protection and innovation, but the evidence is stronger for developed countries than for developing countries. Thirdly, the optimal level of IPR protection should tradeoff the social benefits of enhanced innovation against the social costs of multiple distortions and income inequality. Finally, in an open economy, achieving the globally optimal level of protection requires an international coordination (rather than the harmonization) of IPR protection.
Yi-Tang Lin presents the historical process by which statistics became the language of global health for local and international health organizations. Drawing on archival material from three continents, this study investigates efforts by public health schools, philanthropic foundations, and international organizations to turn numbers into an international language for public health. Lin shows how these initiatives produced an international network of public health experts who, across various socioeconomic and political contexts, opted for different strategies when it came to setting global standards and translating local realities into numbers. Focusing on China and Taiwan between 1917 and 1960, Lin examines the reception, adaptation, and appropriation of international health statistics. She presents the dynamic interplay between numbers, experts, and policy-making in international health organizations and administrations in China and Taiwan. This title is also available as Open Access.
http://authors.elsevier.com/a/1SJC0-CmUWH4E
Malaria elimination rather than control is increasingly globally endorsed, requiring new approaches wherein success is not measured by timely treatment of presenting cases but eradicating all presence of infection. This shift has gained urgency as resistance to artemisinin-combination therapies spreads in the Greater Mekong Sub-region (GMS) posing a threat to global health security. In the GMS, endemic malaria persists in forested border areas and elimination will require calibrated approaches to remove remaining pockets of residual infection. A new public health strategy called ‘positive deviance’ is being used to improve health promotion and community outreach in some of these zones. However, outbreaks sparked by alternative understandings of appropriate behaviour expose the unpredictable nature of ‘border malaria’ and difficulties eradication faces. Using a recent spike in infections allegedly linked to luxury timber trade in Thai borderlands, this article suggests that opportunities for market engagement can cause people to see ‘deviance’ as a means to material advancement in ways that increase disease vulnerability. A malaria outbreak in Ubon Ratchathani was investigated during two-week field-visit in November 2014 as part of longer project researching border malaria in Thai provinces. Qualitative data were collected in four villages in Ubon’s three most-affected districts. Discussions with villagers focused primarily on changing livelihoods, experience with malaria, and rosewood cutting. Informants included ten men and two women who had recently overnighted in the nearby forest. Data from health officials and villagers are used to frame Ubon’s rise in malaria transmission within moral and behavioural responses to expanding commodity supply-chains. The article argues that elimination strategies in the GMS must contend with volatile outbreaks among border populations wherein ‘infectiousness’ and ‘resistance’ are not simply pathogen characteristics but also behavioural dimensions born of insistent market aspirations.
Health and Development : A Circular Causality
Historically population health improvements and economic development are closely interrelated. The theme “Health and Development” poses indeed a large number of both theoretical and empirical questions, and social policy issues in this area are obvious. The issue of bidirectional causality between health and development has contributed to one of the most lively debates in the last two decades in development economics, with an alternation of mainstreams rather than a real dialogue. We offer four pathways to overcome these limitations, some of which are not new but have not been integrated together : (i) reconcile the microeconomic and macroeconomic analyses, (ii) explore the channels of influence to better resolve the ambiguity of the relationship, (iii) establish a dialogue with the epidemiology and biomedical sciences – the definition of a good or bad health is not neutral in this debate, neither are the health indicators used, (iv) develop a supply side analysis, while so far the demand side has received more attention.
Background: In most European and North American countries, the burden of malaria has been drastically reduced or completely eradicated through processes of economic development and disease control. In Sub-Saharan Africa, however, decades of development and malaria control have not significantly reduced or eliminated the risk of malaria infections. Purpose: The purpose of this paper is to better understand why increased policy attention and resource mobilisation to malaria control in a local district of northern Ghana is rewarded with limited progress in the reduction of malaria-related morbidity and mortality. Methods: Anthropological research techniques such as focus group discussions (FGDs), unstructured or in-depth interviews, and direct field observations were employed to collect qualitative narrative accounts of community members and development and health workers. Results: Findings show that processes of development are precipitating waves of environmental changes, which then produce benign unintended consequences that negatively affect human health and wellbeing. This finding allows the paper to problematise and victimise development itself by locating it both as a cause of an increasing malaria burden and a barrier to malaria control efforts in Ghana. Conclusion: The paper significantly improves our understanding of the effects of ongoing development processes on the environment and their relationship to the ecology and epidemiology of malaria transmission. Acknowledgement: The author thanks all the anonymous reviewers for their invaluable criticisms and suggestions on an initial draft of this paper. The author also gratefully acknowledges Dr.
