Archive for the ‘Health’ Category

The demographic landscape in South Asia

19 June, 2012

Recent changes in the demographic landscape of South Asia are producing handsome gains. Fertility and mortality are declining, survival chances are better and there is prolongation of later life. Demographers and public policy analysts attribute this to improved economic performance, the growing outreach of public healthcare services, and reductions in absolute poverty.
Sri Lanka has secured notable achievements, especially in its socio-demographic and health indicators.  Maldives, Nepal, Bhutan and Bangladesh are not far behind. India has reduced its fertility and mortality levels significantly. More than half of its major states have already achieved replacementlevel fertility and it is fast shaping a bulge in favour of working age youths and older adults.
Pakistan is projected to converge soon to joinothers. Afghanistan, unfortunately, remains the exception.
A growing bulge in the region’s younger population has two important economic repercussions.

• A youth bulge leads to a rise in new job seekers. Adopting appropriate economic policies to create more employment
opportunities for them holds the promise of a demographic dividend.
• A growing older population raises issues of income security and health provision.

Much of South Asia has yet to develop policies that explicitly target both these issues. Old age income security still needs to be fully addressed. Employment opportunities, particularly in the organised sector, are also severely lacking.
A South Asia regional conference was organised by the Institute of Economic Growth (Delhi) in 2008, to examine these challenges. It brought together international scholars, including demographers, economists, labour market specialists, poverty analysts and medical doctors. A selection of papers has recently been published in an edited volume,1 highlighting four dimensions of the research and policy challenge:
• Changes in country demographics of the region: opportunities and challenges.
• Bulge of the younger cohorts and meeting employment needs of the growing number of labour market participants.
• Rapid ageing and missing pillars in income and health security provision for the old.
• Achieving population and health MDGs in India and South Asia.

Two clear messages emerge from this research.

Firstly, South Asia is ill-prepared to face the challenges of ageing that will become increasingly visible over the coming years.
Second, the demographic dividend might not be fully realised, due to the failings of South Asian countries in ensuring broad-based opportunities for education, skill formation and decent work.

Read the full article at

Talk the talk – but not walk the walk

1 December, 2008

That’s the way Larry Elliott in The Guardian sums up the donors lack of urgency in meeting the MDGs. Commenting on the just released UNESCO Education for All report, he writes:

“… donor countries can talk the talk but not walk the walk. According to the Unesco study, the aid required for even the most basic primary education provision in poor countries is US$11 bn (£7.2bn) a year. In 2006, spending amounted to around $4bn, leaving a funding gap of $7bn. To put that figure into context, it is around 10% of what Britain spent this autumn recapitalising the banking system”.

Maybe they will walk the walk at the UN Financing for Development summit now underway in Doha. But I wouldn’t hold your breath. “When financial systems fail, the consequences are highly visible and governments act,” concluded UNESCO’s Director-General Koïchiro Matsuura. He added “When education systems fail the consequences are less visible, but no less real”.

I would add that education is the only investment you can be sure of getting at least some return on – provided it’s of good quality and children complete a minimum of 4 years primary education. Well-educated people earn more in the labour market, and find it easier to absorb new technologies and methods when they run micro-enterprises and farms. Education is a means to break the inter-generational transmission of chronic poverty (see this CPRC study for Bangladesh).

And even if it didn’t raise income much – which might be the case in economies that are growing only slowly – it certainly improves health status, especially of children, when mothers are educated. Educated mothers are 50% more likely to immunize their children than mothers with no schooling (go here). Gender inequality in education has high costs for both the family and society (see this IFPRI study).

So the chronic underfunding of education reminds me of that old quotation: if you think education is expensive, try ignorance.

A Fun Way to Harness the Energy of Children to Deliver Clean Water

12 November, 2008

In the discussion of my recent post about bottled water I mentioned that sales of bottled water at Manchester University support water pumps in Africa. Specifically, Playpump, a wonderful invention from South Africa.

As children spin on a roundabout, clean water is pumped from underground into storage tanks. The pumps cost about US$9,500 to install. They are much faster and pump at a more reliable rate than hand-driven pumps, and can supply up to 1,400 litres of water an hour.

Better water infrastructure in Africa not only reduces the incidence of the main water-borne illnesses, but also reduces the amount of time that communities spend collecting water from (often dirty) ponds and rivers. Since water collection is often an activity for girls, requiring them to walk many hours when water is inaccessible, it provides more time for them – including more time in school. More information on Playpump can be found here.

Parks for the Poor

11 November, 2008

Yes, having some greenery around you can improve your chances in life. A new study in the Lancet finds that living near parks or woodland improves life expectancy and health, regardless of income class. People living in poorer areas are more likely to die earlier and to suffer more ill-health than the UK average. This income-related inequality in health is less pronounced in populations with greater exposure to green space, according to the study by Richard Mitchell and Frank Popham from the universities of Glasgow and St Andrews (see this BBC report).

