Poverty Trap Formed by the Ecology of Infectious Disease Matthew H. Bonds, Pejman Rohani, Donald Keenan, Jeffrey Sachs The François-Xavier Bagnoud Center for Health and Human Rights Harvard School of Public Health Partners in Health Under revision, Proc. Roy. Soc. B

Three Paradigms of Global Health 1.Health as a human right 2.Public health as a public good 3.Public health as economic development

Three Paradigms of Global Health 1.Health as a human right 2.Public health as a public good 3.Public health as economic development

Per capita Income Public Health as Economic Development

Per capita Income Malaria Public Health as Economic Development

HIV Per capita Income Public Health as Economic Development

Hookworm Per capita Income Public Health as Economic Development

Explaining the Global Distribution of Wealth and Poverty Public Health as Economic Development

Per Capita Income Across Temperature GEOGRAPHY MATTERS Public Health as Economic Development Income

Per Capita Income Across Latitudes GEOGRAPHY MATTERS Public Health as Economic Development Income

Infectious Disease Burden Across Temperature Burden of Infectious Diseases Public Health as Economic Development GEOGRAPHY MATTERS Burden of Infectious Diseases

Infectious Disease Burden Across Latitude Burden of Infectious Diseases Public Health as Economic Development GEOGRAPHY MATTERS

1.Income determines health - Nutrition - Sanitation and Waste Management - Access to Clean Water - Prevention, such as mosquito nets 2. Health determines income - Labor Productivity - School Attendance Rates - Longevity, Savings, and Investments - Fertility, household size Theory of a Disease-Driven Poverty Trap Public Health as Economic Development From Economics Literature (Sachs, 2001, 2005, Bloom and Canning, 2005):

Explaining the Global Distribution of Wealth and Poverty Poverty Trap Public Health as Economic Development

Theory of a Disease-Driven Poverty Trap S I transmission natural death recovery disease- induced death     birth  Public Health as Economic Development

Theory of a Disease-Driven Poverty Trap S I transmission natural death recovery disease- induced death     birth  income Public Health as Economic Development

1. Economics Determines Distribution of Diseases Theory of a Disease-Driven Poverty Trap Public Health as Economic Development

2. Diseases Determine Distribution of Income Theory of a Disease-Driven Poverty Trap Public Health as Economic Development Time spent healthy (i.e., uninfected)

Theory of a Disease-Driven Poverty Trap Public Health as Economic Development

Theory of a Disease-Driven Poverty Trap Public Health as Economic Development

Theory of a Disease-Driven Poverty Trap Public Health as Economic Development

Theory of a Disease-Driven Poverty Trap Public Health as Economic Development

Theory of a Disease-Driven Poverty Trap Public Health as Economic Development

Theory of a Disease-Driven Poverty Trap Public Health as Economic Development

Theory of a Disease-Driven Poverty Trap Public Health as Economic Development

Theory of a Disease-Driven Poverty Trap Public Health as Economic Development

Poverty Trap Economic Growth Theory of a Disease-Driven Poverty Trap Public Health as Economic Development Longterm impacts require substantial sustained interventions

Theory of a Disease-Driven Poverty Trap Public Health as Economic Development

Theory of a Disease-Driven Poverty Trap Public Health as Economic Development Sensitivity Analysis

Poverty Trap Economic Growth Theory of a Disease-Driven Poverty Trap Public Health as Economic Development

Theory of a Disease-Driven Poverty Trap Public Health as Economic Development Accordingly we can estimate the following linear equations for rich and poor countries: Disease Burden = f(Income, Temp, Rain, Disease Burden of Neighbors) Income = f(Disease Burden, Temp, Rain, Nat Res, Landlocked, ELF) Estimates for Rich Countries Estimates for Poor Countries Impact of Disease on Income -.43***-.51*** Income of Income on Disease -.91*-.57**

Public Health as Economic Development Theory of a Disease-Driven Poverty Trap

Public Health as Economic Development Summary The infectious disease burden is determined simultaneously by ecological and socioeconoimic processes Nonlinear feedbacks between income and disease have the potential to form poverty traps where initial epidemiological and economic conditions can have impacts on long-term health and development of the society