Rapid tests for malaria are being distributed through vendors to individual patients, presenting the dilemma of determining how individuals are incentivized to pursue testing for malaria, versus the traditional approach of presumptively treating fevers with antimalarial drugs.
We incorporated testing and treatment data from 6 African countries into a dynamic model of malaria transmission and nonmalarial causes of fever to investigate how variations in the epidemiologic risk of malaria and the prices of rapid diagnostic tests (RDTs) and treatments affect testing and treatment choices from the perspective of febrile patients, public health officials, and drug shop owners. In environments falling below a critical threshold infection rate (entomological inoculation rate) of 282 for patients older than 5 years (95% confidence interval [CI]: 275-289) or 300 for 0- to 5-year-olds (95% CI: 203-307), testing was more beneficial than presumptive therapy in terms of health and financial costs to patients. Infection and cost conditions generally aligned the best patient-level strategy with the best public health strategy to minimize an overall population's morbidity and mortality from both malaria and nonmalarial causes of fever. However, the infection and cost conditions of very high malaria transmission settings did not align patient interests or public health interests with the interests of private drug shop owners. In such settings, a further lowering of testing prices may realign the interests of all 3 parties.
A threshold transmission rate exists under which malaria testing confers more health and financial benefits to patients than presumptive treatment. Studying local transmission rates and testing and treatment costs may facilitate an approach to align the interests of individual patients, public health officials, and distributors of tests and therapies.
In 1947, the Arabian American Oil Company (ARAMCO) began a malaria control program in Saudi Arabia. Historians of development focus on state-led schemes, ignoring corporate policy. The story of ARAMCO's malaria control efforts indicates that corporate objectives significantly influenced American–Saudi relations in the immediate post-World War II era. Regardless of corporate research that interpreted malaria as a symptom of underdevelopment, the company persisted with the most common control measures at the time, assaults on the mosquito. In contrast, Saudi Arabia and the World Health Organization connected the disease to economic stagnation and its control to development.
Malaria is one of the top five causes of death worldwide, and roughly half the world’s population lives at risk of the disease. This health problem disproportionately affects the poor, particularly those in Africa south of the Sahara, where the disease is widespread. Many of those most afflicted are part of farming households; therefore agriculture, poverty, and health are intimately linked through malaria. Uganda has the highest malaria parasite transmission in the world and is an important case study due to the role agricultural development has played in increasing malaria transmission within the country, according to the literature reviewed here.
This review brings together current research from agricultural economics, environmental science, and epidemiology to provide a foundation for research directly addressing how malaria relates these fields to one another in malaria-endemic settings such as the East African highlands. While each field has addressed malaria within existing academic frameworks, this literature review should support further interdisciplinary research by providing a detailed and well-documented account of integrative work on malaria to date.
More than 280 published articles and reports were included in the final review, and many more were included in the selection process. Due to the massive volume of literature published on malaria, the selection has been limited to those articles found to fill particular gaps in interdisciplinary understanding.
Ambiguities on the causal relationships between malaria and poverty, climate change, irrigation, and land use changes are discussed in the light of high local variation in impact on malaria transmission. Integrated pest management is explored due to its utilization of farmers’ vocational skills and success in reversing the pesticide resistance now threatening malaria interventions worldwide. In particular, integrated pest and vector management (IPVM) interventions are assessed as a potential option to reduce the malaria burden in agricultural communities. Farmer field schools and IPVM may provide a cost-effective and integrated solution for improving both health and poverty outcomes. Such programs can foster collaboration between the health and agricultural sectors, and draw on the expertise of each in contributing to rural development in malaria-endemic areas.
