16 Health & Development, Africa Determinants of Health in Poor Countries SUMMARY PREVIOUS CLASS? Health in Poor Countries Global health? Relationship to inequality? Role of health care? Government subsidies for health care Development process Good examples in the past Africa? Deaton 2003 Learning Objectives Contrast the colonial history of African countries with the current situation Present the health situation in Ghana today compared to a rich African country such as Botswana Explain the impact of structural adjustment policies and political instability on health and development of Nigerians Curse of resources AGENDA Current Health Status: History of Africa Colonial exploitation of continent impact of recaptured slaves manipulation of social structure for colonial economy by institutionalizing two homes for husbands Emancipation after WWII into nation states with growth of socialist governments in 1960s Structural adjustment policies beginning 1980s US agricultural policies (rice, wheat, cotton) HIV epidemic (modern day Tuskeege) Responses needed Curse of resources Making Transition Work for Everyone: Poverty and Inequality in Europe and Central Asia, World Bank 2001 http://ucatlas.ucsc.edu/ http://ucatlas.ucsc.edu/ http://ucatlas.ucsc.edu/ CIESIN 2005 CIESIN 2005 Declining life expectancy Changes in life expectancy in selected African countries (high and low HIV prevalence: 1950-2005) Source: UNAIDS, 2002. Report on the global HIV/AIDS epidemic Jamison et. al 2006 NI 0401-2 Marmot, Lancet 05 African Political History Birth of our species? Egyptian civilization, overcome by Romans Cattle-centered societies, tribes, evidence of empires in Sudanic belt Empires: British Commonwealth (sun never sets) -Spain and Portugal, other European (How Europe Underdeveloped Africa Ray Rodney) carved up continent with no respect for ethnic groups, tribes -manipulation of African social structure to suit colonial enterprise by setting up two homes for men with two wives, one in white controlled urban industrialized areas and other in traditional rural setting African Political History Colonial manipulation African social culture re-engineered for labor retention Extracting wealth: gold, diamonds, skins, forest products Slave trade: begun by Portuguese from 1450 Recaptured slaves in 1800s sent to schools in Europe to be educated and returned to do colonial master's bidding (Black Man's Burden Basil Davidson) African nationalist movements began in 1800s Maintaining Disparity State Department Policy Planning Study # 23, 1948, George Kennan ?The US has about 50% of the world?s wealth but only 6.3% of its population. This situation cannot fail to be the object of envy and resentment. Our real task in the coming period is to devise a pattern of relationships which will permit us to maintain this position of disparity without positive detriment to our national security.? ?a political and economic climate conducive to private investment with adequate repatriation of profits? African Political History Emancipation of Africa -WWII aftermath, USSR gained prestige -UK and French liberals sympathetic to African nationalist claims -cold war led to colonial resurgence, USSR had strong presence in many African countries (Patrice Le Mumba University in Moscow) -nationalist movements in Ghana, Ivory Coast Eventually colonialists were forced to give independence, except in S. Africa, led to euphoria African Political History 1960s many countries had socialist governments and sided ideologically with USSR which threatened US and other powers, led to economic ways of empire 1980s structural adjustment programs (SAP's) Social engineering created tissue culture for HIV Health in Africa declined Present Condition of Africa But the actual and present condition of Africa is one of deep trouble, sometimes a deeper trouble than the worst imposed during the colonial years. For some time now, deserts have widened year by year. Broad savannahs and their communities have lost all means of existence, or else are sorely threatened. Tropical forests such as the world will never see again have fed the export maw. Cities that barely deserve the name have spawned plagues of poverty on a scale never known in earlier times, or even dreamed of. Harsh governments of dictatorships rule over peoples who distrust them to the point of hatred, and usually for good and sufficient reason; and all too often one dismal tyranny gives way to a worse one. Despair rots civil society, the state becomes an enemy, bandits flourish. Meanwhile the "developed" world, the industrialized world, has continued to take its cut of Africa's dwindling wealth. Transfers of this