About Charles Kenny

I'm a development economist working in Washington DC.

Better Socrates Satisfied?

As Andrew Sullivan has chronicled, it has been a couple of exciting weeks for those who hope technology will unleash a wave of democratization.  Texts, tweets and technorati have surely played a role.  At the same time, Marx predicted the railroad would lead to the dictatorship of the proletariat, and we all know how that ended.

Another factor that has clearly influenced events is the spread of education –in particular the number of college students.  This recent paper suggests that educated people (Socrates aside) are far more likely to support democracy.  But again, that may not be the full story.  This paper suggests that there is no link between growing education rates and transition to democracy.  Given the rapid global advance in school enrollments, alongside growth in access to communications technologies, that suggests we may see more and more dissatisfied democrats living in authoritarian regimes.  And falling sales of hemlock.

AIG: The Fifth Horseman?

The recent global financial crisis has added 100 million more to the ranks of the world’s undernourished, according to the FAO.  Doubtless Paul Ehrlich is saying “I told you so.”  But it may be a little soon to dust off your copy of Malthus.  The trend remains towards the tubby.  There are as many people overweight as malnourished (around one billion) and 300 million of them classify as obese.  Many of those overweight live in the same household as an undernourished child.  Within such homes as on a global scale, the problem is one of distribution, not absolute shortages. 

Furthermore, the good Reverend Malthus’ model just doesn’t fit the facts.  No country worldwide exhibits the characteristics that Malthus suggested –stagnant output, rising populations leading to income decline and rising income fostering population growth.   Only one country in the World has seen domestic product grow more slowly than 0.5 percent a year since the 1960s.  Fertility rates are declining and health is improving almost everywhere.   And populations have expanded in counties slow and fast-growing alike.  The global spread of a range of technologies and innovations, fostered by an unprecedented rollout of education, has broken the link between land area and limits to output as much as it has improved the quality of life worldwide.

And in rich countries, a little bit of recession can actually be good for the health, as people eat better and substitute cheap entertainments like a walk in the park for expensive entertainments like drag racing.  Maybe Bernie Madoff is just a misunderstood miracle worker.

Life is Cheap

The WHO has declared swine flu a pandemic and the US is considering a vaccination program involving 600 million doses. 

So far, the CDC estimates that there have been a million infections and 127 deaths in the US.  That’s a pretty low death rate, of around one per ten thousand.  The US rate for measles in the 1970s was almost ten times as high.  In turn, that suggests a comparatively low benefit-cost ratio compared to other vaccine programs.

The good news is that even more expensive vaccine programs are amongst the most cost effective health interventions.  The flu vaccine only costs between $5-9 a dose, for example.  And they are comparatively easy to roll out.  Not least, thanks to vaccinations sold at a dollar a pop, almost no one gets measles in the US any more.  In the first half of this year, there were only 25 cases in the whole country. 

The even better news is that, thanks to expanded vaccination coverage, dramatically fewer people die of measles the world over.  Measles deaths in Africa fell by 91% between 2000 and 2006 alone, from an estimated 396,000 to 36,000.  Keep on going at this rate, and measles might be the next smallpox. 

Other simple health solutions that have saved millions include hand-washing and antibiotics.  Their spread lies behind a dramatic global convergence in health outcomes discussed in this book I’m plugging.  And there’s still scope for cheap solutions to make a big difference to global health outcomes.  One third of the remaining ten million child deaths each year could be prevented if parents worldwide breast fed, used sugar-salt solutions to treat cases of diarrhea and put their children to sleep under insecticide-treated bed nets.  Breast feeding is free, sugar-salt packages cost pennies, and bednets perhaps $5. 

The big problem now is to create demand –informed parents who understand what to do when their child has diarrhea, for example.  In the Indian state of West Bengal, fifty percent of parents think you should give a child less to drink –absolutely the wrong thing to do.  Child mortality in the state is three times higher than in the state of Kerala, where only five percent of parents suggest that response.   And not all parents understand the importance of a vaccination program, especially when their state governors are telling them it is part of a plot to sterilize their children, as it might be –this particular piece of insanity helped delay the global eradication of polio. 

Of course, as the recent flap over MMR in the UK demonstrates, the demand side isn’t just a Third World problem.  Let’s hope we don’t face the same issues with swine flu vaccination.

Africa (and Aid): Not Dead Yet

Dambisa Moyo  is one of Time’s 100 most influential people alongside the women of The View and ahead of Vladimir Putin (influential last year.  This year, meh).  She continues to attract attention and stir acrimonious debate.  But one thing her critics and supporters agree about is that Africa is in a mess.   

I’ve just finished a book (free online, for a bit) that paints a more positive picture.  It is true that the region’s performance in terms of GDP per capita has been pretty dismal –many countries are as poor as economies in Medieval Europe.  But that’s a pretty narrow measure of success or failure.  If you look at measures of health, or education, or civil and political rights, Africa has seen real progress.  Even as parts of the continent are mired in civil war and famine, the average African born today is far more likely to survive childhood, to go to school and to have some modicum of civil and political rights than their parents or grandparents.  Progress in the quality of life has continued at a historically unprecedented pace in large parts of the continent. 

The book discusses how economic stagnation and broader development have coexisted even over the long term –a subject for a later post.  Regardless, these measures of broader success suggest that it is premature to write off the region as a failure –and perhaps even to declare the death of aid.

Health Care Reform: A Bull in China’s Apothecary Shop?

As the healthcare debate continues raging in the US, universally covered Europeans look on smugly from the sidelines.  (Well, not all Europeans.    Tim Worstall argues that high US health spending is the successful application of the will of the market.) 

Meanwhile, President Obama has been telling his staff to read Atul Gawande on the weak relationship between spending and the quality of health provision across the US.  Gawande argues that high costs are driven by unnecessary treatment rather than better care. 

There’s a similar story to tell across the Pacific.  In the 1970s, China had a cooperative medical system that provided coverage to 90 percent of the rural population.  A series of reforms since then have introduced fee for service and health insurance schemes.  These reforms have increased costs, but it is hard to see much impact on improved levels of health.  Per capita health spending increased seven-fold in rural areas over the period 1990-2002, but rates of progress in health outcomes have dramatically slowed. 

That’s in part because the quality of care provided can be pretty grim, not least because of the incentives of the fee for service model.  Over-prescription of drugs is a particularly big problem.  In 1999, a study of eight village clinics in Chongquing and Gansu provinces found less than 0.06% of prescriptions handed out were deemed reasonable by the doctors in the survey team.  

China isn’t the United States, of course.  But it does provide stark evidence that health care reform can have a dramatic impact on the efficiency of provision –for good or ill.