Today More causes of Sub-Saharan Africa & (under)Development Role of disease (again) The role of development aid Role of debt & “Structural Adjustment” Women and development Structure of African economies

Last Time Sub-Saharan Africa & Development The characteristics of the least developed Causes of (under)development Remnants of colonialism SS African environments and human uses Role of conflict Importance of population & demography Agricultural production

The Burden of Disease (again) HIV/AIDS (again) TB (Tuberculosis) G I tract diseases (diarrheas) Malaria Some of the rest Measles African sleeping sickness Yellow Fever Schistosomiasis Onchocerciasis (River blindness)

Reduction in production in a household with an AIDS death, Zimbabwe Crops Reduction in output • Maize Cotton Vegetables Groundnuts Cattle owned 49% 37% 29% 47% 61% • • • • Source: Stover & Bollinger, 1999

TB: re-emerging killer 1.6 million new cases of TB in Africa yearly 600,000 TB deaths occur every year TB is the leading cause of death in people with HIV in Africa Drug resistance increasing WHO estimates that approximately 2 billion people , about 1/3 of the world’s population. Documented history that dates back 3,000 years. Latent in all but about 5 % – 10 % of those infected, as long as immune system is healthy. Active infection damage to organs. Transmitted when exposed to an infected individuals cough or sputum. Immune systems compromised with HIV and poor nutrition. Africa has been hit very hard. Of the 15 countries with the highest TB rates, 13 are in Africa. 2.4 million Africans become infected annually, with 540,000 deaths. Economic toll is huge, with a loss of from 4 % - 7 % of GDP in the hardest hit countries.

HIV/AIDS is Fueling the TB Epidemic HIV/AIDS Prevalence in sub-Saharan Africa Estimated percent of adults living with HIV/AIDS TB High Burden Countries 10% + 3-9% 1-3% TB Incidence 0-99 per 100,000 100-299 per 100,000 > 300 per 100, 000 You can see the geographic overlap with HIV. In those countries most heavily impacted by HIV (left), we see the highest incidence rates of TB. We thought we had TB under control in the 70s, and scientists and public health community, began to concentrate on other issues. Resistance is emerging in many places around the world, DOTS Source: UNAIDS Report, July 2002; WHO Report, 2002, Global TB Control

G. I. Tract Diseases 1.8 billion cases/yr of infant/kid diarrheas, intestinal parasites, cholera, various types of dysentery Most are in SS Africa Infants and kids who are just weaning are especially susceptible due to impure water Many if not most deaths (perhaps 1 million/ yr in the world) can be averted with adequate treatment (Oral Rehydration Therapy) To improve => provide adequate sanitation: in rural Africa only about 20% has access to adequate sanitation

Malaria Also related to water since mosquito vector needs warm stagnant water World wide annual toll More than 1 million deaths 90 % of cases in SS Africa 500 million attacks of acute illness 50,000 cases of neurological damage 400,000 episodes of severe anemia in pregnancy – 400,000 LBW babies Drugs expensive & resistance increasing

Malaria transmission Mosquito life cycle (period 1 – 3 weeks) Gut phase: Female Anopheles mosquito feeds on malarious human Mosquito ingests circulating male and female gametocytes Gametocytes mature and effect fertilization Zygote invades gut wall and forms an oocyte Oocyte grows into a cyst and ruptures Sporozoites released and enter Salivary Glands of the Mosquito Salivary gland phase: Sporozoites travel to salivary glands where they are transmitted to humans Hype-endemic areas: Less than or equal to 50 % of population is parasitemic Transmission is constant or sustained High percentage of population has immunity Immunes have reduced clinical manifestations Mortality seen in Infants and younger children Non-immune adults who travel into the area Non hyper-endemic areas Transmission is intermittent or sporadic, Low percentage of population has immunity, clinical manifestations are not reduced, population suffers repeated epidemics, often seasonal patterns, people of all ages susceptible

The Malaria Challenge Death rates reduced in Asia but rising in Africa World Africa 3.0 Asia China Central & S.America 2.0 Annual Deaths from Malaria (millions) N.America & Europe 1.0 0.1 1900 1930 1950 1970 1990 2000 (R.Carter,1999)

Duration of transmission They are based on the theoretical suitability of local climatic, and therefore the potential duration, onset and end of the malaria transmission season, in the average year. In the Months of Risk model, malaria transmission is strongly seasonal to epidemic (yellow = 1-3 months), seasonal and endemic (light green = 4-6 months) or perennial and endemic (dark green = 7-12 months). Some areas shown as "No transmission" (white) may actually have endemic malaria because of the presence of surface water in an area where there is little or no rain.