wealth to the "developed" countries of Europe and America have annually expanded in value: in 1988, for example, to what was then a record figure, an immense figure, paid out to "developed" creditors. And multitudes starved. Black Man's Burden Basil Davidson 1992 Third world debt: Much of it was/is to private banks, taken on by leaders who used the money in various ways Many private banks were concerned about defaults on these huge loans One way to shift the risk was for IMF and WB to make loans to countries at very low interest rates for discretionary purposes, so the private banks would not have to incur the risk as their loans were paid back Conditions attached to SAP loans would benefit foreign investors and encourage poor country governments to avoid social spending which is anathema to the Washington Consensus ENTIRELY A VIOLATION OF MARKET MECHANISMS STRUCTURAL ADJUSTMENT Since 1983 Promotion of exports Devaluation Trade liberalization-Imports flooding market Increased investment in infrastructure Removable of government subsidies Increased taxation Downsizing of civil service -- Lay offs Privatization Effect of SAP Massive lay offs of workers Marginalization of domestic agriculture and local manufacturing industries Decrease in overall poverty in some cities, but with widening poverty gap between rural and urban and within urban North-South RELATIONSHIPS Dimension North/Upper South/Lower Spatial Urban/Industrial Rural Agricult. Internat. /Dev. IMF/WB Donors/Creditors Poor Recipients/Debtors Ascriptive Male/White Female/Black Life Cycle Parent Child Bureaucracy/Org. Manager/Official Worker Social Patron Client Learning Teacher Student Development Capital Flows 927 billion official bilateral and multilateral aid, grants by private charities, trade credits plus direct private investment and bank loans OECD data, $1345 billion (interest and principal) to the creditor countries does not include other South-to-North outflows such as royalties, dividends, repatriated profits, underpaid raw materials etc. New York Times April 30, 1995 New York Times April 30, 1995 NYT 071107 NYT Oct 12, 2005 NYT Oct 12, 2005 US Generosity to other nations NYT 050417 Clinton asked why Washington seemed so impervious to demands to increase aid. ''Because nobody will ever get beat for Congress or president for not doing it'' President Bill Clinton Total 8.7 million WIDER World Wealth 2006 Total 8.7 million WIDER World Wealth 2006 Resource Depletion reduces economic growth Highly oil dependent countries increased under 5 mortality authoritarian likely civil war high military spending Highly mineral- dependent countries increased under 5 mortality population in poverty low life expectancy high income inequality authoritarian likely civil war high military spending Ross: Extractive Industries And the poor, Oxfam 2001 Curse of Resources Rich countries plundered poor ones (British in India) TODAY: Civil wars Africa is rich in resources: minerals oil timber gold Curse of Resources When God created the world, He endowed Sierra Leone with such a wonderful wealth of natural resources that the angels protested. ?Don?t worry,? God replied. ?Just wait until you see the people I?ve put there.? "Root of conflict is diamonds, diamonds and diamonds" (UN ambassador 2000) "$11.5 trillion of assets held offshore is serious money and sum increasing at a rising rate" "Latin America ~300,000 people hold about $3.7 trillion personal assets, half offshore" Race to the bottom in tax rates to attract corporations Jersey reduced rate on all businesses to 0% to compete with other havens offering same rate Secret World of Offshore Banking John Christensen Five trillion dollars ("conservative estimate") corruptly removed from world's poorest countries -lodged permanently in world's richest countries. -by American businessman enthusiast for capitalism -in study of how multinational corporations, wealthy individuals and unscrupulous governments using world's banking systems in ways that spread poverty. Deaths (Millions) Tuskegee Syphilis Study 1932-1972 (press leak) SOUTH AFRICA Blacks believed they had the right to reclaim and distribute their oppressor's ill-gotten gains, key strategy ANC, and spelled out in Freedom Charter beginning in 1955 South African gov't banned ANC and other parties, but charter circulated Charter: right to work, decent housing, thought and share in wealth of richest country in Africa (diamonds, gold) ANC's Freedom Charter "The national wealth of our country, the heritage of South African's, shall be restored to the people; the mineral wealth beneath the soil, the Banks and monopoly industry shall be transferred to the