Victorian Britain saw great efforts to bring green space to the poor. The first children’s playground was created in a Manchester park in 1859. Many of Britain’s inner city parks went into decline from the mid-twentieth century, and their regeneration began in earnest in the late 1980s. Manchester’s St Michael’s Flags and Angel Meadow Park is an example. The area became notorious in the 19th century for the mass burial of the poor whose families could not afford a proper funeral.

The charity GreenSpace is now working to improve parks and green access in the UK. We also need more efforts in the mega cities of the developing world. On a recent trip to Dhaka I was struck by the lack of accessible greenery. Much appears to have been illegally built over – including one green space now occupied by a truly hideous ‘pleasure park’ which charges for admission.

Green space is also exceptionally important to managing the impact of climate change on urban areas, a theme in Manchester University’s research on sustainable cities (check out John Handley in the School of Environment and Development). So get planting.

Bottled Water. To Buy or Not to Buy?

9 November, 2008

Too few people across the developing world have access to safe water. Too often they end up walking miles to unsafe water sources or, if they live in urban areas, purchasing water from expensive private sources. Safe water and sanitation are one of the main mechanisms to cut infant mortality from water borne diseases. Big donor and government investments are now underway (see the Asian Development Bank for instance).

Actress Thandie Newton explains in today’s FT why she is an ambassador of Volvic and World Vision’s campaign, in which Volvic supplies 10 litres of water in Africa for every litre of water bought in the UK (go here and to World Vision).

Frankly, I try to avoid bottled water whenever I can – costly and environmentally unfriendly. But if I have to buy – and have you tried to get water in an airport recently? what happened to the water fountains? – then Thandie’s rationale might persuade me to choose Volvic. She says:

“I wanted to see if my cynical attitude could be changed and World Vision did change it. Bottled water isn’t going to go away and so I’d rather there was a brand that donates large sums of money to genuinely valuable causes, and which creates philanthropic competition between brands. I’m not a blinkered purist. I know that by infiltrating these large corporations, I’m in a much better position to suggest changes. Right now, for example, I’m encouraging Volvic to switch to biodegradable containers”.

Fair point. In the meantime, can I have a glass of (tap) water please?

The Habitual Food of the Working Man Varies According to his Wages

1 October, 2008

So wrote Friedrich Engels in The Condition of the Working Class in England based on his investigations into poverty in Manchester. The link between poverty and bad nutrition still resonates in Britain as Jamie Oliver’s new TV series Jamie’s Ministry of Food shows. Writing in today’s Guardian, Felicity Lawrence cites work by Tim Lobstein of the International Association for the Study of Obesity who has calculated the cost of 100 calories of food energy from different types of food.

“The cheapest way to get your 100 calories is to buy fats, processed starches and sugars. A hundred calories of broccoli costs 51p, but 100 calories of frozen chips only cost 2p. Good-quality sausages that are high in meat but low in fat cost 22p per 100 calories, but “value” fatty ones are only 4p per 100 calories. Poor quality-fish fingers are 12p per 100 calories compared with 29p for ones made with fish fillet that are higher in nutrients. Fresh orange juice costs 38p per 100 calories, while the same dose of energy from sugary orange squash costs 5p”.

The result? Rising obesity, and the associated diseases, among Britain’s poor. This is one reason why life expectancy can differ so radically within just a short distance in Britain, as you go between low-income and higher income areas: by as much as 28 years – yes 28 years – according to WHO.

One of the areas investigated by Engels was ‘Little Ireland‘, populated by those who escaped the Irish famine of the 1840s. The area that was Little Ireland is close to the University of Manchester and Manchester Metropolitan University.

Carbon Taxes Will Need to be Higher to Pay for Development

25 September, 2008

Jeff Sachs and Bono are blogging on the FT web site during this week’s MDG summit in New York (go here). Today, Jeff reports that some bold and creative proposals are coming from the EU, Mexico and Norway, among others. Carbon taxation is to the fore, in particular.

“According to the Swiss Government’s proposal, a $2 per ton levy on carbon dioxide would raise around $48bn per year, money that could play a critical role in helping impoverished countries to meet the Millennium Development Goals and to adapt to climate change. I believe that we’ll be hearing a lot more about carbon levies in the months ahead, as a practical approach to climate change control and development finance”.

Back in 2003, we took a thorough look at innovative sources of finance in a UNU-WIDER project led by Tony Atkinson of Nuffied College, Oxford (go here). The study concluded that many of the proposals were feasible, including carbon taxes. I chipped in with a proposal for a global premium bond to fund chronic poverty reduction – based on the successful UK premium bond scheme (Addison and Chowdhury paper here).

Amongst all the innovative finance proposals, carbon taxes get the most support among economists (more than the popular Tobin  tax: although that may be boosted by the present financial malaise). They not only reduce carbon emissions (a global bad) but also, as Jeff Sachs says, they generate a flow of revenues to finance a step-up in official development assistance (both multilateral and bilateral) as well as global funds to deal with the urgent challenges of climate change, conflict, and HIV/AIDs (to name but three).

All of these problems just get worse without early action: notably climate change, since a stock of carbon is already in the atmosphere, warming the earth — which we will have to adapt to — even as we attempt to reduce the flow of carbon from new emissions. But this is true of conflict and viruses too: war generates more war (notably in the Congo where violence is still endemic after the supposed ‘peace deal’) and viruses mutate to become deadlier (notably unchecked TB).