Resistance to Chloroquine - 1960 Source: FHI

Resistance to Chloroquine - 2000 This pattern of resistance is troubling and occuring again with new Malaria treatments. Recently, the WHO issued a statement regarding concerns about Artemisinin an important new drug in the fight against Malaria. The new WHO guidelines malaria must be treated with artemisinin combination therapies (ACTs). WHO is concerned about the decreased sensitivity to the drug in SEA, a region that has traditionally been a birthplace for anti malarial resistance. In Thailand, sulfadoxine-pyrimethaninme (SP) was initially considered 100 % effective when it was introduced in in 1977. But within 5 years, it was curing only 10 % of the cases. Source: FHI

Many others African sleeping sickness — transmitted to humans and livestock by the tsetse fly — endemic in much of SS Africa Yellow fever — more epidemic than endemic in most all lowland Africa Schistosomiasis (also called bilharzia) — absent only in highland areas Onchocerciasis (also called river blindness) — common in savanna zones

Onchocerciasis

Aid and underdevelopment Aid applied according to development theories & ideologies current at the time – or for geopolitical goals Often not well enough thought out Much US aid to Egypt, Israel for example Results often aided the Global N or Trans National Corporations NGOs, smaller, may have better record, but still have their own agenda

Debt & underdevelopment Post-independence (1960s-70s) Good prices for primary sector exports Encouraged international investment (debt financed) Investments were often poorly thought out 1980s bust in prices => lower income But debt still needed to be paid By 1980s debt service (interest + capital) = 25% of all governmental income

Debt and underdevelopment II Inefficient and corrupt governments “Structural adjustments” (IMF & World Bank) force governments to reduce spending to pay debts Loss of social security nets Loss of subsidies to agriculture (e.g., for fertilizer) Recently some re-organization and call for debt forgiveness etc.

World Bank & IMF Created after United Nations Monetary and Financial Conference (1944-45) Loans and grants to ~ 184 members, almost the entire UN Focused on Global South Human development Agriculture and rural development Environmental protection Infrastructure & Governance Borrowers must launch reforms

Criticisms of World Bank & IMF A tool of the Global N imposing policies that support Its interests Supports international corporate interests over local ones Neo-liberal economic principles (privatization & markets) Required repayment no matter what (structural adjustment) Governance based on level of financial contribution (from Global N) US 16.4%; Japan 7.9%; Germany 4.5% Major policy shift requires 85% yes; thus, US controls

Women and development Cycle of Overwork – poverty – and demands of child rearing => Elevated infant mortality Elevated maternal mortality Slower fertility decline Close birth spacing => Poor levels of female education

Maternal Mortality Ratio* Western Africa 1,040 Eastern Africa 1,340 North Africa 460 Central Africa 1,020 Southern Africa 360 Sub-Saharan Africa 1,100 South Asia 430 East Asia/Pac. 140 LA & C 190 Developing Countries 440 This map gives an indication of maternal mortality throughout geographical regions in Africa. As you can see, the average MMR in SSA is 2.5 times higher than the average in South Asia, almost 6 times higher than in LAC, and almost 8 times higher than in East Asia/Pacific. Maternal Mortality is unacceptably high in SSA. *Maternal deaths per 100,000 live births Source: Kenneth Hill, Carla Abou Zahr, & Tessa Wardlaw: Estimates of maternal mortality for 1995. Bulletin of the World Health Organization, vol.79, no.3, 182-193.

Ratio of Girl’s to Boy’s Primary Education

Structure of economy & development Narrowly focused economies often have troubles Primary sector (such as agriculture or mining) economies have most problems Recall the least developed countries A risky primary sector economy => little opportunity to create a more diverse economy

Agricultural pastoral economies West Africa: Liberia, Cote d’Ivoire (Ivory Coast) East Africa: Tanzania Central Africa: Congo, Cameroon, C. African Republic Southern Africa: Madagascar, Mozambique, Malawi

Agricultural pastoral economies

African Crop Land Navin Ramankutty, Nicholas J. Olejniczak, and Jonathan A. Foley Center for Sustainability and the Global Environment http://www.sage.wisc.edu

Problems for ag-pastoral economies Commercial/export ag often benefits only a few usually occupies best lands Ag/pastoral sector usually less rapidly growing at risk to environmental fluctuations at risk to land degradation and loss of productive potential Great competition among ag sector primary product exporters tends to lower prices to producers (e.g., many countries world-wide export coffee)

Mostly mineral extraction-based primary/extractive economies West Africa: Nigeria Central Africa: Zaire/Democratic Congo Republic, Gabon Southern Africa: Zambia, Botswana, Namibia, Angola

Mineral extraction-based primary/extractive economies

Problems with mineral-export economies Price fluctuations often extreme Minerals are a “wasting” resource Often mines are foreign owned and controlled Environmental problems in places Corruption seems to accompany mineral wealth

Dual - Sector Economies: agricultural/pastoral and minerals West Africa: Mauritania, Senegal, Guinea, Ghana Southern Africa: Zimbabwe, Swaziland and Lesotho Problems Still primary sector based => low rates of growth and productivity

Dual - Sector Economies

Diverse economies — not just primary sector Kenya Yet Kenya’s GNI/capita still very low South Africa

Diverse economies

Themes for SS Africa Development/Underdevelopment Environmental uncertainty Disease Population growth Food production shortfalls Conflict Debt Structure of economy All work together in geographic complexity!