ownership of the people as a whole; all other industry and trade shall be controlled to assist the well-being of the people." SOUTH AFRICA Nelson Mandela 1990 in prison "The nationalization of the mines, banks and monopoly industries is the policy of the ANC and the change or modification of our views in this regard is inconceivable. Black economic empowerment is a goal we fully support and encourage, but in our situation, state control of certain sectors in the economy is unavoidable." SOUTH AFRICA 1994 Opportunity to reject free-market ideology Mandela then a living saint ANC did adopt neoliberal ideology and inequality exploded, so most unequal country on the planet today, surpassing Brazil SOUTH AFRICA 1994 Negotiations between F. W. de Klerk and Mandela who had millions behind him Whites worked to safeguard their wealth White negotiated trade agreements to hand power to IMF, World Bank and National Park, and ANC leaders were duped "we were caught completely off guard" Ended up with a Reserve Bank & treasury run separately (by old apartheid bosses) from the gov't, which could restrict policies of ANC ANC outmaneuvered in rules and regulations SOUTH AFRICA 1994 Land reform became impossible Joined GATT which restricted subsidizing factories, so job creation not possible Money tied up in servicing massive debt Can't impose currency controls (to avoid capital flight) because of an IMF deal that was signed "We'll keep everything and you [ANC] will rule in name?. Have political power and fašade of governing but real governance will take place somewhere else" SOUTH AFRICA after 1994 Tried to make good on redistribution Increasing debt and pressure to privatize so gov't had to raise prices FOUR white-owned megaconglomerates controlled 80% of Johannesburg Stock Exchange Life expectancy dropped 10+ years ANC leadership accepted the new economic order Globalization: mobility of capital and markets give countries few options today Mandela in 1994 "In our economic policies ? there is not a single reference to things like nationalization and this is not accidental?.. There is not a single slogan that will connect us with any Marxist ideology" "Mr. Mandela has in recent days sounded more like Margaret Thatcher than the socialist revolutionary he was once thought to be." Wall Street Journal Oct 6, 1994 SOUTH AFRICA RESULTS Since 1994 number of people living on less than $1 a day has doubled, from 2 million to 4 million in 2006 Between 1991 and 2002, the unemployment rate for black South Africans more than doubled, from 23 percent to 48 percent. Of South Africa's 35 million black citizens, only five thousand earn more than $60,000 a year. The number of whites in that income bracket is twenty times higher, and many earn far more than that amount. The ANC government has built 1.8 million homes, but 2 million people have lost their homes. 1 million people have been evicted from farms Shack dwellers has grown by 50 percent. In 2006, more than one in four South Africans lived in shacks located in informal shantytowns,without water or electricity http://www.ukzn.ac.za/CCS/files/Shock%20Doctrine%20ch%2010%20pt.pdf NIGERIA 1985 - 2000 1985 1990 1999 GNP per capita US$510 US$325 US$310 Exchange rate ? Naira to dollar N1 N1 N120 Total external debt/GDP - 126.3 83.8 Population of the poor 36.1 million 34.7 million 55.8 million % contribution of oil to national income earnings 77.8% Imports of goods and services (% of GDP) 25.2 38.1 42.3 Nigeria compared to other OPEC countries source: Human Development Report, 1997 OPEC countries Human Poverty index(%) Survival deprivation (%) Deprivation in adult literacy (%) No access to safe water (%) No access to health care (%) (%) under weight children under 5 years Indonesia 20.8 14.8 16.8 38.0 7.0 35 Mexico 10.9 8.3 10.8 17.0 7.0 14 Iran 22.6 11.7 31.4 10.0 12.0 16 Nigeria 41.6 33.8 44.4 49.0 49.0 36.0 Nigeria CORRUPTION Corruption perception index (TI) Denmark-10.0 Finland 9.6 Sweden 9.5 New Zealand 9.4. USA 7.5 Nigeria ranked- at 1.9 2001 Nigeria- ranked 2nd most corrupt Nigeria DEBT TRAP $27-32 billion 75% GDP 186% export earnings Trap by 2020 ? paid $5 for $1 borrowed and owe $27 Billion?. 4 Nigeria: Debt Trap Loans of dubious value Low impact, high cost projects Oil doom attrition of agric sector import dependence. Dividends of Democracy Nigeria national anthems 1960 people oriented 1978 focused on structure 62 45 43 31 17 Nigeria's Resource Curse Chevron Shell responses Media as Business Product Buyer Seller Print Times, PI The Stranger Television XBC, CNN Cable Radio commercial PBS Internet
Want to see the other 69 page(s) in Hserv482-15-Africa.ppt?JOIN TODAY FOR FREE!