Graduation date: 2010 Malaria is the world’s most important parasitic infectious disease, and is a major cause of mortality and morbidity in many developing countries. In this dissertation I study the interaction of malaria and economic development at both the macro- and micro-economic levels. In the first essay I examine the economic impact of malaria on income per capita using cross-country time-series data for 100 malaria prone countries between the years 1985 and 2001. I try to explain the so-called “malaria gap,” which refers a general difference (gap) in parameter estimates found between macro- and micro-economic studies of the impact of malaria on economic well-being. By using more detailed data and controlling for a larger number of economic determinants of malaria than previous macro-economic studies, I am able to resolve most of the “malaria gap” associated with earlier studies in the literature. I show that the impact of malaria on economic well-being is statistically significant but fairly small, which coincides with the findings of certain recent micro-level studies. Policy implications of these empirical findings are discussed. In the second essay I turn my focus to the fact that malaria itself is an endogenous variable over which households and government have some control. I start with simple plots of data that show that malaria has a negative correlation with national income per capita, whether looking across countries at a point in time, or looking at a single country over time. Some countries have moved steadily over time from an equilibrium characterized by low income and high malaria, to a new equilibrium with a relatively high income and low rate of malaria. I develop and estimate a simultaneous equations model to explain these relationships. I distinguish three potential causal chains: the ability for decreases in malaria to increase income, the ability for increases in income to reduce malaria (reverse causality), and external factors that may lead to both higher income and lower malaria (incidental association). I find that changes in income have a much stronger effect on malaria incidence than the other way around. While a 1% rise in the number of malaria cases per million decreases income per capita by less than 0.01%, a 1% rise in income per capita decreases the number of malaria cases per million by more than 1.1%. If income were just 1% higher, 603,189 cases of malaria could be averted annually in the 100 countries of the sample. In the third essay I take a completely different approach in that I use micro-economic household survey data to examine how farming households in poor, malaria-prone areas respond to an outbreak of malaria. I focus on their choice of cropping pattern, since they may shift away from labor-intensive, high-risk yet high-return crops towards those with lower risk and effort yet much lower returns. Households may also move away from formal jobs with long time commitments towards daily labor type activities in which they only work when healthy. These hypotheses are tested using detailed data for 919 households of the Kagera region in Tanzania over the 1991-94 period. To specify an appropriate econometric model, I first develop a theoretical model that captures the micro-economic processes that I highlight above. The econometric results are generally consistent with the ideas in the theoretical model. Outbreaks of malaria and other natural disasters, such as pest attacks and drought, prompt households to move away from chemical-input- and labor-intensive crops (e.g., sugarcane, tobacco, cotton) towards subsistence (e.g., cassava and sweet potato) and tree crops (e.g., coffee and banana). At the same time, they are found to be depending more on casual labor employment and remittance income, while cutting down expenditures on purchased agricultural inputs and net asset creation.
We assess quantitatively the effect of exogenous health improvements on output per capita. Our simulation model allows for a direct effect of health on worker productivity, as well as indirect effects that run through schooling, the size and age-structure of the population, capital accumulation, and crowding of fixed natural resources. The model is parameterized using a combination of microeconomic estimates, data on demographics, disease burdens, and natural resource income in developing countries, and standard components of quantitative macroeconomic theory. We consider both changes in general health, proxied by improvements in life expectancy, and changes in the prevalence of two particular diseases: malaria and tuberculosis. We find that the effects of health improvements on income per capita are substantially lower than those that are often quoted by policy-makers, and may not emerge at all for three decades or more after the initial improvement in health. The results suggest that proponents of efforts to improve health in developing countries should rely on humanitarian rather than economic arguments.
The eradication of endemic malaria in Sardinia is evaluated for its demographic and socioeconomic impact in an examination of the relationship between disease control, population growth, and economic development. Pre‐eradication public health literature had argued that malaria was a sufficient cause of underdevelopment, Unking disease, labor shortages, and agricultural inefficiency in a pattern of involution. In Sardinia, population growth was a desired effect of disease control. A cultural ecological model labeled the “Malaria Blocks Development” hypothesis is used to generate specific questions about the effects of malaria eradication. Demographic analysis reveals that malaria control causes a substantial decrease in overall mortality rates, much greater than the simple elimination of malaria‐specific deaths. The geographical distribution of population growth does not follow the predicted pattern. Historical analysis of economic change in a particular ex‐malarial community and of regional economic data demonstrate that the expected intensification of agriculture fails to occur. Sardinian economic change, described as modernization without development, is best understood in terms of the impact of policies of the European Common Market. It is concluded that political economic shifts are more influential to economic development than health improvements made by disease control programs.This paper explores the relationship between health improvements, economic development, and population growth through a study of the demographic and socioeconomic effects of malaria eradication in Sardinia, Italy. It is an anthropological study of a disease control program as an agent of medical, economic, and demographic change. Historically, international public health programs have often been conceived and financed as a form of international foreign aid.