Given the high returns to taking action now on these global bads, it would be worth accepting a much higher levy on carbon than the Swiss proposal. This would send a clear signal to the market, encouraging a faster rate of invention and adoption of clean technologies. And the additional funds could be spent on peace-keeping and more research for the diseases of the poor world.

But I worry that the US is way behind Europe in all of this, California perhaps excepted. Dealing with the present financial crisis is vital, but it is also a huge distraction from the larger issues such as climate change. And the present administration has been adamant in its opposition to global taxes. Does anybody detect much of a shift in the US position, the occasional piece of rhetoric aside?

The author is executive director of the Brooks World Poverty Institute, University of Manchester.

Making New Medicines Accessible to All

29 August, 2008

The diseases of the poor constitute an immense amount of human suffering (see our recent post on George Bush meets the Guinea worm). And they are an immense economic burden as well — both for the poor and for poor economies (which will grow faster with a healthier workforce).

Privately funded pharmaceutical research responds to incentives: and the diseases of the wealthy world supply the biggest bucks. Not enough R&D is put into the diseases of poverty. So it is to the wealthy world that the drugs are supplied. Market failure has a deadly effect. Ill-health drives people into chronic poverty and traps them there — too often until a premature and painful death.

So we are impressed by the hard thinking that has gone into The Health Impact Fund: Making New Medicines Accessible to All a new report from Incentives for Global Health. Go here to download the entire report or listen to one of the report’s lead authors, philosopher Thomas Pogge, talk about the proposal at Public Ethics Radio.

So, what’s the new idea? In brief, the proposed Health Impact Fund (HIF) seeks to correct market failure by rewarding any new medicine, if priced at cost, on the basis of its impact on global health. Any pharmaceutical company can opt to register its product with the HIF. The firm must then sell its drug at an administered price near the average cost of its production and distribution. This price applies worldwide. What does the company get compared with exercising its usual patent rights and selling at a higher price? It gets a stream of payments from the HIF based on the assessed global health impact of its drug.

Lead author, University of Calgary economist Aidan Hollis says:

“We’re not asking for corporations to give their products away … If it is used correctly, the fund would reward those drugs that have the most impact on the world and companies should earn the same amount of money as they would if they didn’t take part.”

The advantage of the scheme is that it uses the market to work for poor people and those who help them — the drugs get developed and distributed at a low cost.

The report certainly resonates with us at Manchester. Last month Manchester’s new Institute for Science, Ethics and Innovation (iSEI) together with BWPI brought together BWPI’s chair, Joe Stiglitz, and iSEI’s chair, John Sulston to debate ‘Who Owns Science?’. You can download the interview with the two Nobel Laureates on the BBC Today programme here. And don’t forget to take a look at Incentives for Global Health.

What next for George Bush? De-worming, that’s the future!

29 August, 2008

George Bush is no doubt contemplating what to do in his well-deserved retirement. He might clear some more brush on his family ranch in Texas — an occupation which he is fanatical about apparently (at least according to Laura Bush and Jay Leno). And no doubt the presidential memoirs will need some hard work.

But he might want to take a leaf out of Jimmy Carter’s book, and get to grips with the Guinea worm, a nasty piece of nature’s work (pictures here). The thin white parasitic worm bores holes through you, before emerging — very painfully — to go on to infect others.  It is a major blight on the lives of poor people in West Africa. The disability caused by the disease is seasonal, often returning around harvest time, making it the “the disease of the empty granary.” Ex-President Carter, now in his 84th year, has been working to eradicate the Guinea worm for over two decades (see FT story).

Reducing the impact of the Guinea worm is one of development’s success stories (George: read this, it’s quite short). There were 50 million cases in the 1950s according to WHO. In 1986 some 3.5 million in 20 countries were still infected. That’s down to fewer than 13,000 today in the remaining five countries where the disease is still prevalent: Sudan (where Carter convinced belligerents to agree to a six-month “Guinea worm ceasefire” in 1995 to get eradication started) as well as Ghana, Mali, Nigeria and Niger.

So, George, it could be so much more interesting than clearing brush wood. Or editing those memoirs.

The Places We Live

5 August, 2008

More people now live in towns than in the countryside. And up to one-third of the world’s urban population is poor. That’s more than one billion people — and growing. Lacking adequate services and with poor health standards, the slums are home to many of the world’s chronically poor people. Often close to the water line (as in Dhaka) or on hillsides (as in Caracas), slums are vulnerable to natural disasters of all kinds.

The Nobel Peace Centre in Oslo is now running an exhibition by Magnum photographer Jonas Bendiksen.  “The Places We Live” presents 16 homes in four different slum areas: Kibera (Nairobi); Dharavi (Mumbai); Barrios (Caracas); and Kampongs (Jakarta). Nairobi’s Kibera is home to at least one million people, while Dharavi is close to Mumbai’s booming financial centre — a gross example of the rising inequality that takes the shine off India’s “economic miracle”.


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