To determine the health and safety training provided to veterinary students, ascertain their injuries, and evaluate the vaccinations they received we surveyed the 28 veterinary schools in the United States and Canada. Eighteen (64%) of the schools responded. It appears that veterinary schools could better train their students considering the number of injuries and illnesses reported in the previous two years as a direct result of working in the health care setting. For example, 14 schools reported 1-12 bites/maulings, 14 reported 1-5 kicks/gorings, 11 reported 2-27 scratches, and 11 schools reported 1-5 scalpel/knife cuts. In addition, some, students training for food animal practice are poorly prepared to work in confinement housing as only 39% (7/18) of schools train students in how to choose and wear a breathing mask and only 11% (2/18) train students in how to choose and wear ear protection. In contrast, 14 (78%) respondents agreed with the statement that, in general, most of their veterinary students are adequately prepared to work safely. In general, to increase the training and assistance offered to students, schools should: develop a uniform curriculum for occupational health and safety, provide a mechanism for reporting injuries and illnesses, implement policies on (1) vaccinations, (2) physical examinations, (3) restrictions for pregnant students and (4) serum banking, provide training in basic first aid and cardio-pulmonary resuscitation, and information of the risk that pets pose to people with immunocompro-mising disorders.
Household heads were questioned about household income and household expenditures on the treatment or prevention of malaria in a nationwide malaria knowledge, attitudes, and practices (KAP) survey conducted in Malawi in 1992. Very low income households with an average annual income of $68 constituted 52% of the sampled households. The primary income source for these households was farm production (92%), with the majority of goods produced consumed by the household and not available as discretionary income. Expenditure on malaria prevention varied with household income level. Only 4% of very low income households spent resources on malaria preventive measures compared to 16% of other households. In contrast, over 40% of all households, independent of income level, reported expenditures on malaria treatment. Almost half of the reported malaria cases sought treatment at a health facility at a cost of $0.21 per child case and $0.63 per adult case. The overall direct expenditure on treatment of malaria illness in household members was $19.13 per year (28% of annual income) among very low income households and $19.84 per year (2% of annual income) among low to high income households. The indirect cost of malaria, calculated on the basis of days of work lost, was $2.13 per year (3.1% of annual income) among very low income households and $20.61 per year (2.2% of annual income) among low to high income households. Very low income households carried a disproportionate share of the economic burden of malaria, with total direct and indirect cost of malaria among these households consuming 32% of annual household income compared to 4.2% among households in the low to high income categories.
This article explores the control of rural malaria shortly before and after World War II. During this period rural malaria moved from being an almost impossible problem to control to one which many believed could be eradicated. However, instead of rural development serving as an operational and economic framework for malaria control, as some had advocated before the war, malaria control moved toward independence in the form of a global eradication campaign. Whereas this transition is generally portrayed strictly in terms of the success of DDT, I document how various factors, the Cold War in particular, contributed to the "inevitability" of eradication.
Until the late Nineteenth century, endemic malaria was a serious public health problem in Sardinia, as in much of Southern Italy. As the poorest region of the new Italian nation, Sardinia was characterized by poor health, very low population densities, low agricultural productivity, and weak state authority associated with banditry. In this context, however, malaria was singled out as a key underlying problem for the situation of "internal underdevelopment." This paper describes the Italian scholarly literature about the relationship of malaria and economic productivity as a cultural model that can be labeled as "malaria blocks development" (MBD). Anti-malaria programs, including the state control of the distribution of quinine as well as land reclamation projects, played a major role in the decrease of malaria mortality in the first part of this century. Based on the logic of the MBD model, the decrease in malaria was expected to decrease an obstacle to "natural processes" of economic development. During the Fascist era, scientifically based antimalaria efforts formed a key element in centralized attempts for agricultural intensification and encouragement of immigration from over-populated parts of the country. Immediately after W.W.II, Sardinia was the site of a successful American-sponsored eradication project that represented one of the first uses of DDT against an indigenous anopheles vector. Hypotheses based on the MBD model about the nature of economic change after the removal of malaria are not supported. Nevertheless, variations of the MBD cultural model continue to be used in the field of International Health to the present day.
Malaria and poverty are intimately connected. Controlling for factors such as tropical location, colonial history, and geographical isolation, countries with intensive malaria had income levels in 1995 of only 33% that of countries without malaria, whether or not the countries were in Africa. The high levels of malaria in poor countries are not mainly a consequence of poverty. Malaria is geographically specific. The ecological conditions that support the more efficient malaria mosquito vectors primarily determine the distribution and intensity of the disease. Intensive efforts to eliminate malaria in the most severely affected tropical countries have been largely ineffective. Countries that have eliminated malaria in the past half century have all been either subtropical or islands. These countries' economic growth in the 5 years after eliminating malaria has usually been substantially higher than growth in the neighboring countries. Cross-country regressions for the 1965-1990 period confirm the relationship between malaria and economic growth. Taking into account initial poverty, economic policy, tropical location, and life expectancy, among other factors, countries with intensive malaria grew 1.3% less per person per year, and a 10% reduction in malaria was associated with 0.3% higher growth. Controlling for many other tropical diseases does not change the correlation of malaria with economic growth, and these diseases are not themselves significantly negatively correlated with economic growth. A second independent measure of malaria has a slightly higher correlation with economic growth in the 1980-1996 period. We speculate about the mechanisms that could cause malaria to have such a large impact on the economy, such as foreign investment and economic networks within the country.
Where malaria prospers most, human societies have prospered least. The global distribution of per-capita gross domestic product shows a striking correlation between malaria and poverty, and malaria-endemic countries also have lower rates of economic growth. There are multiple channels by which malaria impedes development, including effects on fertility, population growth, saving and investment, worker productivity, absenteeism, premature mortality and medical costs.
This book is the first comprehensive study of malaria in ancient Italy since the research of the distinguished Italian malariologist, Angelo Celli, in the early 20th century. It demonstrates the importance of disease patterns in understanding ancient human demography. It argues that malaria became prevalent in Roman times in central Italy as a result of environmental changes, such as deforestation and the spread of certain types of mosquitoes. Using contemporary sources and comparative material from other periods, it is suggested that malaria had a significant effect on mortality rates in certain regions of Roman Italy. All the important advances made in many relevant fields since Celli’s time are incorporated. These include geomorphological research on the development of the coastal environments of Italy that were notorious for malaria in the past; biomolecular research on the evolution of malaria; ancient biomolecules as a new source of evidence for palaeodisease; the differentiation of mosquito species that permits understanding of the phenomenon of anophelism without malaria; and recent medical research on the interactions between malaria and other diseases. In addition to its medical and demographic effects, the social and economic effects of malaria are also considered, for example on settlement patterns and agricultural systems. The varied human responses to and interpretations of malaria in antiquity, ranging from the attempts at rational understanding made by the Hippocratic authors and Galen to the demons described in the magical papyri, are also examined.
When it was suggested that I speak to this distinguished group, I accepted the assignment with great diffidence. For many years I have had a strong belief in the fruitfulness of cross fertilization between the several fields of learning, and it seemed logical that even so inexact and fumbling a discipline as economics should be able to contribute something of use and value to a group such as this whose concentration has focused upon carrying the findings of medical science to the great task of controlling disease in tropical areas.
My misgivings stemmed from the realization that my knowledge of tropical medicine was so scant that—if I may employ a vulgar phrase that may be meaningful to your craft— if put into one's eye it might or might not be sufficient to induce an acute conjunctivitis.
We exploit the major international health improvements from the 1940s
to estimate the effect of life expectancy on economic performance.
We construct predicted mortality using preintervention mortality
rates from various diseases and dates of global interventions. Predicted
mortality has a large impact on changes in life expectancy starting
in 1940 but no effect before 1940. Using predicted mortality as an
instrument, we find that a 1 percent increase in life expectancy
leads to a 1.7–2 percent increase in population. Life expectancy
has a much smaller effect on total GDP, however. Consequently, there
is no evidence that the large increase in life expectancy raised
income per capita.
We exploit differences in European mortality rates to estimate the effect of institutions on economic performance. Europeans adopted very different colonization policies in different colonies, with different associated institutions. In places where Europeans faced high mortality rates, they could not settle and were more likely to set up extractive institutions. These institutions persisted to the present. Exploiting differences in European mortality rates as an instrument for current institutions, we estimate large effects of institutions on income per capita. Once the effect of institutions is controlled for, countries in Africa or those closer to the equator do not have lower incomes. (JEL O11, P16, P51).
I here present a summary of a detailed report that I made to the California State Board of Health, March 1, 1919, concerning the prevalence of malaria in the Anderson-Cottonwood Irrigation District, situated in Shasta County, Calif. The summary presents data as to the economic loss caused by malaria in this district in 1918. The three items of medicine, medical service and labor loss were carefully determined, and were found to average not less than $31.70 per family: in different sections of the district this varied from $1.86 to $75.10 per family per year.DESCRIPTION OF THE DISTRICT
The Anderson-Cottonwood Irrigation District comprises approximately 32,000 acres of valley and foothill land lying on both sides of the Sacramento River in Shasta and Tehama counties, in the northern part of California. The population of the district is approximately 1,300 persons, of whom approximately 450 live in Anderson town, 200 in Cottonwood
Value is the basic concept in economics. The question arises as to just what are the values of health resort therapy. The definition and treatment of value in the economics of industry and trade differ widely from those in the economics of medicine. In traditional or "classic" economics value is based on "utility," which is defined as follows in an American textbook on economics:1The term utility does not connote any ethical worth. Opium has economic utility as well as bread. Vice has economic utility as well as virtue. The test of economic utility is strictly that somebody wants the good. Whether the want be good or bad, it equally reflects the economic utility of the good. Utility is strictly neutral on the moral aspects of want satisfaction.The medical profession has always had an entirely different idea of value. The Oath of Hipprocrates says:I will follow that
The disability-adjusted life year (DALY) has emerged in the international health policy lexicon as a new measure of the ‘burden of disease’. We argue that the conceptual and technical basis for DALYs is flawed, and its assumptions and value judgements are open to serious question. In particular, the implications of age-weighting and discounting are found to be unacceptable. Moreover, the proponents of DALYs do not distinguish between the exercises of measuring the burden of disease and of allocating resources. But the appropriate information sets for the two exercises are quite different. Allocating resources by aggregate DALY-minimization is shown to be inequitable.
1. Introduction 2. Types of malaria 3. Evolution and prehistory of malaria 4. The ecology of malaria in Italy 5. The demography of malaria 6. The Pontine Marshes 7. Tuscany 8. The city of Rome 9. The Roman Campagna 10. Apulia 11. Geographical contrasts and demographic variation
Abstract It is argued in this article that malaria eradication was only one of a group of factors which were responsible for the lowering of mortality levels in Ceylon in the years after 1946. The magnitude of the contribution made by these other factors has not generally been taken into account since they took effect during the period of malaria eradication, but since some of them were carried out in a few of the endemic malarial areas during the pre-eradication period, some attempt to measure them can be made of their impact on mortality levels. Further the effect of malaria eradication on mortality levels in the absence of these other measures is also studied by examining the case of Guatemala where in spite of malaria eradication the decline in mortality levels has not been so significant as in Ceylon.
Abstract The protracted and inconclusive debate on the cause of the post-war mortality decline in Ceylon reflects our ignorance of this complex historical event and although I am reticent to prolong this already lengthy discussion, I feel that it is necessary to reply to certain points raised by Mr Palloni. The object of my paper 'The Decline of Mortality in Ceylon and the Demographic Effects of Malaria Control'(9) was to re-examine some of the past work on this subject in order to attempt a synthesis of previous theories, was not, however, intended to provide a definitive account of all the causal mechanisms underlying the decline of mortality as it is my view that the data are insufficient for such an undertaking. In the reappraisal I was mainly concerned with the validity of Newman's regression model and, as far as the data would permit, an assessment of Meegama's thesis that there were significant disturbing variables which confounded the simple regression of mortality decline and malaria prevalence. I will try first to respond to Mr Palloni's specific substantive points and then go on to consider the broader question of regression models.
Abstract With his article 'The Decline in Mortality in Ceylon and the Demographic Effects of Malaria Control', R. H. Gray has added a new contribution to the long discussion of the effects of malaria eradication on the abrupt mortality decline experienced by Ceylon immediately after World War II. He has used new information and at the same time introduced slight modifications in the statistical procedures designed to evaluate the validity of the hypothesis. However, certain aspects of his article need to be clarified; they are related to the methodology employed and to the theoretical approach used.
This three-volume set brings together a comprehensive selection of papers on development policy making and economic performance in the five major economies in South Asian countries - India, Pakistan, Bangladesh, Nepal and Sri Lanka - during the second half of the 20th century.
A significant proportion of migration in low-income countries, particularly in rural areas, is composed of moves by women for the purpose of marriage. The authors seek to explain these mobility patterns based on a framework in which the marriage of daughters to locationally distant, dispersed yet kinship-related households is a manifestation of implicit interhousehold contractual arrangements aimed at mitigating income risks and facilitating consumption smoothing in an environment characterized by information costs and spatially covariant risks. Analyses of longitudinal data on consumption patterns, income, and marital arrangements in South Indian households lend support to the theory. Copyright 1989 by University of Chicago Press.
This paper formulates and estimates a finite-horizon, structural dynamic model of agricultural investment behavior that incorporates the major features of low-income agricultural environments: income uncertainty, constraints on borrowing and rental markets, and the use of investment assets to generate income and smooth consumption. The model is fit to longitudinal Indian household data on farm profits, bullock stocks, and pump sets. The estimated structural parameters are used to assess th e effects on the life-cycle accumulation of bullocks, agricultural profits, and welfare associated with complete markets and bullock liquidity and with second-best policies that provide assured sources of income to farmers and weather insurance. Copyright 1993 by University of Chicago Press.
The study estimates an empirical model of return intentions using a dataset compiled from an internet survey of Turkish professionals residing abroad. In the migration literature, wage differentials are often cited as an important factor explaining skilled migration. The findings of our study suggest, however, that non-pecuniary factors, such as the importance of family and social considerations, are also influential in the return or non-return decision of the highly educated. In addition, economic instability in Turkey, prior intensions to stay abroad and work experience in Turkey also increase non-return. Female respondents also appear less likely to return indicating a more selective migration process for females.
Although malaria is the major health problem in Africa, there is little research on its economic impact. This study adapts a framework for assessing the economic costs of illness to available data on malaria. Direct costs of illness are the costs of treatment and control activities, and indirect costs are the value of lost time due to morbidity and premature mortality. Direct costs were estimated by applying the average estimated health systems costs per case to the number of cases. Indirect costs were assessed by multiplying adult output per day times the estimated productive time lost through both adult and childhood cases. As data are not available to assess the economic impact of malaria in Africa as a whole, four case studies were performed on countries or regions for which needed data could be found. The four sites (Rwanda, Solenzo medical district of Burkina Faso, Mayo-Kebbi district, Chad, and Brazzaville, Congo) were chosen to illustrate the diversity in kinds of data which can be used (aggregate national health statistics versus household surveys) and in locations (urban versus rural). Costs were calculated for the recent past and were projected to 1995 based on recent epidemiological trends. Estimates for all sub-Saharan Africa were derived from the averages of these sites. In 1987, a case of malaria cost $9.84 (in 1987 US dollars)--$1.83 in direct costs and $ 8.01 in indirect costs. As the average value of goods and services produced per day in Africa was $0.82, this cost is equivalent to 12 days of output.(ABSTRACT TRUNCATED AT 250 WORDS)
The relationship between disease control, population growth and economic development is examined through a comparison of changes subsequent to malaria eradication campaigns in Sri Lanka and Sardinia. Both islands were similar in terms of malaria morbidity and mortality rates as well as a history of massive malaria eradication campaigns using DDT immediately after the Second World War. The critical comparative distinction is that Sardinia had a much lower population density than Sri Lanka. In both cases, the anticipated effects of malaria control were increased agriculture production in endemic zones coupled with a relief of population pressure in non-malaria areas. This has not happened. Patterns of demographic change, marked by sharp declines in general mortality and accelerated population rates, are similar in both cases. Malaria control has resulted in economic development in neither case, however, and this is explained using ecological and political-economic analyses.
In a study of the impact of malaria prophylaxis upon the physical working capacity of Liberian industrial workers, two groups of men, one with and the other without malaria prophylaxis, were compared over a period of one year. At the beginning and at the end of the study, the haemoglobin concentration, haematocrit, blood volume and physical performance--measured by bicycle ergometry and expressed as work load at heart rate 170--were compared. No significant differences were found, either within or between the two groups. Routinely distributed malaria prophylaxis thus seems to be of little importance with respect to working capacity in this type of community, where malaria is meso-endemic.
The physical working capacity of adult Liberian males, living in areas with different malariometric indices, was studied by bicycle ergometry and placed in relation to total haemoglobin. No major differences were found between farmers living in holo-endemic areas and mining company workers living in meso-endemic areas. This implies that there is no major impact of malaria on physical work capacity in these age groups. Likewise, no difference was found between the Liberian material and Swedish male normals in the relation between physical working capacity and total haemoglobin.
The paper seeks to examine the economic impact of malaria in the Sudan. Using longitudinal empirical data from a farming population in the Gezira, it examines and quantifies labour losses through malaria within families, observing simultaneously the manner in which altruism or "nafeer" helps families and communities insure their members against disease and other consequences of uncertainty.
In 1995 the World Health Assembly voted to launch a global program for the eradication of malaria. The program lasted fourteen years. Though it was successful in a number of countries, eradication failed in most of the developing world. Studies that have examined the failure of malaria eradication have focused on the various technical, organizational, and financial problems which hampered the program. While these critiques are valid, they lose sight of the wider political, economic and cultural context within which eradication was conceived and executed. Malaria eradication was a product of a postwar vision of economic and social development and needs to be examined in this context. Many of the problems that plagued eradication efforts flowed from this intense association between eradication and "development".
Short-run economic consequences of 'malaria' on households were examined in a household survey in Matale, a malaria-endemic district of Sri Lanka. On average a household incurred a total cost of Rs 318 (US$ 7) per patient who fully recovered from 'malaria'. 24% of this was direct cost, 44% indirect cost for the patient and 32% indirect cost for the household. Direct costs were greater for those seeking treatment in the private sector. Notably a large proportion of direct costs was spent on complementary goods such as vitamins and foods considered to be nutritional. Indirect cost was measured and valued on the basis of output/ income losses incurred at the household level rather than using a general indicator such as average wage rate. Loss of output and wages accounted for the highest proportion of the indirect cost of the patients as well as the households. Relative to children, more young adults and middle-aged people had 'malaria' which also caused greater economic loss in these age groups. Women tended to care for patients rather than substitute their labour to cover productive work lost due to illness. We compare the methods used by other researchers for valuing indirect cost, demonstrating the significant impact that methods of measurement and valuation can have on the estimation of indirect cost, and justify the recommendation for methodological research in this area.
Antimalarial chemoprophylaxis during pregnancy significantly increases the birth weight of babies born to primigravidae, but coverage in sub-Saharan Africa is very limited. This analysis assessed whether increasing coverage is justified on cost-effectiveness grounds. A standardized modeling framework was used to estimate ranges for the cost per discounted year of life lost averted by weekly chloroquine chemoprophylaxis and intermittent sulfadoxine-pyrimethamine (SP) treatment for primigravidae in an operational setting with moderate to high malaria transmission. The SP regimen was found to be more cost-effective than the chloroquine regimen, because of both lower costs and higher compliance. Both regimens appear to be a good value for money in comparison with other methods of malaria control and based on rough cost-effectiveness guidelines for low-income countries, even with high levels of drug resistance. However, extending the SP regimen to all gravidae and increasing the number of doses per pregnancy could make the intervention significantly less cost-effective.
This paper is a reappraisal of the decline of mortality in Ceylon with special reference to the effects of malaria control after 1945. Before the Second World War there was an association between the level of mortality and the prevalence of malaria by district in Ceylon. It is shown by the use of a regression model and by geographical analysis that this inter-district differential in mortality can be largely, if not exclusively, ascribed to the inter-district variation in malaria prevalence. Also, the distribution of health services and variations in the levels of nutrition cannot explain mortality differentials in pre-war Ceylon. There was a rapid decline in mortality during the post-war period which was associated with an island-wide malaria control campaign, an extension of the health services, an improvement in nutrition and some economic development. During this period, the previous inter-district differentials in mortality were eliminated and death rates became homogeneous throughout Ceylon. From a regression model correlating the proportional decline in district mortality with the prevalence of malaria, it is estimated that the malaria control programme contributed approximately 23 per cent or 2.3 per thousand to the decline in the national crude death rate, and malaria control was the major factor responsible for the elimination of the pre-war variation in district mortality levels. Similar effects of malaria control on mortality have been observed in a number of countries. By applying a multiple regression model it is shown that changes in the distribution of health services cannot account for the excessive fall in mortality observed in the more malarious districts, and that improvements in the health services, nutrition, and economic development contributed individually indeterminate amounts to the overall mortality decline. The conclusions drawn from the present analysis are critically compared with the results of previous studies on the mortality decline in Ceylon.
Information on the economic burden of malaria in Africa is needed to target interventions efficiently and equitably, and to justify investment in research and control. A standard method of estimation has been to sum the direct costs of expenditure on prevention and treatment, and the indirect costs of productive labour time lost. This paper discusses the many problems in using such data to reflect the burden to society or the potential benefits from control. Studies have generally focussed on febrile illness, overestimating the burden of uncomplicated malaria, but underestimating the costs of severe illness, other debilitating manifestations, and mortality. Many use weak data to calculate indirect costs, which fail to account for seasonal variations, the difference between the average and marginal product of labour, and the ways households and firms 'cope' in response to illness episodes. Perhaps most importantly, the costs of coping mechanisms in response to the risk of disease are excluded, although they may significantly affect productive strategies and economic growth. Future work should be rooted in a sound understanding of the health burden of malaria and the organisation of economic activities, and address the impact on the productive environment, and epidemiological and socio-economic geographical variation.
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